title: Long-term cannabis abuse and early-onset cannabis use increase the severity of cocaine withdrawal during detoxification and rehospitalization rates due to cocaine dependence.
abstract: BACKGROUND
  Long-term and early-onset cannabis consumption are implicated in subsequent substance- related problems. The aim of this follow-up study was to investigate whether these patterns of cannabis use could impact cocaine withdrawal severity and cocaine craving intensity during detoxification. In addition, we investigated their impact in the rehospitalization rates due to cocaine dependence 2.5 years after detoxification assessment.
  
  
  METHODS
  The sample was composed of 93 female cocaine-dependent inpatients who were enrolled in an inpatient detoxification unit. Cocaine withdrawal symptoms were measured at the 4th, 9th and 14th days of detoxification using the cocaine selective severity assessment (CSSA). Data on the age of first years of drug use - alcohol, cannabis and cocaine - and the years of substance abuse were obtained using the Addiction Severity Index (ASI-6). Other relevant clinical variables were also investigated, including a 2.5 years follow-up assessment of number of rehospitalization due to cocaine dependence.
  
  
  RESULTS
  Early-onset cannabis use and long-term cannabis abuse were associated with an increase instead of a reduction in the severity of cocaine withdrawal symptoms and craving intensity during detoxification. In addition, long-term cannabis abuse predicted higher number of rehospitalization due to cocaine dependence after 2.5 years of the first detoxification assessment.
  
  
  CONCLUSIONS
  Early-onset cannabis use and long-term cannabis abuse are associated with a worse detoxification treatment response. Our findings may help to identify patients who will struggle more severely to control cocaine withdrawal syndrome during early drug abstinence, and indicate that cannabis use prior to cocaine withdrawal should be considered an adverse factor.
authors.affiliation: Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681, prédio 11, sala 928, 90619-900 Porto Alegre, RS, Brazil.
authors.forename: Thiago Wendt
authors.initials: TW
authors.lastname: Viola
authors.affiliation: Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681, prédio 11, sala 928, 90619-900 Porto Alegre, RS, Brazil.
authors.forename: Saulo Gantes
authors.initials: SG
authors.lastname: Tractenberg
authors.affiliation: Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681, prédio 11, sala 928, 90619-900 Porto Alegre, RS, Brazil.
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Wearick-Silva
authors.affiliation: Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681, prédio 11, sala 928, 90619-900 Porto Alegre, RS, Brazil.
authors.forename: Caroline Silva de Oliveira
authors.initials: CS
authors.lastname: Rosa
authors.affiliation: Health Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
authors.forename: Júlio Carlos
authors.initials: JC
authors.lastname: Pezzi
authors.affiliation: Centre of Studies and Research in Traumatic Stress, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681, prédio 11, sala 928, 90619-900 Porto Alegre, RS, Brazil. Electronic address: rodrigo.grassi@pucrs.br.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Grassi-Oliveira
mesh_terms: D000328:Adult; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002189:Marijuana Abuse / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D013997:Time Factors; D055815:Young Adult
chemical_list: D003042:Cocaine
keywords: Addictive behavior; Adolescent; Cannabis; Cocaine; Hospitalization; Substance withdrawal syndrome