HHS Public Access: Prolonged Cannabis Withdrawal in Young Adults With Lifetime Psychiatric Illness
HHS Public Access: Prolonged Cannabis Withdrawal in Young Adults With Lifetime Psychiatric Illness
HHS Public Access: Prolonged Cannabis Withdrawal in Young Adults With Lifetime Psychiatric Illness
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Prev Med. Author manuscript; available in PMC 2018 November 01.
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Abstract
Young adults with psychiatric illnesses are more likely to use cannabis and experience problems
from use. It is not known whether those with a lifetime psychiatric illness experience a prolonged
cannabis withdrawal syndrome with abstinence. Participants were fifty young adults, aged 18–25,
recruited from the Boston-area in 2015–2016, who used cannabis at least weekly, completed the
Structured Clinical Interview for DSM-IV to identify Axis I psychiatric diagnoses (PD+ vs PD−),
and attained cannabis abstinence with a four-week contingency management protocol. Withdrawal
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symptom severity was assessed at baseline and at four weekly abstinent visits using the Cannabis
Withdrawal Scale. Cannabis dependence, age of initiation, and rate of abstinence were similar in
PD+ and PD− groups. There was a diagnostic group by abstinent week interaction, suggesting a
difference in time course for resolution of withdrawal symptoms by group, F(4,46)=3.8, p=0.009,
controlling for sex, baseline depressive and anxiety symptoms, and frequency of cannabis use in
the prior 90 days. In post hoc analyses, there was a difference in time-course of cannabis
withdrawal. PD− had significantly reduced withdrawal symptom severity in abstinent week one
[t(46)=−2.2, p=0.03], while PD+ did not report improved withdrawal symptoms until the second
abstinent week [t(46) =−4.1, p=0.0002]. Cannabis withdrawal symptoms improved over four
weeks in young people with and without a lifetime psychiatric diagnosis. However, those with a
psychiatric illness reported one week delayed improvement in withdrawal symptom severity.
Longer duration of cannabis withdrawal may be a risk factor for cannabis dependence and
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difficulty quitting.
Address correspondence to: Randi Melissa Schuster, PhD, 60 Staniford Street, Boston, MA 02114; phone: (617) 643-6673; fax: (617)
7243726; Rschuster@mgh.harvard.edu.
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Schuster et al. Page 2
Keywords
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Introduction
Cannabis use is common among young adults1, particularly among those with a current or
lifetime psychiatric illness2–6. For example, national epidemiologic data indicate up to
double the prevalence of cannabis use among those with a past year depressive episode
versus those without7. This high prevalence of comorbidity may be clinically relevant as co-
occurring mood and cannabis use disorders may complicate both substance use and mood
disorder treatment.
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Little is known about the association between lifetime psychiatric illness and the course of
cannabis withdrawal symptom severity during the first weeks of cannabis abstinence.
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Cannabis withdrawal has been identified as a key criterion of cannabis use disorder21,22,
impacting between 35% to 75% of adolescents and young adults with a use disorder
attempting to reduce or discontinue use23. According to the DSM-V, the cannabis
withdrawal syndrome involves the manifestation of three or more of the following six
symptoms: irritability or anger; nervousness or anxiety; sleep difficulty (i.e., insomnia,
disturbing dreams); decreased appetite or weight loss; restlessness; depressed mood; and at
least one physical symptom causing discomfort (i.e., abdominal pain, shakiness/tremors,
sweating, fever, chills, headache)24–26. Due to the long half-life of Δ9-tetrahydrocannabinol
(THC) and its metabolites, the cannabis withdrawal syndrome may last for several days to
weeks following last use. Importantly, the presence of withdrawal symptoms with abstinence
has been found to be a marker for problematic cannabis use, predicting severity of use, rapid
reinstatement of use during a quit attempt, and problems from use21,26,27 In a sample of
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adolescent cannabis users followed over one year, greater withdrawal symptom severity was
associated with fewer days abstinent23
In a separate sample of 110 treatment-seeking emerging adults who were heavy cannabis
users, those with significant cannabis withdrawal had a 53% greater risk of earlier
resumption of cannabis use than those who did not report significant withdrawal
symptoms28.
