Is There Evidence for Symptoms of Cannabis Withdrawal in the National Epidemiologic Survey of Alcohol and Related Conditions?
Corresponding Author
Arpana Agrawal PhD
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
Washington University School of Medicine, Department of Psychiatry, 660 S. Euclid, Box 8134, St. Louis, MO, 63110. E-mail: [email protected]Search for more papers by this authorMichele L. Pergadia PhD
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorMichael T. Lynskey PhD
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorCorresponding Author
Arpana Agrawal PhD
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
Washington University School of Medicine, Department of Psychiatry, 660 S. Euclid, Box 8134, St. Louis, MO, 63110. E-mail: [email protected]Search for more papers by this authorMichele L. Pergadia PhD
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorMichael T. Lynskey PhD
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
Search for more papers by this authorAbstract
We examined the prevalence of 20 individual symptoms of cannabis withdrawal in the U.S. general population. More than 29% of past 12-month cannabis users reported experiencing at least two cannabis withdrawal symptoms, with 8% reporting impairment from at least two symptoms or withdrawal relief. The most common withdrawal symptom was eating more than usual/gaining weight. Co-occurring tobacco use modestly increased the likelihood of reporting certain symptoms, as did other illicit drug use, though to a lesser degree. Even after controlling for intensity of cannabis use, a history of parental alcohol/drug problems was associated with an increased likelihood of experiencing cannabis withdrawal. Evidence from this and prior studies demonstrating withdrawal strongly suggest that future editions of DSM need to reconsider the exclusion of withdrawal from criteria for cannabis dependence.
REFERENCES
- 1 Compton WM, Grant BF, Colliver JD, Glantz MD, Stinson FS. Prevalence of marijuana use disorders in the United States: 1991–1992 and 2001–2002. JAMA.. 2004; 291: 2114–2121.
- 2 Wallace JM Jr, Bachman JG, O'Malley PM, Johnston LD, Schulenberg JE, Cooper SM. Tobacco, alcohol, and illicit drug use: racial and ethnic differences among U.S. high school seniors, 1976–2000. Public Health Rep. 2002; 117 Suppl. 1 S67–S75.
- 3 Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Teen drug use down but progress halts among youngest teens University of Michigan News and Information Services Ann Arbor, Michigan. 2005 http://www.monitoringthefuture.org/pressreleases/O5drugpr_complete.pdf Available at. Accessed May 5, 2006.
- 4 National Institute on Drug Abuse. National Household Survey on Drug Abuse U.S. Department of Health and Human Services Washington D.C.. 1991.
- 5 Fergusson DM, Horwood LJ. Cannabis use and dependence in a New Zealand birth cohort. N Z Med J.. 2000; 113: 156–158.
- 6 Reid A, Lynskey M, Copeland J. Cannabis use among Australian adolescents: findings of the 1998 National Drug Strategy Household Survey. Aust N Z J Public Health.. 2000; 24: 596–602.
- 7 Stinson FS, Ruan WJ, Pickering R, Grant BF. Cannabis use disorders in the USA: prevalence, correlates and co-morbidity. Psychol Med.. 2006; 36: 1447–1460.
- 8 Soellner R. Dependence on cannabis—an everlasting issue. Subst Use Misuse.. 2005; 40: 857–867.
- 9 Budney AJ. Are specific dependence criteria necessary for different substances: how can research on cannabis inform this issue?. Addiction. 2006; 101 Suppl. 1 125–133.
- 10 Budney AJ, Hughes JR, Moore BA, Vandrey R. Review of the validity and significance of cannabis withdrawal syndrome. Am J Psychiatry. 2004; 161: 1967–1977.
- 11 Budney AJ, Hughes JR. The cannabis withdrawal syndrome. Curr Opin Psychiatry.. 2006; 19: 233–238.
- 12 Kouri EM, Pope HG Jr, Lukas SE. Changes in aggressive behavior during withdrawal from long-term marijuana use. Psychopharmacology (Berl).. 1999; 143: 302–308.
- 13 Kouri EM, Pope HG Jr. Abstinence symptoms during withdrawal from chronic marijuana use. Exp Clin Psychopharmacol. 2000; 8: 483–492.
- 14 Budney AJ, Novy PL, Hughes JR. Marijuana withdrawal among adults seeking treatment for marijuana dependence. Addiction.. 1999; 94: 1311–1322.
- 15 Haney M, Ward AS, Comer SD, Hart CL, Foltin RW, Fischman MW. Bupropion SR worsens mood during marijuana withdrawal in humans. Psychopharmacology (Berl).. 2001; 155: 171–179.
- 16 Haney M, Hart CL, Ward AS, Foltin RW. Nefazodone decreases anxiety during marijuana withdrawal in humans. Psychopharmacology (Berl).. 2003; 165: 157–165.
- 17 Haney M, Comer SD, Ward AS, Foltin RW, Fischman MW. Factors influencing marijuana self-administration by humans. Behav Pharmacol.. 1997; 8: 101–112.
