For some reason many people are in denial about cannabis dependence and wish to assert that there is no such thing, or if there is, it is somehow of lesser importance than is dependence on other substances of abuse. There are many ways to assess importance of course. What gets me going, however, are the assertions about cannabis abuse and dependence that are informed by anecdote and personal experience with a handful of users instead of an understanding of the available evidence.
To provide a little context for todays' post, I took MarkH of denialism blog to task for his expression of what I viewed as standard cannabis science denialism a fair while ago. In a comment following his post, MarkH specifically identified nicotine withdrawal as being worse than cannabis withdrawal. This is the perfect setup since there are two recent papers which set out explicitly to test this hypothesis. Let us see what they found, shall we?
First off, what does cannabis withdrawal look like? As I've mentioned before the Diagnostic and Statistical Manual of Mental Disorders (DSM; current major version DSM-IV) employs generic substance abuse and dependence criteria for cannabis dependence. One of the ways the DSM gets revised over time is that researchers provide data and studies in-between revisions to attempt to refine and clarify diagnoses. The individual I most associate with the effort to describe the nature of cannabis dependence, and specifically withdrawal, is Alan J. Budney. He has a 2006 review of his (and others') work in this area and anyone who wishes to grapple with the consistency of findings and the subtleties of the subject samples under investigation should track back through the reviewed articles. For today, the important issue is that Budney proposes that a symptom list for cannabis withdrawal should be included in the next revision of the DSM as follows (from Table 1):
Common symptoms
- Anger or aggression
- Decreased appetite or weight loss
- Irritability
- Nervousness/anxiety
- Restlessness
- Sleep difficulties including strange dreaming
Less common symptoms/equivocal
- Chills
- Depressed mood
- Stomach pain
- Shakiness
- Sweating
Hmm. Very broadly consistent with symptoms established for other drugs of abuse, including nicotine. This brings us to the two papers comparing nicotine and cannabis withdrawal which have recently appeared; perhaps unsurprisingly, Budney is an author on each of these.
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. 2008 Jan 1;92(1-3):48-54. Epub 2007 Jul 23.
Budney AJ, Vandrey RG, Hughes JR, Thostenson JD, Bursac Z. Comparison of cannabis and tobacco withdrawal: Severity and contribution to relapse. J Subst Abuse Treat. 2008 Mar 12; [Epub ahead of print]
The first study, Vandrey et al, 2008, includes a relatively small sample (N=12) of cannabis/tobacco users (>6mo of 25 days/mo cannabis smoking, 10 tobacco cigarettes or more per day; all the usual exclusions of other issues). Importantly these individuals were not seeking treatment for either tobacco or cannabis use. The design was a series of blocks of Smoking As Usual (SAU) and the abstaining from cigarettes, cannabis or both for a 5 day interval. SAU for 9 days was interleaved between any of the abstinence intervals. Okay, so what did they find?
Fig. 2. Mean ratings for WSC items for which significant condition by day interactions were observed. Filled symbols indicate values significantly different from SAU. Subscripts designate differences by condition on a given study day (a = dual > cannabis and tobacco; b = dual and tobacco > cannabis; c = dual > cannabis;
d = dual > tobacco). Squares indicate abstinence from cannabis only, circles indicate abstinence from tobacco only, and triangles indicate abstinence from cannabis and tobacco.
Discontinuation of both substances seemed to cause the greatest degree of withdrawal, particularly in terms of anger, irritability and aggression on day 2. Cannabis discontinuation (alone) seemed to cause sleep disturbances for longer than did nicotine discontinuation (alone). Perhaps most strikingly, the discontinuation of cannabis (alone) or nicotine (alone) seemed to produce approximately equivalently severe withdrawal symptoms as rated by these dual-users.
The next study, Budney et al, 2008, included a larger samples of individuals who had recently attempted to quit tobacco (N= 54) or cannabis (N= 67). This was a retrospective method (unlike the above prospective method) to survey symptoms experienced during the subjects' prior attempts to quit substance use. Nevertheless the outcome was strikingly similar.
Fig. 1. Group mean severity scores for the WDS (refer to Y-axis scale on left side of figure) and individual symptoms on the Withdrawal Symptom Checklist
(refer to Y-axis scale on right side of figure). Asterisk indicates a significant difference between groups after controlling for age, gender, race, and Global Symptom Index score from the Brief Symptom Inventory in the linear regression models.
With the exception of appetite, craving and sweating symptoms, the severity of withdrawal symptoms was approximately equivalent across substances. This study also included the frequency of symptoms, i.e., the proportion of the sample which experienced each symptom.
