Over the last several decades, researchers have started to understand more about addiction, substance abuse, and variables related to the notion of a withdrawal syndrome.
Several decades ago, withdrawal syndromes were characterized as having more objective and very discreet physical symptoms, whereas in the current mode of thinking, it is understood that withdrawal symptoms can consist of more subjective feelings of distress along with very concrete physical symptoms. As a result of more modern approaches to substance abuse and addiction, the American Psychiatric Association included diagnostic criteria for cannabis withdrawal in its latest edition of the Diagnostic and Statistical Manuals of Mental Disorders (see below). Thus, the answer to the question, “Is marijuana withdrawal real?” is easily answered by referring to these diagnostic criteria and by subsequent research documenting its effects.
Withdrawal SyndromesA withdrawal syndrome is defined as the onset of specific negative symptoms, which can be physical, emotional, and even behavioral, that occur after one stops using a drug. Symptoms gradually lessen over time, or the withdrawal syndrome can also be relatively quickly reversed by engaging in use of the drug.
The first thing to understand is that it is certainly true that marijuana is not as physically addictive as drugs like heroin, alcohol, benzodiazepines, etc. These other drugs have a high potential for the development of both abuse and physical dependence, whereas the level of physical dependence associated with even chronic marijuana usage is comparatively mild.
Nonetheless, it is important to emphasize that the most difficult substance use disorder to recover from is the one that you suffer from. Comparisons of which drug or class of drugs is more addictive than which drug or class of drugs are pointless in this context.
Recovering from a substance use disorder is an important undertaking and is difficult for anyone.
Withdrawal from Marijuana
The symptoms described by the American Psychiatric Association indicate that the most salient symptoms of withdrawal will present themselves in individuals who use marijuana daily or nearly daily for at least a few months.
- Feelings of anger, irritability, and/or aggressiveness
- Sensations of extreme nervousness or anxiety
- Disturbances with sleep that can include insomnia or very disturbing dreams and even nightmares
- A decrease in appetite that may or may not be associated with a significant loss of weight
- Feelings of restlessness and general malaise
- The onset of feelings of depression
The inclusion of at least one physical symptom that causes significant distress, such as abdominal pain, fever, chills, sweating, headache, and/or tremors or shakiness.
The individual must exhibit three or more of the listed symptoms and one must be of a physical nature. Research that has investigated the course of the symptoms for marijuana/cannabis withdrawal has indicated that there is a withdrawal timeline to be expected:
- The symptoms begin within a week after discontinuation.
- The symptoms peak within 10 days after an individual has discontinued marijuana use.
- Following the peak of the symptoms, they begin a steady decline in severity over a period of 10-20 days.
- The symptoms can be very quickly resolved if the individual begins smoking marijuana again.
- The actual length and severity of symptoms are related to the amount and frequency of marijuana use in the individual.
For some individuals, there is always the possibility that they will continue to experience symptoms of lethargy, mild depression, mood swings, issues with motivation, and intermittent cravings for marijuana for weeks, months, and maybe even years after they have stopped using the drug. In addition, there are relatively high relapse rates associated with any substance use disorder. Individuals who begin smoking marijuana after even lengthy periods of abstinence run the risk of reestablishing their old habits rather quickly and in many cases significantly more quickly than their cannabis use disorder took to develop the first time.
The withdrawal process from marijuana is not considered to be life-threatening; however, in some individuals, there is always the potential for someone to exhibit poor judgment, be more prone to accidents, and even develop suicidal thoughts as a result of the distress and depression that can occur during cannabis withdrawal. Thus, it is suggested that individuals who intend to stop using marijuana, especially individuals who used marijuana daily or nearly daily, discontinue use of the drug under the supervision of a mental health professional.
Medications to Assist with Cannabis WithdrawalThere are no currently approved medications specifically designed to assist in withdrawal from cannabis. However, a number of medications can be used to address the specific symptoms associated with cannabis withdrawal. There also several medications that have shown promise in the treatment of cannabis withdrawal. These include:
- Ambien (zolpidem) has demonstrated some promise for helping individuals with sleep difficulties during marijuana/cannabis withdrawal.
- BuSpar (buspirone) appears to have some utility for addressing many of the issues with irritability and anxiety that individuals may experience during withdrawal period.
- Neurontin (gabapentin) may also address sleep issues.
- A class of drugs known as fatty acid amide hydrolase inhibitors or FAAH inhibitors may have some promise in breaking down the ingredients of cannabis in the system; however, clinical trials for other uses for these drugs indicate some potential serious side effects.
- Drugs that are allosteric modulators for cannabis may be useful in reducing cravings during withdrawal.
Again, it is important to understand that the medications used to assist with withdrawal from cannabis are typically forms of symptom management and used based on the specific symptoms that are giving the individual trouble at any period in time. Currently, there is no approved overall medication to assist with withdrawal from cannabis. Other medications, such as antidepressants, anti-anxiety medications, medications for nausea, mild analgesics, etc., could conceivably be administered as needed.