While associations have been reported between lifetime psychiatric diagnosis and cannabis
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use, and between cannabis withdrawal symptom severity and worse cannabis use outcomes,
there are no reports to our knowledge of cannabis withdrawal trajectories by lifetime
psychiatric diagnosis. It is plausible that those with a current or past psychiatric illness will
have a more severe and prolonged cannabis withdrawal syndrome, as it is well known that
psychiatric populations experience more intense withdrawal from other substances, such as
nicotine29–33.
We investigated the time course and severity of cannabis withdrawal symptoms during four
weeks of incentivized abstinence, and hypothesized that a lifetime psychiatric diagnosis
would be associated with a slower rate of withdrawal symptom improvement among young
adults who used cannabis at least weekly.
Methods
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Participants
Eligible participants were otherwise healthy young adults, aged 18–25, who reported using
cannabis at least weekly, recruited via peer referral and advertisements in the community
that sought potential participants ‘who use marijuana and are between age 18 and 25.’
Inclusion criteria, determined via phone screen, included cannabis use in the week prior to
the baseline visit, English language fluency, and willingness to stop using cannabis for 30
days. There was no requirement that potential participants wish to permanently discontinue
cannabis use.
Assessments
At baseline, current and lifetime diagnoses of Axis I disorders were assessed with the
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Structured Clinical Interview for DSM-IV (SCID-IV)34. For this study, the lifetime
psychiatric diagnosis group (PD+) was comprised of participants meeting diagnostic criteria
for any current or lifetime Axis I disorder, with the exception that current or prior substance
use disorder was not adequate for inclusion. Additional baseline assessments included the
Wechsler Test of Adult Reading (WTAR)35 for predicted full-scale IQ, Mood and Anxiety
Symptoms Questionnaire (MASQ)36, Cannabis Use Disorder Identification Test – Revised
(CUDIT-R)37, and Alcohol Use Disorders Identification Test (AUDIT)38. Detailed
interviews using a modified Timeline Followback method39 were conducted at baseline to
approximate quantity and frequency of past 90-day cannabis and alcohol use.
At each study visit, cannabis use was assessed with a quantitative urine toxicology
assessment and self-report40. Cannabis withdrawal symptom severity was assessed using the
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Intervention
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This study was conducted between July and November 2016. A detailed description of
procedures has been described previously40. All study procedures were approved by the
Partners Healthcare Human Subjects Committee. Eligibility was confirmed and written
informed consent was performed during this first in-person visit.
Participants were asked to arrive for the baseline assessment after overnight cannabis
abstinence. Participants were also asked to refrain from using illicit drugs and alcohol on the
day of all study visits. Following baseline assessments, participants began a contingency
management (CM) program of financial incentives for four weeks of continuous
abstinence40. Briefly, participants were enrolled in a four-week abstinence-based incentive
program. Participants earned incentives based on a two-track system for attendance and
abstinence, with escalating denominations for both attendance and abstinence to encourage
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study retention and achievement of longer periods of continuous abstinence. The first 35
participants earned $585 for 30 days of abstinence with full attendance ($405 for continuous
abstinence and $180 for full attendance). Due to the overwhelming success of the CM
paradigm at eliciting 30 days of cannabis abstinence, the payment schedule was reduced by
approximately 30% for the final 15 participants ($315 for 30 days of continuous abstinence
and $105 for full attendance). Incentives were distributed via reloadable credit cards through
Clinical Trials Payer (CT Payer) on the day of the study visit for attendance and upon receipt
of the quantitative urinalysis results confirming abstinence (described below).