Fig. 2. Percentage of participants from each group that reported each withdrawal symptom, i.e., scoring greater or equal to 1 on the 0-3 point Withdrawal
Checklist Scale. Asterisk indicates significant differences between groups on chi square analysis (p b .05).
As with symptom severity, the frequencies were similar. Except that cannabis withdrawal resulted in more individuals with irritability and decreased appetite while nicotine discontinuation resulted in more individuals with increased appetite and craving.
In total, these studies paint a picture in which the discontinuation of nicotine and cannabis produce withdrawal symptoms of relatively similar severity and in similar proportion.
Comments
I find the repeated use of the phrase "seemed to produce" rather telling here. There is also much missing information. First of all, I would only consider studies of withdrawal effect from cannabis made on subjects whose _only_ potentially addictive drug was cannabis, and who were using it at a similar dosage level to a distinct group of nicotine users, i.e constantly high (5 or more complete un-shared joints/day) vs 20 or more cigarettes per day. I would place both at high abuse levels, arrived at through early uninformed peer-pressure that overdose is the only way to use. But testing on subjects who used both, even if only one of the substances was to be stopped, cannot separate the otherwise well known effects of nicotine withdrawal from withdrawal problems per se. Perhaps the presence of nicotine causes withdrawal problems from any other drug? Has this been tested? It is not clear if the second study cited contained single-drug users.
I know you do not consider "anecdotal" experience to be "evidence", but I submit that over the last 40 years I have observed a far larger sample of people struggling with addictions than the sizes of the samples in those two studies. Plus I myself spent nearly 20 years trying to release myself from 45 (total) years of nicotine dependence (succeeded 3+ years ago, discovered it was much more of a behavioral problem than chemical). I have had friends who had to deal with alcohol, cocaine, crack, heroin, and various prescription drug issues. I watched from inside the 60's counter-culture and its aftermath. I met or knew nobody - I repeat nobody - who experienced any problems from pot alone, and all of those who did have problems used other drugs that were more obviously the problem even if they did also use pot. Yes, pot + exacerbates the problems of other addictive drugs, typically by apparently removing the thoughts that something might be wrong with the behavior, thus enabling even deeper excursions with the other drug(s). But pot on its own? Even with periodic barren periods? Never an issue. Indeed, with some friends who had other medical problems, especially with epilepsy, pot was a positive influence. Much better than the zombie-fying prescription solution. As long as _only_ pot was in the picture.
Pot is known to enhance appetite. So obviously ceasing its use will decrease appetite. And craving was associated with nicotine cessation, not pot cessation. I thought cravings were the signature of withdrawal - so pot cessation symptoms could more likely be a sign of habit changing more than chemical dependence. And irritability - again, the pot haze is 'laid-back', maybe that is the contrast. I have to say I think the root cause of the symptoms observed with pot cessation are not the same cause as chemical withdrawal symptoms seen from all the other drugs, from nicotine and alcohol on up the chain. Or, these studies should seek to identify and compensate for behavioral habit change symptoms before ascribing causal effects to the chemical withdrawal. Habit changes cause issues whatever the habit that has to change. Try having to drop the 'married' habits. Irritability, loss of appetite, loss of attention to personal hygiene, sleep problems, etc. Clearly not chemical withdrawal, but can be very intense.
Posted by: Gray Gaffer | April 29, 2008 5:30 PM
I find the repeated use of the phrase "seemed to produce" rather telling here. There is also much missing information.
quoth the denialist. I use the phrase "seemed to produce" because I think this leads to less sloppy thinking in science than to act as if any given result is definitive proof. yes of course you can pick holes in any particular study because this is the way science works. It is exceptionally rare that any one paper is going to effectively nail down every possible objection. This post of mine addresses a fairly specific issue, namely the comparison between two smoked recreational drugs. The fact that I am talking about two specific papers does not alter the fact that there are many other papers that are relevant to this issue!
First of all, I would only consider studies of withdrawal effect from cannabis made on subjects whose _only_ potentially addictive drug was cannabis, and who were using it at a similar dosage level to a distinct group of nicotine users, i.e constantly high (5 or more complete un-shared joints/day) vs 20 or more cigarettes per day.
You are welcome to go through the literature. I suspect if you take a good faith effort you will find the appropriately restricted samples in one study or another. start with the Budney review and/or the PubMed search link under his name. Beware of the standard denialist tactic of defining "what would convince you" so narrowly that it cannot possibly be satisfied experimentally, however. Also feel free to explore why if all the supposedly flawed studies are flawed in different ways and yet all point toward the same conclusions there is any hope that your perfect pie-in-sky study will prove something else.
