Is Marijuana Addictive?
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Symptoms of Withdrawal
The evidence for cannabis withdrawal in humans is based on inpatient studies involving abstinence after sustained consumption of oral THC or smoked cannabis, and also on symptoms either described in interviews or checked on lists by people in rehab and in studies of outpatients trying to quit.
The main complaints, says Alan Budney, are irritability, sleeplessness, anger, restlessness, and “not feeling right.” They also include appetite loss and, less frequently, depression and nausea. They peak after two or three days of abstinence and last a week or two, he wrote in 2008.
“There’s no doubt that it exists. We see it all the time in clinics,” he says. When he first published his studies, he says, he got phone calls from Marijuana Anonymous thanking him for confirming what its participants had been talking about in meetings.
The concept is “still somewhat controversial,” says Lichtman. Earleywine believes it is “very misleading” to use the word withdrawal. “There’s obviously some mild discomfort in humans who quit suddenly,” he says, “but the connotations of the word ‘withdrawal’ make people think of heroin.” He also finds it absurd that loss of appetite is considered a symptom of marijuana withdrawal, given that “it’s a drug so notorious for enhancing appetite that it’s got its own expression—the munchies.”
The DSM-IV did not include cannabis withdrawal, on the grounds that its symptoms’ “clinical significance is uncertain.” Budney is trying to get it listed in the forthcoming DSM-V.
“We think it’s important enough,” he says. He adds that he’s not on a crusade against marijuana: “I’m out there helping people who want to quit.”
Whatever cannabis withdrawal is, it’s definitely much milder than detoxing from heroin or alcohol. Stopping drinking can cause fatal seizures in severe alcoholics, notes Carl Hart, a neuroscientist at Columbia University College of Physicians and Surgeons. He calls cannabis withdrawal “unpleasant but not threatening.”
“It’s certainly not like heroin withdrawal,” says Budney. But he adds that the “milder symptoms are what make people go back and smoke.”
Those symptoms are likely confined to a minority of potheads. Hart says they appear in a “select group of heavy, heavy users”; some, but not all, people who smoke several joints a day will have sleep disturbances and become irritable when they quit. Budney estimates that half of heavy users and “not a high percentage” of moderate users will suffer withdrawal.
Dr. Jeff Hergenretter, a Sebastopol, California, physician who has been seeing mainly medical-marijuana patients for the past 12 years, says the number is insignificant. Less than 1 percent of his 2,000 patients, he says have described any withdrawal symptoms, “and it’s short-lived, mild, lasting a day or two.” The vast majority have “no withdrawal symptoms whatsoever. No discomfort, no dysphoria, no nothing.”
Marijuana withdrawal is most comparable to quitting cigarettes, says Budney. In a study he published in 2008, tobacco smokers and daily pot-smokers who were trying to quit reported equal levels of discomfort in telephone interviews. However, 44 percent of the cigarette-smokers were using nicotine-replacement therapies such as patches.
That “definitely would warp results,” he agrees, but “we just had to take who we had.” Nevertheless, he says, the people using nicotine replacement also reported being irritable, and an “accumulation across these studies” confirms his theory.
“Most people think it’s akin to coffee craving. I know that’s true in my case,” says Fred Gardner, editor of O’Shaughnessy’s, a California-based magazine devoted to medical-marijuana research.
“Caffeine withdrawal may be in the DSM this time,” says Budney. While coffee can improve people’s work functioning, he explains, those who stop drinking it can suffer acute headaches.