Prospective assessment of cannabis withdrawal in adolescents with cannabis dependence: a pilot study.
OBJECTIVE
To prospectively identify and assess withdrawal symptoms in adolescents with cannabis dependence.


METHODS
Twenty-one adolescents ages 13 to 19 years voluntarily entering residential and day/outpatient substance abuse programs, with cannabis dependence as their only current substance of dependence, were assessed using the Teen-Addiction Severity Index, Substance Use Survey, Cannabis Withdrawal Scale, and the Structured Clinical Interview for DSM-IV Childhood Diagnoses Substance Use Disorders Module. Weekly assessments continued for 4 weeks. Thirteen youths attained a minimum of 2 weeks of abstinence.


RESULTS
Cannabis withdrawal symptoms were present in adolescents. Cannabis withdrawal was greatest in the first 2 weeks of abstinence with evidence that it continued well into week 3. Most withdrawal symptoms were endorsed with a high degree of frequency. Those symptoms endorsed with the greatest severity were restlessness, appetite change, and thoughts of and cravings for cannabis, with the highest ratings occurring in week 1. Over the course of the study, participants reported fewer symptoms with decreasing levels of severity. Youth ratings of overall severity of withdrawal were significantly and positively correlated with withdrawal symptoms of irritability (r = 0.56), depression (r = 0.56), twitches and shakes (r = 0.57), perspiring (r = 0.57), thoughts of (r = 0.86), and cravings for (r = 0.69) cannabis.


CONCLUSIONS
Findings support the presence of clinically significant cannabis withdrawal symptoms in adolescents with cannabis dependence seeking substance abuse treatment. This study also provides supporting evidence suggesting a vulnerability of adolescents to physiological cannabis dependence. The study supports the addition of cannabis withdrawal as a distinct entity for inclusion in DSM-V.
Milin
Robert
R
Dr. Milin and Ms. Walker are with and Dr. Dare was formerly with the Royal Ottawa Mental Health Centre and Institute of Mental Health Research; Dr. Manion is with the Provincial Centre of Excellence for Child and Youth Mental Health at Children's Hospital of Eastern Ontario.. Electronic address: rmilin@rohcg.on.ca.
Manion
Ian
I
Dr. Milin and Ms. Walker are with and Dr. Dare was formerly with the Royal Ottawa Mental Health Centre and Institute of Mental Health Research; Dr. Manion is with the Provincial Centre of Excellence for Child and Youth Mental Health at Children's Hospital of Eastern Ontario.
Dare
Glenda
G
Dr. Milin and Ms. Walker are with and Dr. Dare was formerly with the Royal Ottawa Mental Health Centre and Institute of Mental Health Research; Dr. Manion is with the Provincial Centre of Excellence for Child and Youth Mental Health at Children's Hospital of Eastern Ontario.
Walker
Selena
S
Dr. Milin and Ms. Walker are with and Dr. Dare was formerly with the Royal Ottawa Mental Health Centre and Institute of Mental Health Research; Dr. Manion is with the Provincial Centre of Excellence for Child and Youth Mental Health at Children's Hospital of Eastern Ontario.
D000293:Adolescent; D002186:Cannabinoids / Q000009:adverse effects*; D003631:Day Care, Medical; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000534:rehabilitation*; D009460:Neurologic Examination / Q000187:drug effects; D010147:Pain Measurement; D010865:Pilot Projects; D011446:Prospective Studies; D016320:Substance Abuse Treatment Centers; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology*
D002186:Cannabinoids