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Abstract
Aims. The clinical relevance of marijuana withdrawal has not been established. This study is the first to document the incidence and severity of perceived marijuana withdrawal symptoms in a clinical sample of marijuana-dependent adults. Measurements. Fifty-four people seeking outpatient treatment for marijuana dependence completed a 22-item Marijuana Withdrawal Symptom checklist based on their most recent period of marijuana abstinence. Findings. The majority (57%) indicated that they had experienced>=six symptoms of at least moderate severity and 47% experienced >= four symptoms rated as severe. Withdrawal severity was greater in those with psychiatric symptomatology and more frequent marijuana use. Conclusions. This study provides further support for a cluster of withdrawal symptoms experienced following cessation of regular marijuana use. The affective and behavioral symptoms reported were consistent with those observed in previous laboratory and interview studies. Since withdrawal symptoms are frequently a target for clinical intervention with other substances of abuse, this may also be appropriate for marijuana.
Introduction
Marijuana (cannabis) withdrawal is not recognized in the DSM-IV, as the manual states that there "have been some reports of withdrawal symptoms, but these have not yet been reliably shown to be clinically significant".1 The ICD-10 allows for a diagnosis of marijuana withdrawal, but it does not provide descriptors of the symptoms that comprise such a syndrome.2 Given that non-human and human inpatient studies have demonstrated clearly that withdrawal can occur following abrupt cessation of marijuana or tetrahydrocannabinol (THC) administration (see below), the reason for its omission from DSMIV appears due to the lack of generalizable, controlled outpatient studies of the incidence and severity of marijuana withdrawal among regular users. Unfortunately, the exclusion of marijuana withdrawal from the DSM contributes to the perception that marijuana use has minimal risk for harm or development of dependence, and that the development of behavioral or pharmacological treatments specifically for marijuana dependence is not necessary. Indeed, these perceptions are inaccurate as marijuana use can produce dependence at rates comparable to other substances of abuse, increase psychiatric and medical problems and impair psychosocial functioning.3-6 Many marijuana users have difficulty quitting and maintaining abstinence from marijuana; moreover, response to treatment and relapse rates among people seeking treatment for marijuana dependence are similar to those observed with other substances of abuse.7,8 Whether relapse...