title: The prevalence of cannabis withdrawal and its influence on adolescents' treatment response and outcomes: a 12-month prospective investigation.
abstract: BACKGROUND
  Withdrawal, a diagnostic indicator of cannabis use disorder, is often minimized or ignored as a consequence of cannabis use, particularly among adolescents. This study aims to characterize cannabis withdrawal among adolescents in outpatient treatment for substance use disorder and evaluate the clinical significance of withdrawal as a predictor of substance-related outcomes.
  
  
  METHODS
  Adolescent outpatients (N = 127) reporting cannabis as their drug of choice (n = 90) were stratified by the presence of withdrawal and compared on demographic and clinical variables at treatment intake. Hierarchical linear models compared the effect of withdrawal on percentage days abstinent (PDA) and related outcomes over a 1-year follow-up period.
  
  
  RESULTS
  Adolescents reporting withdrawal (40%) were more likely to meet criteria for cannabis dependence, have higher levels of substance use severity, report more substance-related consequences, and have a mood disorder. Withdrawal was not associated with PDA over the follow-up period; however, this relationship was moderated by problem recognition such that adolescents reporting withdrawal and a drug problem improved at a greater rate with respect to PDA than those who did not recognize a problem with drugs and did not report withdrawal.
  
  
  CONCLUSIONS
  Withdrawal is common among adolescent outpatients and is associated with a more clinically severe profile. In this sample, all adolescents reporting withdrawal met criteria for cannabis dependence, suggesting that withdrawal is a highly specific indicator of cannabis use disorder. Although withdrawal does not seem to be independently associated with substance use outcomes posttreatment, moderating factors such as drug problem recognition should be taken into account when formulating treatment and continuing care plans.
authors.affiliation: From the Center for Addiction Medicine (MCG, JFK), Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: M Claire
authors.initials: MC
authors.lastname: Greene
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D002188:Cannabis / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000628:therapy*; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology*; D016896:Treatment Outcome
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