I met or knew nobody - I repeat nobody - who experienced any problems from pot alone, and all of those who did have problems used other drugs that were more obviously the problem even if they did also use pot.
First, as I have covered elsewhere and likely will again, it is only a small minority of people who "smoke pot" who will meet criteria for dependence. Perhaps 10% although one can argue about the appropriate denominator and/or population to refer to as sufficiently "smoking pot". (the 25 days + per month is just one way to operationalize matters) As to what fraction of those that meet diagnostic criteria comport with your subjective opinion about what "a problem" might be, well, that's a different issue.
The bottom line for me is that there are significant number of people seeking to cut back their pot use and having difficulty. People who are seeking treatment. As I remarked to MarkH in that prior discussion the colleague I know who does this type of research says after a single solicitation for treatment-seekers in the newspaper, the project is overwhelmed with potential subjects- a phenomenon that is NOT common with other drugs of abuse including alcohol from what I understand from colleagues.
To suggest that you don't know any treatment seekers (and really, how many of these people have you followed though the substantial number of years or decades that it typically takes for a recreational drug user to go full distance with a dependence problem?) so therefore these existing treatment seekers mustn't actually exist is arrogant in the extreme. If you think at all about the way that the many researchers doing this work sample their available populations it should be obvious that this is far more likely as a whole to be representative than the number of people you have personally known to be pot smokers.
And craving was associated with nicotine cessation, not pot cessation.
This is an incorrect reading of the data. The point was that nicotine craving was greater than pot craving. Pot craving, however, was measurable and non-zero. Again, you can delve into the prior literature to see how the withdrawal measures have been validated.
so pot cessation symptoms could more likely be a sign of habit changing more than chemical dependence....Clearly not chemical withdrawal, but can be very intense.
and this is precisely where I got so exercised at MarkH for his apparent closet dualism. In his phrasing it was "psychological" vs. "physical" dependence but it sounds as though you are trying to strike a similar distinction. Please explain, very clearly, what you mean by "habit" and "chemical dependence" and how these things are likely to differ in categorical root cause.
Posted by: DrugMonkey | April 29, 2008 6:15 PM
I tend to smoke weed in bursts- multiple times a day day for a few weeks or months, then not at all for much longer than that. When I stop, nothing happens. The only withdrawal I go through is a brief "damnit I really wish I had some more weed" phase that lasts maybe a couple days. Then I forget about it.
Absolutely no other effects, whatsoever. I suffer horrible withdrawal if I come off Paxil cold-turkey... I know what physical withdrawal feels like... I really don't think weed causes it at all.
Posted by: Abbie | April 29, 2008 6:27 PM
it is only a small minority of people who "smoke pot" who will meet criteria for dependence
Of those who smoke tobacco, what proportion qualify as dependent? You mention that studies seeking subjects who want to cut back on pot are overwhelmed, whereas this doesn't happen so much with alcohol -- what about nicotine?
And of course, there are established methods and programs for cutting back alcohol and nicotine. Just the fact that these programs exist will likely cut into the number of subjects responding to treatment study ads -- in contrast, an academic study is probably the only quit-pot program around.
I have no problem with the idea that pot is just as addictive as nicotine or alcohol. What I wonder about is whether the consequences of its use and abuse are so different from the consequences of alcohol or tobacco abuse that it ought to be regulated so very differently.
Full disclosure: I like a drink, me, but I've never smoked tobacco *or* pot (on anything remotely resembling a regular basis).
Posted by: bill | April 29, 2008 6:34 PM
I suffer horrible withdrawal if I come off Paxil cold-turkey... I know what physical withdrawal feels like... I really don't think weed causes it at all.
aaaaannnd we have goal post moving. Gracias, Abbie!
Just because there are recreational and other drugs that cause more severe or qualitatively different signs and symptoms of withdrawal does not mean that cannabis does not cause so called physical withdrawal at all.
When I stop, nothing happens. The only withdrawal I go through is a brief "damnit I really wish I had some more weed" phase that lasts maybe a couple days.
yeah well that sure sounds like "something happens" to me. And the bottom line is that despite what you might think you are not always the best and most detached analyzer of things that are happening to you. Especially if they are relatively subtle or have occurred frequently enough that you simply think of it within the normal range of your behavior.
This is why proper studies use well-validated measures that go beyond "did you go into withdrawal? oh, you don't think so, good enough for me".
and then finally, read my comments above. it is possible you are in the probable majority of pot smokers that indeed won't become dependent. Lucky you. This does not mean that others won't become dependent nor does it mean that such dependence isn't a direct effect of cannabis smoking in those individuals.