Urine samples were shipped by overnight courier to Dominion Diagnostics (Kingstown, RI,
USA) for quantitative assessment of concentration the 11-nor-9-carboxy-Δ9-
tetrahydrocannabinol (THCCOOH) metabolite of THC, using liquid chromatography/
tandem mass spectrometry (LC-MS/MS). Quantitative indices were tracked to determine if
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Analytic Approach
Data were analyzed from baseline and the four consecutive weekly post-baseline
‘abstinence’ assessments using Stata 13.1 and SAS 9.4. We inspected data for non-normal
distribution and outliers, and performed rank-based nonparametric procedures (Mann-
Whitney U tests, Spearman’s rank order correlations) when assumptions of normality were
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controlling for baseline covariates, examining the effect of group at each study week as well
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as the pattern of change in withdrawal severity within each group. As exploratory analyses,
correlations were conducted between levels of withdrawal intensity at the time point when
PD groups were most different and parameters of cannabis use severity. Finally, sensitivity
analyses using marginal models were conducted to evaluate the independent effect of
covariates that differed between PD groups on level of cannabis withdrawal symptoms over
time. Alpha was set at 0.05 for all statistical tests.
Results
Participant Characteristics
Forty-four of 50 (88%) participants maintained biochemically-confirmed continuous
abstinence for the four-week CM protocol, 22 in the PD+ group and 22 in the PD− group.
Data were included for all participants at all time points with verified abstinence (see
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Methods). Those in the PD+ group were more likely to be female and report greater baseline
symptom severity on the MASQ Anxious Arousal and Anhedonic Depression subscales.
Groups were otherwise comparable across assessed demographic, mood, and alcohol use
indices, including frequency and amount of alcohol consumed in the 90 days prior to and
during the intervention. The most frequent Axis I psychiatric diagnoses in the PD+ group
were major depressive disorder (92%), generalized anxiety disorder (16%), posttraumatic
stress disorder (12%), panic disorder (8%), and bulimia (8%). Thirty-two percent of the PD+
sample had more than one psychiatric diagnosis by SCID-IV criteria. Baseline
characteristics of the samples are presented in the table.
PD+, 15.96 (2.09) years for PD−; t=0, p=1.00) or number of symptoms of cannabis
dependence [CUDIT scores: 14.32 (4.49) for +PD, 13.96 (6.29) for −PD; t=−0.23, p=0.82].
Those in the PD+ group reported using cannabis more frequently in the three months prior to
enrollment [63.52 (22.53) days for PD+, 44.1 (22.5) days for PD−; t=−3.04, p=0.004].
After controlling for sex, self rating of anxious arousal and anhedonic depression, and past
90 day cannabis use frequency, there was a main effect of time (study week) [F(4,46) = 3.41,
p = .02], but not PD group [F(1,46) = 0.09, p = 0.77] on cannabis withdrawal symptom
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severity. There was a significant PD group by time (study week) interaction [F(4,46) = 3.84,
p = 0.009], suggesting that the group effect was modified by study week. Groups were not
different at baseline and weeks 2, 3, and 4 [p-values >0.32], and there was a trend for the PD
+ group to have higher withdrawal scores at week 1 [t(46)=1.87 p=0.07]. Additionally, there
was significant reduction in withdrawal severity by 8.25 units from baseline to week 1 in the
PD− group [t(46) = −2.24, p = 0.03], but no significant change from baseline to abstinent
week 1 the PD+ group [t(46) = 0.27, p = 0.79]. From abstinent week 1 to 2, there was no
significant reduction in withdrawal severity in the PD− group [t(46) = 0.83, p = 0.41], but
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there was significant reduction in withdrawal symptom severity score from week 1 to week 2
in the PD+ group [12.89 units; t(46) = −4.13, p = 0.0002]. Pairwise comparisons for
withdrawal symptom severity in weeks 2 to 3 and 3 to 4 in each group were not significant
[p-values > 0.48].
Exploratory correlation analyses suggested that withdrawal symptom intensity at one week
of abstinence, when PD groups were most different, was positively associated with number
of symptoms of cannabis dependence [ρ=0.38, p=0.009], frequency of baseline cannabis use
[ρ=0.34, p=0.02], and there was a trend for a negative association with age of first cannabis
use [ρ=−0.27, p=0.06]. There was no association between withdrawal symptom intensity at
week 1 and amount of cannabis used in the 90 days prior to baseline [ρ=0.23, p=0.12].
