25 Jul Marijuana, Nicotine Withdrawal Equally Tough, Study Finds
Cannabis use withdrawal is a mental health condition that occurs in habitual, heavy cannabis (marijuana) users in the aftermath of a significant drop in use or complete cessation of use. It appears for the first time in the “substance-related and addictive disorders” chapter of DSM 5, the 2013 edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. For a long time, researchers and mental health professionals debated whether or not marijuana users actually go through psychologically harmful withdrawal. However, current evidence supports the reality of harmful withdrawal in regular marijuana users, and the inclusion of cannabis use withdrawal in the “Diagnostic and Statistical Manual” reflects this reality.
The previous edition of the Diagnostic and Statistical Manual (known as DSM IV) did not contain a listing for cannabis withdrawal, but it did contain a listing for a condition called cannabis intoxication, which is also included in DSM 5. People affected by cannabis intoxication develop a minimum of two out of four specific symptoms associated with recent cannabis use. These symptoms include an unusually dry mouth, an unusually rapid heartbeat, a spike in appetite, and fluid buildup in the eyelids’ mucous membranes. A diagnosis for the disorder also requires the presence of harmful changes in one’s mental state or outward behaviors. In addition, affected individuals must be free of other mental or physical conditions that explain their symptoms. Not all substance-specific intoxication disorders listed in DSM IV were accompanied by related withdrawal disorders; however, many intoxication disorders did appear along with matching withdrawal disorders.
Substance withdrawal is the general medical term for the unpleasant physical and psychological reactions that occur when habitual users of a given substance either stop using that substance altogether or significantly decrease their normal level of intake. Withdrawal from some substances produces only minor unpleasantness, while withdrawal from other substances can produce moderate or severe unpleasantness, or even life-threatening health complications. The specific degree of discomfort involved in the withdrawal process is critical to deciding whether withdrawal from a given substance qualifies as a mental health disorder. According to the guidelines contained in both DSM IV and DSM 5, affected individuals must experience either substantial mental anguish or life skills impairment in order to meet the criteria for a withdrawal disorder diagnosis. They must also have a history of extensive, long-term use of the substance in question, and must not have other physical or mental issues that could potentially produce their discomfort.
Most doctors and researchers have long agreed that abrupt reduction or cessation of marijuana can produce some degree of mental and/or physical discomfort. Still, these professionals disagreed in significant ways regarding the amount and seriousness of the discomfort involved, and for this reason past editions of the Diagnostic and Statistical Manual did not contain a listing for cannabis withdrawal as a mental health concern. However, since the publication of the last updated version of DSM IV in 2000, scientific opinion on cannabis withdrawal has changed considerably, and substantial evidence now supports the real-world impact of this physical and psychological condition.
For example, in a study published in 2012 in the journal PLOS ONE, a team of Australian researchers examined the effects of cannabis withdrawal on a group of 49 adults who used marijuana habitually and met the basic criteria for a condition then known as cannabis dependence. During the study, these habitual users agreed to stop using marijuana two weeks. At the end of this period, the study’s authors assessed the impact of this sudden cessation of usage on the participants’ mental and physical well being.
Specific symptoms of cannabis withdrawal identified in the study group included depression, sleep disruptions, abnormal muscle tension, anxiety, appetite suppression and unpredictable changes in mood. The authors concluded that these symptoms were intense enough to meet the basic Diagnostic and Statistical Manual requirements for a withdrawal disorder. In fact, habitual marijuana users who go through cannabis withdrawal experience roughly the same amount of mental anguish and/or life disruption as habitual cigarette smokers who go through nicotine withdrawal.
Cannabis withdrawal was included in DSM 5 as part of a larger rethinking and restructuring of substance-related mental health disorders. Other components of this process include the elimination of separate listings for substance abuse and substance dependence (e.g., cannabis use and cannabis dependence) and the creation of combined listings for these conditions called “use disorders” (e.g., cannabis use disorder or alcohol use disorder), which include symptoms once attributed specifically to either abuse or dependence. As is true with the establishment of cannabis withdrawal as a diagnosable condition, these changes reflect the current state of knowledge regarding the real-world effects of substance use and misuse.
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