- 18 Hart CL, Haney M, Ward AS, Fischman MW, Foltin RW. Effects of oral THC maintenance on smoked marijuana self-administration. Drug Alcohol Depend.. 2002; 67: 301–309.
- 19 Haney M, Ward AS, Comer SD, Foltin RW, Fischman MW. Abstinence symptoms following smoked marijuana in humans. Psychopharmacology (Berl).. 1999; 141: 395–404.
- 20 Haney M, Ward AS, Comer SD, Foltin RW, Fischman MW. Abstinence symptoms following oral THC administration to humans. Psychopharmacology (Berl).. 1999; 141: 385–394.
- 21 Budney AJ, Vandrey RG, Hughes JR, Moore BA, Bahrenburg B. Oral delta-9-tetrahydrocannabinol suppresses cannabis withdrawal symptoms. Drug Alcohol Depend.. 2007; 86: 22–29.
- 22 Copersino ML, Boyd SJ, Tashkin DP et al. Cannabis withdrawal among non-treatment-seeking adult cannabis users. Am J Addict.. 2006; 15: 8–14.
- 23 Wiesbeck GA, Schuckit MA, Kalmijn JA, Tipp JE, Bucholz KK, Smith TL. An evaluation of the history of a marijuana withdrawal syndrome in a large population. Addiction.. 1996; 91: 1469–1478.
- 24 Cottler LB, Schuckit MA, Helzer JE et al. The DSM-IV field trial for substance use disorders: major results. Drug Alcohol Depend.. 1995; 38: 59–69.
- 25 Budney AJ, Moore BA, Vandrey RG, Hughes JR. The time course and significance of cannabis withdrawal. J Abnorm Psychol.. 2003; 112: 393–402.
- 26 Young SE, Corley RP, Stallings MC, Rhee SH, Crowley TJ, Hewitt JK. Substance use, abuse and dependence in adolescence: prevalence, symptom profiles and correlates. Drug Alcohol Depend.. 2002; 68: 309–322.
- 27 Amos A, Wiltshire S, Bostock Y, Haw S, McNeill A. “You can't go without a fag…you need it for your hash”—a qualitative exploration of smoking, cannabis and young people. Addiction.. 2004; 99: 77–81.
- 28 Patton GC, Coffey C, Carlin JB, Sawyer SM, Lynskey M. Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence. Addiction.. 2005; 100: 1518–1525.
- 29 Hughes JR. Effects of abstinence from tobacco: etiology, animal models, epidemiology, and significance: a subjective review. Nicotine Tob Res.. 2007; 9: 329–339.
- 30 Tsuang MT, Bar JL, Harley RM, Lyons MJ. The Harvard Twin Study of Substance Abuse: what we have learned. Harv Rev Psychiatry.. 2001; 9: 267–279.
- 31 Kendler KS, Prescott CA. Cannabis use, abuse, and dependence in a population-based sample of female twins. Am J Psychiatry.. 1998; 155: 1016–1022.
- 32 Han C, McGue MK, Iacono WG. Lifetime tobacco, alcohol and other substance use in adolescent Minnesota twins: univariate and multivariate behavioral genetic analyses. Addiction.. 1999; 94: 981–993.
- 33
McGue M,
Elkins I,
Iacono WG.
Genetic and environmental influences on adolescent substance use and abuse.
Am J Med Genet.. 2000; 96: 671–677.
10.1002/1096-8628(20001009)96:5<671::AID-AJMG14>3.0.CO;2-W CAS PubMed Web of Science® Google Scholar
- 34 Maes HH, Woodard CE, Murrelle L et al. Tobacco, alcohol and drug use in eight- to sixteen-year-old twins: the Virginia Twin Study of Adolescent Behavioral Development. J Stud Alcohol.. 1999; 60: 293–305.
- 35 Agrawal A, Lynskey MT. The genetic epidemiology of cannabis use, abuse and dependence: a review. Addiction.. 2006; 101: 801–812.
- 36 Lynskey MT, Heath AC, Nelson EC et al. Genetic and environmental contributions to cannabis dependence in a national young adult twin sample. Psychol Med.. 2002; 32: 195–207.
- 37 Neale MC, Harvey E, Maes HH, Sullivan PF, Kendler KS. Extensions to the modeling of initiation and progression: applications to substance use and abuse. Behav Genet.. 2006; 36: 507–524.
- 38 Heath AC, Martin NG, Lynskey MT, Todorov AA, Madden PA. Estimating two-stage models for genetic influences on alcohol, tobacco or drug use initiation and dependence vulnerability in twin and family data. Twin Res.. 2002; 5: 113–124.
- 39 Kendler KS, Neale MC, Sullivan P, Corey LA, Gardner CO, Prescott CA. A population-based twin study in women of smoking initiation and nicotine dependence. Psychol Med.. 1999; 29: 299–308.
- 40 Agrawal A, Neale M, Jacobson K, Prescott CA, Kendler KS. Illicit drug use and abuse/dependence: modeling of two-stage variables using the CCC approach. Addict Behav.. 2005; 30: 1043–1048.
