Related Experiment Video
Updated: Jan 15, 2026

Brain Morphology of Cannabis Users With or Without Psychosis: A Pilot MRI Study
Published on: August 18, 2020
Consumption patterns and withdrawal symptoms in dual cannabis-tobacco users in Spain: Cross-sectional study
Judith Saura1,2,3,4, Marta Enríquez1,2, Ariadna Feliu5
1Tobacco Control Unit, Cancer Control and Prevention Program, WHO Collaborating Center On Tobacco Control, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain.
Background:
Cannabis use has increased worldwide, with over 188 million users annually. In Spain, past-year prevalence among people aged 15-64 is 10.6%. Dual use of cannabis and tobacco is common, increasing health risks and complicating cessation. This study examines consumption patterns and cannabis withdrawal severity among dual users undergoing treatment for cannabis use disorder (CUD).
Method:
A cross-sectional study was conducted in substance use treatment programs in Catalonia, Spain. Participants were cannabis users initiating CUD treatment. A questionnaire collected sociodemographic data, cannabis and tobacco use characteristics (e.g., number of spliffs, tobacco amount), nicotine dependence, motivation to quit, and cannabis withdrawal symptoms. Hierarchical cluster analysis using Gower's distance identified behavioral patterns among participants.
Results:
Data from 94 participants seeking CUD treatment were included. Daily tobacco use was reported by 91.5%, with a mean Fagerström score of 4.2/10. Most participants (88.1%) co-used cannabis with tobacco, and 75.8% experienced cannabis withdrawal symptoms, with women reporting greater severity. Cluster analysis revealed two profiles: Cluster 1 (71.0%) included mostly older males with higher motivation to quit and fewer withdrawal symptoms; Cluster 2 (29.0%) was younger, more sex-balanced, and showed higher nicotine dependence, and more severe withdrawal symptoms.
Conclusions:
Co-use of cannabis and tobacco is highly prevalent among individuals entering CUD treatment. Higher nicotine dependence is associated with more severe withdrawal symptoms. Older males with higher motivation and fewer withdrawal symptoms may have better prognosis, highlighting motivation as cessation predictor. Findings underscore the need to enhance motivation to quit both substances and integrated treatment.Trial registration number. The DuCATA project has been registered at Clinicaltrials.gov under the identifier [NCT05512091].
Related Concept Videos
Drug Dependence
CNS Depressants: Alcohol and Nicotine
Substance Use Disorders Affecting Sleep
Understanding the concepts of physical dependence,...
Observational Studies
There are three types of observational studies – Prospective, retrospective, and cross-sectional.
Prospective Study
Prospective studies, also known as longitudinal or cohort studies, are carried out by collecting future data from groups sharing similar characteristics. One...
Drug Abuse and Addiction: Pharmacological Phenomena
Bioavailability Study Design: Healthy Subjects Versus Patients