Sensitivity Analyses
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More frequent cannabis use and more severe self-rated symptoms of anhedonic depression
prior to abstinence were associated with more severe withdrawal in the full sample
[frequency of cannabis use F(1,48) = 4.41, p = 0.04; anhedonic depression symptoms:
F(1,48) = 12.24, p = 0.001]. However, neither the effect of frequency of cannabis use nor
depressive symptoms was modified by time [cannabis use frequency by time interaction:
F(4,48) = 1.06, p = 0.39; anhedonic depression by time interaction: F(4,48) = 0.53, p =
0.71], suggesting that neither explained why withdrawal symptoms were changing
differently over time among ±PD groups. Sex was neither associated with withdrawal
severity [F(1,48) = 0.49, p = 0.49], nor time-course [F(4,48) = 0.46, p = 0.76]. In contrast,
more severe baseline anxious arousal was associated with more symptoms of cannabis
withdrawal [F(1,48) = 11.48, p = 0.001], and this effect varied with time [F(4,48) = 3.72, p =
0.01]. At baseline, each unit increase in anxious arousal severity predicted a 2.25 unit
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Discussion
Though the prevalence of psychiatric illness among young adult regular cannabis users is
high, little is known about the impact of psychiatric illness on the time-course of the
cannabis withdrawal syndrome. In this sample of 50 young adults who use cannabis
regularly, lifetime psychiatric illness was associated with more persistent cannabis
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Findings from this study replicate prior work suggesting that psychiatric diagnosis is
associated with several indicators of greater severity of cannabis use4,6,8. In our sample,
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psychiatric history was associated with more frequent and heavier cannabis use in the prior
90 days, but unlike other studies27,43,44, not with earlier onset of use or more symptoms of a
cannabis use disorder.
symptoms, more frequent cannabis use, and earlier age of cannabis use initiation.
There are several potential explanations for the finding of more persistent cannabis
withdrawal among young adult cannabis users with psychiatric illness. Young adults with
psychiatric illness may be more likely to experience, or are more sensitive to, the symptoms
of cannabis withdrawal, which overlap with symptoms of many psychiatric illnesses. This
may be due to shared influences on the endocannabinoid system45–47, and may be
particularly apparent in adolescence and young adulthood when the endocannabinoid system
is maturing48. Despite the fact that only 16% of those in the PD+ group met criteria for a
current Axis I diagnosis, it is also possible that those young adults with a lifetime psychiatric
illness endorse greater withdrawal symptoms due to sub-syndromal current illness. This is
supported by the finding that baseline anxiety independently predicted withdrawal in the
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first two weeks of abstinence. However, purely non-specific symptoms would not be
expected to resolve after two weeks of cannabis abstinence.
The present results underscore the need to take into account co-morbidities when assessing
cannabis withdrawal and calls for further work investigating the extent of symptomatic
overlap between cannabis withdrawal and various psychiatric diagnoses. Yet these study
results should be interpreted in light of the study limitations. The sample size was modest,
hampering our ability to detect small effects, to detect the impact of specific withdrawal
symptoms on the time course of resolution of total withdrawal scores (e.g., negative affect
and sleep disruption49), and to evaluate potential moderators such as differential effects on
withdrawal by sex50. The study also involved young adults, and generalizability to older or
younger cannabis using populations is not known. Additionally, many prior studies on
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CWS after four weeks of abstinence was not zero, and therefore it is not known whether
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these remaining low-level symptoms represent a full return-to-baseline. The scale items are
non-specific and may reflect normal variability in daily functioning, sub-threshold
symptoms common among people with a lifetime psychiatric diagnosis, or persistent
withdrawal. This would be clarified by future studies that prospectively examine psychiatric
history and cannabis withdrawal during regular use, acute deprivation, short-term sustained
abstinence, and longer-term abstinence.
