Cannabis withdrawal severity and short-term course among cannabis-dependent adolescent and young adult inpatients

While previous studies questioned the existence of a cannabis withdrawal syndrome (CWS), recent research provided increasing evidence of a number of clinical symptoms after cessation of frequent cannabis consumption. The aim of this study is to prospectively assess the course of CWS in a sample of cannabis-dependent inpatients and to provide an estimate of the proportion of subjects experiencing CWS.

118 subjects, aged 16-36 years, diagnosed with a cannabis dependence (DSM-IV, assessed by SCID I) were enrolled in the study. CWS was assessed prospectively over 10 days using a modified version of the Marijuana Withdrawal Checklist. Personality dimensions were assessed with the NEO-FFI.

73 subjects (61.3%) completed all assessments over the observation period. Most symptoms peaked on day 1. Model-based analyses revealed a high and low intensity CWS group. Less than half of the patients belonged to the high intensity craving, psychological, or physical withdrawal symptoms group. Symptom intensity decreased almost linearly over time. Indicators of cannabis consumption intensity as well as personality dimensions, but not recalled withdrawal were related to membership in the high intensity CWS group.

A clinically relevant CWS may only be expected in a subgroup of cannabis-dependent patients. Most subjects with an elevated CWS experience physical and psychological symptoms. The small to negligible associations between recalled and prospectively assessed symptoms raise questions about the validity of the former approach.