- 41 Grant BF, Kaplan K, Shepard J, Moore T. Source and Accuracy Statement for Wave 1 of the 2001–2002 of the National Epidemiologic Survey on Alcohol and Related Conditions National Institute on Alcohol Abuse and Alcoholism Bethesda Md.. 2003.
- 42 Grant BF, Dawson DA, Stinson FS, Chou PS, Kay W, Pickering R. The Alcohol Use Disorder and Associated Disabilities Interview Schedule–IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend.. 2003; 71: 7–16.
- 43 SAS Institute SAS User Guide, Version 8.2 SAS Institute Inc. Cary NC. 1999.
- 44 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Association Washington DC. 1994.
- 45 Lynskey MT, Agrawal A. Psychometric properties of DSM assessments of illicit drug abuse and dependence: Results from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Psychol Med.. 2007; 4: 1–11.
- 46 Agrawal A, Lynskey MT. Does gender contribute to heterogeneity in criteria for cannabis abuse and dependence? results from the National Epidemiological Survey on Alcohol and Related Conditions. Drug Alcohol Depend.. 2007; 88: 300–307.
- 47 Teesson M, Lynskey M, Manor B, Baillie A. The structure of cannabis dependence in the community. Drug Alcohol Depend.. 2002; 68: 255–262.
- 48 Swift W, Hall W, Teesson M. Characteristics of DSM-IV and ICD-10 cannabis dependence among Australian adults: results from the National Survey of Mental Health and Wellbeing. Drug Alcohol Depend.. 2001; 63: 147–153.
- 49 Gillespie NA, Neale MC, Prescott CA et al. Factor and item-response analysis of DSM-IV criteria for abuse of and dependence on cannabis, cocaine, hallucinogens, sedatives, stimulants and opiates. Addiction. 2007; 102: 920–930.
- 50 Nelson CB, Rehm J, Ustun TB, Grant B, Chatterji S. Factor structures for DSM-IV substance disorder criteria endorsed by alcohol, cannabis, cocaine and opiate users: results from the WHO reliability and validity study. Addiction.. 1999; 94: 843–855.
- 51 Morgenstern J, Langenbucher J, Labouvie EW. The generalizability of the dependence syndrome across substances: an examination of some properties of the proposed DSM-IV dependence criteria. Addiction.. 1994; 89: 1105–1113.
- 52 Langenbucher J, Labouvie EW, Martin C et al. An application of item response theory analysis to alcohol, cannabis and cocaine criteria in DSM-IV. J Abnorm Psychol.. 2004; 113: 72–80.
- 53 Sullivan PF, Kendler KS. The genetic epidemiology of smoking. Nicotine Tob Res. 1999; 1 Suppl. 2 S51–S57.
- 54 Madden PA, Heath AC, Pedersen NL, Kaprio J, Koskenvuo MJ, Martin NG. The genetics of smoking persistence in men and women: a multicultural study. Behav Genet.. 1999; 29: 423–431.
- 55 Madden PA, Pedersen NL, Kaprio J, Koskenvuo MJ, Martin NG. The epidemiology and genetics of smoking initiation and persistence: crosscultural comparisons of twin study results. Twin Res.. 2004; 7: 82–97.
- 56 Vink JM, Willemsen G, Boomsma DI. Heritability of smoking initiation and nicotine dependence. Behav Genet.. 2005; 35: 397–406.
- 57 Kaprio J, Hammar N, Koskenvuo M, Floderus-Myrhed B, Langinvainio H, Sarna S. Cigarette smoking and alcohol use in Finland and Sweden: a cross-national twin study. Int J Epidemiol.. 1982; 11: 378–386.
- 58 Le MM, Koob GF. Drug addiction: pathways to the disease and pathophysiological perspectives. Eur Neuropsychopharmacol.. 2007; 17: 377–393.
- 59 Bierut LJ, Dinwiddie SH, Begleiter H et al. Familial transmission of substance dependence: alcohol, marijuana, cocaine, and habitual smoking: a report from the Collaborative Study on the Genetics of Alcoholism. Arch Gen Psychiatry.. 1998; 55: 982–988.
- 60 Merikangas KR, Stolar M, Stevens DE et al. Familial transmission of substance use disorders. Arch Gen Psychiatry.. 1998; 55: 973–979.
- 61 Kendler KS, Jacobson KC, Prescott CA, Neale MC. Specificity of genetic and environmental risk factors for use and abuse/dependence of cannabis, cocaine, hallucinogens, sedatives, stimulants, and opiates in male twins. Am J Psychiatry.. 2003; 160: 687–695.
- 62 Kendler KS, Prescott CA, Myers J, Neale MC. The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Arch Gen Psychiatry.. 2003; 60: 929–937.
- 63 Pergadia ML, Heath AC, Martin NG, Madden PA. Genetic analysis of DSM-IV nicotine withdrawal in adult twins. Psychol Med.. 2006; 36: 963–972.