Acknowledgments
This publication was made possible by support from 1K23DA042946 (Schuster); 1K01DA034093 (Jodi Gilman);
K24 DA030443 (Evins), the Norman E. Zinberg Fellowship in Addiction Psychiatry and Livingston Fellowship
from Harvard Medical School (Schuster), and by the Louis V. Gerstner III Research Scholar Award (Schuster).
References
1. Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2013
National Survey on Drug Use and Health: Summary of national findings. Rockville, MD:
SAMHSA; 2014.
2. Buckner JD, Schmidt NB, Lang AR, Small JW, Schlauch RC, Lewinsohn PM. Specificity of social
anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res. 2008; 42(3):
230–239. [PubMed: 17320907]
Author Manuscript
3. Feingold D, Weiser M, Rehm J, Lev-Ran S. The association between cannabis use and mood
disorders: A longitudinal study. J Affect Disord. 2015; 172:211–218. [PubMed: 25451420]
4. Hooshmand S, Willoughby T, Good M. Does the direction of effects in the association between
depressive symptoms and health-risk behaviors differ by behavior? A longitudinal study across the
high school years. J Adolesc Health. 2012; 50(2):140–147. [PubMed: 22265109]
5. Marmorstein NR, White HR, Loeber R, Stouthamer-Loeber M. Anxiety as a predictor of age at first
use of substances and progression to substance use problems among boys. J Abnorm Child Psychol.
2010; 38(2):211–224. [PubMed: 19821024]
6. Wittchen HU, Frohlich C, Behrendt S, et al. Cannabis use and cannabis use disorders and their
relationship to mental disorders: A 10-year prospective-longitudinal community study in
Author Manuscript
12. Marmorstein NR, Iacono WG. Explaining associations between cannabis use disorders in
adolescence and later major depression: A test of the psychosocial failure model. Addict Behav.
2011; 36(7):773–776. [PubMed: 21411234]
13. Kedzior KK, Laeber LT. A positive association between anxiety disorders and cannabis use or
cannabis use disorders in the general population: A meta-analysis of 31 studies. BMC Psychiatry.
2014; 14:136. [PubMed: 24884989]
14. Henquet C, Krabbendam L, de Graaf R, ten Have M, van Os J. Cannabis use and expression of
mania in the general population. J Affect Disord. 2006; 95(1– 3):103–110. [PubMed: 16793142]
15. Lagerberg TV, Sundet K, Aminoff SR, et al. Excessive cannabis use is associated with earlier age
at onset in bipolar disorder. Eur Arch Psychiatry Clin Neurosci. 2011; 261(6):397–405. [PubMed:
21267743]
16. Patton GC, Coffey C, Carlin JB, Degenhardt L, Lynskey M, Hall W. Cannabis use and mental
health in young people: Cohort study. BMJ. 2002; 325(7374):1195–1198. [PubMed: 12446533]
17. van Laar M, van Dorsselaer S, Monshouwer K, de Graaf R. Does cannabis use predict the first
Author Manuscript
incidence of mood and anxiety disorders in the adult population? Addiction. 2007; 102(8):1251–
1260. [PubMed: 17624975]
18. Wright NE, Scerpella D, Lisdahl KM. Marijuana use is associated with behavioral approach and
depressive symptoms in adolescents and emerging adults. PLoS One. 2016; 11(11):e0166005.
[PubMed: 27835662]
19. Medina KL, Shear PK. Anxiety, depression, and behavioral symptoms of executive dysfunction in
ecstasy users: Contributions of polydrug use. Drug Alcohol Depend. 2007; 87(2–3):303–311.