Posted by: DrugMonkey | April 29, 2008 6:40 PM
bill, the post where I discussed trying to determine conditional probability of dependence was this one:
http://scienceblogs.com/drugmonkey/2008/04/recreational_drug_use_in_the_y_1.php
I also had a prior post which may underline the issue of nicotine dependence as a less obligatory phenomenon then we may think.
http://drugmonkey.wordpress.com/2007/04/26/drugs-are-bad-mkay/
I haven't had any conversations on the topic of human volunteers with anyone who does nicotine research yet. I'll ask next time I see one of them.
from what I can tell, the treatment market is spooling up to meet cannabis treatment demand but it isn't really my area of knowledge.
Posted by: DrugMonkey | April 29, 2008 6:56 PM
It is a strange thing to me to be taking the opposite side from seemingly scientific research, but this is a gigantic load of crap.
I have had MASSIVE personal experience with drugs. I have known hundreds of drug users. None of us ever felt any withdrawal symptoms from weed. I knew many people with heavy heroin habits ($200/day plus). without exception, they said that it was easier to kick heroin than it was to stop smoking.
I don't know what your agenda is, but the truth is that marijuana consumption is virtually totally benign compared to the consequences of tobacco smoking. Anyone who denies that is living in some sort of mysterious dream world.
Posted by: Green Eagle | April 29, 2008 7:52 PM
In regards to Eagle: I don't quite see why so many people are raising so many objections. As DrugMonkey aptly put, it is entirely misguided to look comparisons between withdrawal experiences (especially when all you proffer is anecdotes). In fact, I'll go so far as to say it's infantile.
And then you go and make the statement that consumption of marijuana is totally benign? The very process of bringing smoke into the lungs is not without consequence.
You, and the other posters here, are conflating issues. This is not a discussion about politics, which is essentially what you guys are reacting to given that every post here has been party line responses to the misrepresentation of cannabis as being extremely harmful.
Posted by: Rowan | April 29, 2008 8:17 PM
DM- an interesting set of articles. I agree with your bottom line- there are people out there trying to quit pot and having trouble. I don't think it behooves anyone to minimize the struggles people go through, including those with quiting pot.
One technical question- in the second study, how recently had these folks quit? Do we have any info on the timeline that these symptoms might be expected?
Although I can't imagine what it would take to actually design the study, it would be kind of cool to see what *external* signs occured during cessation of various drugs. Is it harder to be around someone who quits pot or tobacco? I think this is a valid (and, as far as I know [although it's not my field] understudied) aspect of consequences of dependence/addiction. And how should we factor in health risks of when there is increased weight gain post-tobacco cessation?
(tounge-in-cheek: maybe we shouldn't legalize pot afterall- imagine what the munchies would do to the Fast Food Nation)
Posted by: Becca | April 29, 2008 8:27 PM
Both dad and I smoke. He is definitely dependent (3-5 unshared joints per day) and I am not (
So withdrawal, to me, even anecdotally, is a real phenomenon, but I don't think that's the real issue. The real issue is the threshold of dependence, which for nicotine seems to be a whole lot easier to reach than for marijuana. Of course, that's not what's being discussed here, and I have no issues with the data here.
You know, hippies like the idea that everything we do is ultimately organic, natural and good for us :) It's probably not, and acknowledging that permits a much healthier cost-benefit analysis for users, IMHO.
Posted by: Lindsay | April 29, 2008 8:36 PM
Forgive me if I'm misinterpreting here -
It seems that a relatively low proportion of people who smoke pot smoke enough to be considered dependent, and of those, a small proportion develop withdrawal symptoms (not so sure about this one - I might be reading into something here), but that those withdrawal symptoms can be as severe and frequent as those caused by nicotine. The question is, what is it that seems to make pot smokers less likely to consume enough regularly to lead to dependence? That may be why a lot of people A) know a lot of pot smokers, and B) don't know any that had any trouble stopping. I myself have a hard time believing that cannabis dependence can be as much a problem as nicotine, even though I can see the data right in front of me. Interesting how we can put up barriers to things we don't want to hear.
That being said, I've had a similar experience to Abbie's. Although n=2 means a whole lot of nothing.
I'm curious about a comparison with other drugs that cause a similar level/type of high, as opposed to nicotine.
