title: Diagnostic criteria for cannabis withdrawal syndrome.
abstract: OBJECTIVE
  Cannabis withdrawal occurs in frequent users who quit, but there are no accepted diagnostic criteria for a cannabis withdrawal syndrome (CWS). This study evaluated diagnostic criteria for CWS proposed in DSM-V and two earlier proposals.
  
  
  METHODS
  A convenience sample of 384 adult, non-treatment-seeking lifetime cannabis smokers provided retrospective self-report data on their "most difficult" quit attempt without formal treatment, which was used in this secondary analysis. Prevalence, time of onset, and peak intensity (5-point Likert scale) for 39 withdrawal symptoms (drawn from the literature) were assessed via computer-administered questionnaire. Subject groups were compared using chi-square or ANOVA. Symptom clustering was evaluated with principal components analysis.
  
  
  RESULTS
  40.9% of subjects met the DSM-V criterion of ≥3 symptoms from a list of 7. There were no associations with sex, race, or type of cannabis preparation used. There were significant positive associations between duration or frequency of cannabis use prior to the quit attempt and experiencing CWS. Subjects with CWS had a significantly shorter duration of abstinence. Alternative syndromal criteria (dropping physical symptoms from DSM-V list; requiring ≥2 or ≥4 symptoms from a list of 11) yielded a similar prevalence of CWS and similar associations with prior cannabis use and relapse. The PCA yielded 12 factors, including some symptom clusters not included in DSM-V.
  
  
  CONCLUSIONS
  Findings support the concurrent and predictive validity of the proposed DSM-V CWS, but suggest that the list of withdrawal symptoms and number required for diagnosis warrant further evaluation.
authors.affiliation: Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA. dgorelic@intra.nida.nih.gov
authors.forename: David A
authors.initials: DA
authors.lastname: Gorelick
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Levin
authors.forename: Marc L
authors.initials: ML
authors.lastname: Copersino
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Heishman
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Boggs
authors.forename: Deanna L
authors.initials: DL
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002188:Cannabis / Q000009:adverse effects*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult