For me, cleaning house or my car under the influence of Mary Jane was an adventure...I would REALLY get into what I was doing and do a good job..

Study Demonstrates That Marijuana Smokers Experience Significant Withdrawal


By Patrick Zickler, NIDA NOTES Staff Writer

Animal research and controlled studies of marijuana smokers during inpatient treatment suggest that marijuana dependence, like dependence on other addictive drugs, is associated with withdrawal symptoms -- such as irritability, anger, depressed mood, headaches, restlessness, lack of appetite, and craving -- that can make it difficult to stop using the drug.

Now, NIDA-supported research conducted by Dr. Alan Budney and colleagues at the University of Vermont in Burlington has found that marijuana smokers who stop using the drug while in their home environment suffer withdrawal symptoms that appear as severe as those associated with tobacco-smoking.

Severity of Symptoms During Marijuana Use Versus Abstinence
Severity of Symptoms During Marijuana Use Versus Abstinence - Graph

Marijuana smokers living at home reported "clinically significant" withdrawal symptoms -- such as sleep difficulty, marijuana craving, aggression, and irritability -- during periods of abstinence from the drug. The participants' self-reports were confirmed, in part, by observers who reported increased restlessness and irritability among the marijuana users when they were not smoking.

"These findings represent a significant step toward general acceptance of withdrawal as a key aspect of chronic marijuana use," says Dr. Jag Khalsa of NIDA's Center on AIDS and Other Medical Consequences of Drug Abuse. Treatment providers may not address the problem of marijuana withdrawal because the condition is not currently included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the standard reference published by the American Psychiatric Association.

Dr. Budney and his colleagues evaluated withdrawal symptoms in 12 adult marijuana smokers (7 male, 5 female, average age 30 years) over 3-day abstinence periods that followed 5-day periods when participants could smoke marijuana at will. "We found consistent emotional and behavioral symptoms that increased during abstinence and dramatically decreased when marijuana smoking resumed, suggesting that these types of symptoms are the hallmark of acute marijuana withdrawal," Dr. Budney says. "The symptoms most closely resembled many of those observed during nicotine withdrawal."

During the study, participants lived at home and made daily records rating the intensity of withdrawal symptoms (on a scale from 0, "not at all," to 3, "severe") over the preceding 24 hours. In addition, each participant designated an observer -- a friend or family member who spent at least 2 hours each day with the participant -- to provide an independent rating of the participant's withdrawal symptoms. The participants made daily laboratory visits during which their abstinence was confirmed by urine tests.

During the abstinence periods, participants reported increases in the severity of craving and sleep difficulty, decreased appetite, and increased aggression, anger, and irritability. In addition, participants reported an increase in "strange dreams" during the second abstinence period. Observers reported increased irritability and restlessness among the participants during abstinence.

"Marijuana withdrawal doesn't include dramatic physical symptoms such as the pain, nausea, heavy sweating, and cramps associated with opiate withdrawal. Nevertheless, the symptoms of marijuana withdrawal appear clinically significant. It seems clear now that withdrawal from marijuana produces identifiable behavioral and emotional distress that may be as important as, if not more important than, physical symptoms in the development of dependence and undermining attempts to quit using the drug," Dr. Budney says.

"Confirming withdrawal as part of marijuana dependence will increase the likelihood that treatment providers will alert patients to its symptoms and will help them cope with it through behavioral or pharmacological treatments," says Dr. Khalsa.

Source

Budney, A.J.; Hughes, J.R.; Moore, B.A.; Novy, P.L. Marijuana abstinence effects in marijuana smokers maintained in their home environment. Archives of General Psychiatry 58(10):917-924, 2001.


Volume 17, Number 3 (October 2002)

Chronic Marijuana Users Become Aggressive During Withdrawal

People who have smoked marijuana daily for many years display more aggressive behavior when they stop smoking the drug, according to a new study by researchers at Harvard Medical School. The study, funded by the National Institute on Drug Abuse (NIDA), National Institutes of Health, is further evidence that a withdrawal syndrome is associated with abstinence from long-term marijuana use, and suggests that aggressive behavior is part of this syndrome.