[PubMed: 17074449]
20. Rubino T, Zamberletti E, Parolaro D. Adolescent exposure to cannabis as a risk factor for
psychiatric disorders. J Psychopharmacol. 2012; 26(1):177–188. [PubMed: 21768160]
21. Cornelius JR, Chung T, Martin C, Wood DS, Clark DB. Cannabis withdrawal is common among
treatment-seeking adolescents with cannabis dependence and major depression, and is associated
with rapid relapse to dependence. Addict Behav. 2008; 33(11):1500–1505. [PubMed: 18313860]
22. Nocon A, Wittchen HU, Pfister H, Zimmermann P, Lieb R. Dependence symptoms in young
cannabis users? A prospective epidemiological study. J Psychiatr Res. 2006; 40(5):394–403.
Author Manuscript
[PubMed: 16169014]
23. Greene MC, Kelly JF. The prevalence of cannabis withdrawal and its influence on adolescents’
treatment response and outcomes: A 12-month prospective investigation. J Addict Med. 2014;
8(5):359–367. [PubMed: 25100311]
24. Milin R, Manion I, Dare G, Walker S. Prospective assessment of cannabis withdrawal in
adolescents with cannabis dependence: A pilot study. J Am Acad Child Adolesc Psychiatry. 2008;
47(2):174–178. [PubMed: 18176332]
25. Vandrey RG, Budney AJ, Hughes JR, Liguori A. A within-subject comparison of withdrawal
symptoms during abstinence from cannabis, tobacco, and both substances. Drug Alcohol Depend.
Author Manuscript
36. Watson D, Weber K, Assenheimer JS, Clark LA, Strauss ME, McCormick RA. Testing a tripartite
model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptom
scales. J Abnorm Psychol. 1995; 104(1):3–14. [PubMed: 7897050]
37. Adamson SJ, Sellman JD. A prototype screening instrument for cannabis use disorder: the
Cannabis Use Disorders Identification Test (CUDIT) in an alcohol-dependent clinical sample.
Drug Alcohol Rev. 2003; 22(3):309–315. [PubMed: 15385225]
38. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use
Disorders Identification Test (AUDIT): WHO Collaborative Project on early detection of persons
with harmful alcohol consumption–II. Addiction. 1993; 88(6):791–804. [PubMed: 8329970]
39. Robinson SM, Sobell LC, Sobell MB, Leo GI. Reliability of the Timeline Followback for cocaine,
cannabis, and cigarette use. Psychol Addict Behav. 2014; 28(1):154–162. [PubMed: 23276315]
40. Schuster RM, Hanly A, Gilman J, Budney A, Vandrey R, Evins AE. A contingency management
method for 30-days abstinence in non-treatment seeking young adult cannabis users. Drug Alcohol
Depend. 2016; 167:199–206. [PubMed: 27590742]
Author Manuscript
41. Lafolie P, Beck O, Blennow G, et al. Importance of creatinine analyses of urine when screening for
abused drugs. Clin Chem. 1991; 37(11):1927–1931. [PubMed: 1934467]
42. Schwilke EW, Gullberg RG, Darwin WD, et al. Differentiating new cannabis use from residual
urinary cannabinoid excretion in chronic, daily cannabis users. Addiction. 2011; 106(3):499–506.
[PubMed: 21134021]
43. Degenhardt L, Coffey C, Romaniuk H, et al. The persistence of the association between adolescent
cannabis use and common mental disorders into young adulthood. Addiction. 2013; 108(1):124–
133. [PubMed: 22775447]
44. Foster DW, Garey L, Buckner JD, Zvolensky MJ. Social anxiety and cannabis-related impairment:
The synergistic influences of peer and parent descriptive and injunctive normative perceptions.
Author Manuscript
50. Herrmann ES, Weerts EM, Vandrey R. Sex differences in cannabis withdrawal symptoms among
treatment-seeking cannabis users. Exp Clin Psychopharm. 2015; 23(6):415–421.
51. Chung T, Martin CS, Cornelius JR, Clark DB. Cannabis withdrawal predicts severity of cannabis
involvement at 1-year follow-up among treated adolescents. Addiction. 2008; 103:787–799.
[PubMed: 18412757]
52. National Research Council and Institute of Medicine. Preventing Mental, Emotional, and
Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: The
National Academies Press; 2009.
