Cannabis Withdrawal in the United States: Results From NESARC
J Clin Psychiatry 2008;69(9):1354-1363
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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
Method: 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 ( >= 3 times/week), and a "cannabis-only" subset (N = 1119) never
binge-drank or used other drugs >= 3 times/week.
Results: In the full sample and subset, 44.3% (SE =
1.19) and 44.2% (SE = 1.75), respectively, experienced 2 cannabis withdrawal
symptoms, while 34.4% (SE = 1.21) and 34.1% (SE = 1.76), respectively,
experienced >= 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 < .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 <
Conclusion: 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