Human and animal studies conducted since the early 1970s have suggested the existence of a marijuana withdrawal syndrome, characterized by insomnia, restlessness, loss of appetite, and irritability. "This syndrome - although less dramatic than the withdrawal syndrome associated with alcohol, opiate, or cocaine withdrawal - may contribute to relapse among those dependent on marijuana," says NIDA Director Dr. Alan I. Leshner. "People addicted to marijuana may continue to use the drug at least partly to prevent the onset of withdrawal symptoms. Identifying the exact nature of this syndrome is crucial to developing treatment strategies for those attempting to stop their marijuana use."

The Harvard study, using a computer test of aggressive behavior, compared 17 long-term heavy users of marijuana with 20 people who were infrequent or former smokers. All of the volunteers were abstaining from the use of marijuana and all other drugs of abuse during the study. To avoid any suggestive influences, the investigators did not reveal to the volunteers that their aggressive behavior was being studied. Instead, the volunteers were told that they were participating in a test designed to measure movements and a variety of physiological characteristics, such as pulse rate and body temperature. They were also told that another volunteer of the same sex was sitting in another experimental chamber and would be participating in the test with them.

Facing each volunteer in the experimental chamber was a computer monitor and a response panel. On the panel were two buttons, labeled A and B. Pressing A 100 times allowed the volunteer to gain 1 point, which was worth 50 cents. Pressing B 10 times subtracted 1 point from the other participant, who, in actuality, was not a person but a computer. Three 1-second beeps signaled that the "opponent" was subtracting 1 point from the volunteer. The researchers labeled the pressing of B as an aggressive response, and the point subtractions from the volunteer as provocations.

The volunteers participated in one of these sessions on each of five different occasions: at the beginning of the study, and at days 1, 3, 7, and 28 of abstinence. Results showed that the current marijuana users became significantly more aggressive, as indicated by the number of times they pressed B, on days 3 and 7 of withdrawal, as compared to the infrequent or former marijuana users.

"Most of the studies that have been published on marijuana withdrawal symptoms in people have relied on self-report," says Dr. Elena Kouri, lead author of the paper. "In these studies, long-term marijuana users report that they feel irritable when they are abstaining from marijuana use, but these studies generally do not involve measurements of aggressive behavior to verify these self-reports. In our study, we demonstrated that long-term marijuana users do, indeed, exhibit more aggressive behavior during the first week of abstinence, and that this aggressive behavior can be measured."

Marijuana is the most widely used illicit drug in the United States. More than 11 million people have smoked marijuana within the past month, according to the 1997 National Household Survey on Drug Abuse.

Long-term marijuana use can lead to addiction in some people. These marijuana-addicted individuals use the drug compulsively, and this use often interferes with family, school, work, and recreational activities. Individuals with cannabis dependence may also persist in using the drug despite knowing that it causes them physical problems, such as a chronic cough related to smoking, or psychological problems, such as excessive sedation due to high doses.

"Although it is difficult to be certain of the exact prevalence of cannabis addiction in the United States, I can tell you anecdotally that we had no difficulty recruiting dozens of people between the ages of 30 and 55 who have smoked marijuana at least 5,000 times," says Dr. Harrison Pope, Jr., principal investigator of the study. "A simple ad in the paper generated hundreds of phone calls from such people."

This study on changes in aggressive behavior during withdrawal from long-term marijuana use appears in the April issue of Psychopharmacology.

NIDA supports more than 85 percent of the world's research on the health aspects of drug abuse and addiction. The Institute also carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Fact sheets on health effects of drugs of abuse and other topics can be ordered free of charge in English and Spanish, by calling NIDA Infofax at 1-888-NIH-NIDA (-644-6432) or 1-888-TTY-NIDA (-889-6432) for the deaf. These fact sheets and further information on NIDA research and other activities can be found on the NIDA home page at http://www.nida.nih.gov/.