Cannabis withdrawal in the United States: results from NESARC.
OBJECTIVE
Although cannabis is the most widely abused illicit drug, little is known about the prevalence of cannabis withdrawal and its factor structure, clinical validity, and psychiatric correlates in the general population.


METHODS
National Epidemiologic Survey on Alcohol and Related Conditions participants were assessed, in 2001-2002, with structured in-person interviews covering substance history, DSM-IV Axis I and II disorders, and withdrawal symptoms after cessation of use. Of these, 2613 had been frequent cannabis users (> or = 3 times/week), and a "cannabis-only" subset (N = 1119) never binge-drank or used other drugs > or = 3 times/week.


RESULTS
In the full sample and subset, 44.3% (SE = 1.19) and 44.2% (SE = 1.75), respectively, experienced > or = 2 cannabis withdrawal symptoms, while 34.4% (SE = 1.21) and 34.1% (SE = 1.76), respectively, experienced > or = 3 symptoms. The symptoms formed 2 factors, one characterized by weakness, hypersomnia, and psychomotor retardation and the second by anxiety, restlessness, depression, and insomnia. Both symptom types were associated with significant distress/impairment (p < .01), substance use to relieve/avoid cannabis withdrawal symptoms (p <.01), and quantity of cannabis use (among the cannabis-only users p < .05). Panic (p < .01) and personality (p > .01) disorders were associated with anxiety symptoms in both samples, family history of drug problems was associated with weakness symptoms in the subset (p = .01), and depression was associated with both sets of symptoms in the subset (p < or = .05).


CONCLUSIONS
Cannabis withdrawal was prevalent and clinically significant among a representative sample of frequent cannabis users. Similar results in the subset without polysubstance abuse confirmed the specificity of symptoms to cannabis. Cannabis withdrawal should be added to DSM-V, and the etiology and treatment implications of cannabis withdrawal symptoms should be investigated.
Hasin
Deborah S
DS
Mailman School of Public Health, Columbia University/New York State Psychiatric Institute, 1051 Riverside Dr., Box 123, New York, NY 10032, USA. dsh2@columbia.edu
Keyes
Katherine M
KM
Alderson
Donald
D
Wang
Shuang
S
Aharonovich
Efrat
E
Grant
Bridget F
BF
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D002186:Cannabinoids / Q000008:administration & dosage*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology / Q000534:rehabilitation*; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology; D012737:Sex Factors; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D014481:United States; D055815:Young Adult
D002186:Cannabinoids; D013287:Illicit Drugs