53. Johnson KA, Stewart S, Rosenfield D, Steeves D, Zvolensky MJ. Prospective evaluation of the
effects of anxiety sensitivity and state anxiety in predicting acute nicotine withdrawal symptoms
during smoking cessation. Psychol Addict Behav. 2012; 26(2):289–297. [PubMed: 21644805]
54. Weinberger AH, Desai RA, McKee SA. Nicotine withdrawal in U.S. smokers with current mood,
anxiety, alcohol use, and substance use disorders. Drug Alcohol Depend. 2010; 108(1–2):7–12.
[PubMed: 20006451]
Author Manuscript
55. Zvolensky MJ, Farris SG, Guillot CR, Levental AM. Anxiety sensitivity as an amplifier of
subjective and behavioral tobacco abstinence effects. Drug Alcohol Depend. 2014; 142:224–230.
[PubMed: 25015688]
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Highlights
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• History of psychiatric illness was associated with more frequent cannabis use.
Figure 1.
Weekly Ratings of Cannabis Withdrawal Intensity (Raw Scores) during Four Weeks of
Verified Abstinence in Those with and without a Lifetime Psychiatric Illness from the
Boston-Area in 2015/16
Note. All values represent raw means and standard errors.
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Table 1
Characteristics of Young Adult Cannabis Users Recruited in Boston from 2015 to 2016
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Demographics
Gender (n, (%) Female) 7 (28) 15 (60) 0.02
Age (years) 20.9 (1.3) 21.0 (1.8) 0.79
Education (years) 14.5 (1.0) 14.5 (1.6) 0.45
Race (%)
White 68 64
Black 20 4 0.22
Asian 4 4
More than One Race 8 24
Other 0 4
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Psychiatric History
General Anxiety Symptom Subscale Score (MASQ) 20 (6.1) 21.8 (5.6) 0.28
Anxious Arousal Subscale Score (MASQ) 22.8 (3.9) 25.6 (5.2) 0.03
General Depressive Symptom Subscale Score (MASQ) 22.4 (8.3) 25.9 (7.8) 0.13
Anhedonic Depression Subscale Score (MASQ) 52.3 (12.6) 60.7 (12.8) 0.02
SCID-IV Psychiatric Diagnoses (Current/Lifetime; n)
Major Depressive Disorder N/A 1/23 –
Bipolar I N/A 1/1 –
Panic Disorder N/A 2/2 –
Agoraphobia N/A 1/1 –
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Alcohol Use
Age of Initiation (years) 15.1 (1.9) 14.9 (2.2) 0.73
Past 90 Day Alcohol Use
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Drinking Days in 1st Week/Overall 3.0 (1.9)/10.1 (5.5) 3.5 (2.6)/11.0 (5.8) 0.46/0.57
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Cannabis Use
Age of Initiation (First Use) 15.9 (2.1) 15.9 (1.7) 1.00
Past 90 Day Cannabis Use
Days Cannabis Consumed 44.1 (22.5) 63.5 (22.5) 0.004
Total Times Cannabis Consumed 101.0 (77.9) 159.7 (176.7) 0.14
Grams Consumed (Mdn, IQR) 20.7 [7.8, 55.5] 36.5 [11.6, 81.0] 0.18
Dependence Symptoms (CUDIT) 14.0 (6.3) 14.3 (4.5) 0.82
Days Since Last Use (Mdn, IQR) 1 [1, 2] 1 [1, 1] 0.07
30-Day Abstinence (n, (%) Abstinent) 22 (88%) 22 (88%) –
Note: All values are means, standard deviations, unless otherwise noted; AUDIT, Alcohol Use Disorders Identification Test; CUDIT, Cannabis Use
Disorder Identification Test; CN-THCCOOH, creatinine-adjusted THCCOOH levels; FSIQ, Wechsler Test of Adult Reading Full Scale IQ; IQR,
Interquartile range; MASQ, Mood and Anxiety Symptom Questionnaire; Mdn, Median; MJ, cannabis; SCID-IV, Structured Clinical Interview for
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