Posted by: Wisaakah | April 29, 2008 9:00 PM
http://scienceblogs.com/drugmonkey/2008/04/recreational_drug_use_in_the_y_1.php
This study completely ignored nicotine, which -- given the mode of delivery -- seems an obvious comparison for MJ. The comparisons with alcohol don't show what I would call a striking difference.
http://drugmonkey.wordpress.com/2007/04/26/drugs-are-bad-mkay/
This study strikes me as odd: 40% of long-term daily smokers are "not dependent"? Insert all the usual arguments against DSM-IV as a research tool, plus the usual complaints about self-reported rather than revealed preferences/information. That figure just seems way too low to me: why the fuck would you smoke 10/day for 10 years if you didn't have a jones? I'd like to know how many of the "not dependent" population could quit and stay quit -- in other words, I wish that first study had included nicotine.
(In case anyone's wondering, my "agenda" is that the War on Some Drugs seems like an unconscionable waste of time and money to me -- particularly those battalions whose target is maryjane. Is anyone safer on the street because they put Tommy fucking Chong in jail?)
Posted by: bill | April 29, 2008 9:07 PM
what is it that seems to make pot smokers less likely to consume enough regularly to lead to dependence?
For one thing, you can drive a car (function on the job) while you smoke tobacco, or if you smoked a couple of cigarettes at lunch.
(Also, note to self: next time strip the http:// so the damn spamfilter won't recognize the links as links and send me to Moderation Limbo.)
Posted by: bill | April 29, 2008 9:10 PM
FWIW, I have known people who did go through withdrawal when quitting pot - 2 of them. And both were definitely of the "dependent" variety.
I've also seen what I always thought were "withdrawal" symptoms in casual users, who like Abbie, binged on pot for a short period, then stopped. I had dismissed them as being "merely psychological" not physiological, but was never really comfortable with that.
On the other hand, I also know several 'casual' users of tobacco. A few that only smoke when they are drinking in a bar (not anymore, of course, you can't drink in bars where I live). Another that will smoke once a month, with a particular group of colleagues.
Never having used either tobacco or pot, I can't speak from any personal knowledge, only observation.
all of which only goes to prove two things - we all know some exception to the rule and the plural of anecdote still isn't data.
Posted by: CanadianChick | April 29, 2008 9:13 PM
"I tend to smoke weed in bursts-multiple times a day for a few weeks or months, then not at all for much longer than that. When I stop, nothing happens. The only withdrawal I go through is a brief "damnit I really wish I had some more weed" phase that lasts maybe a couple days. Then I forget about it. Absolutely no other effects, whatsoever...I really don't think weed causes it at all."
This is exactly my experience. I've been smoking pot for 35 years, and I do not smoke tobacco. I smoke, fine; I don't smoke...no withdrawal. I am among the lucky 90%, then. Thank ghod. After watching numerous people drop dead after a lifetime of smoking tobacco while all us pot smokers keep on ticking (except those who also smoked tobacco, poor bastards), I feel very fortunate, indeed, that I never got addicted to the true devil's weed, which would be tobacco.
Really, the study that ought to be done to assess the harmful effects of tobacco vs. marijuana is this:
Bake two batches of brownies. In one batch, add 15 grams of powdered marijuana; in the other, add 15 grams of powdered tobacco. Divide test subjects into 2 groups: one that will eat the marijuana brownies, and one that will eat the tobacco brownies. Wait a couple of hours to determine the results. I speculate what the outcomes would be: Oops! All the marijuana-brownie eaters are knocking on the door asking for more brownies, while all the tobacco-brownie-eaters are DEAD! That's right, marijuana is a relatively benign substance (and in all probability, a beneficial substance) while tobacco is a deadly poison.
Posted by: pmont | April 29, 2008 9:20 PM
I wonder if the persons suffering from "withdrawal" also exhibited addictive personalities. The study seems to ignore other factors in determining whether marijuana is addictive.
Seems odd to compare the two substances. How many "social" cigarette smokers are there? Among the people I know, you either smoke cigarettes or you do not smoke cigarettes. I do not know anyone that smokes a cigarette or two on the weekend or when they go to a concert. Conversely, I know a number of people that smoke a joint on the weekend or at a concert. The conflation of the substances seems to be a crusade rather than an investigation.
Posted by: Onkel Bob | April 29, 2008 9:48 PM
Smoking weed kicks fucking ass!
Posted by: PhysioProf | April 29, 2008 10:38 PM
I guess I'm in the other 10% then. I can't really stop smoking weed once I start and I definitely jones for it when I don't have any. It's not so much physical withdrawal like from alcohol or heroin but anxiety and craving. I'm sure I'm more irritable, too. But staying off weed is far easier than quitting smoking cigarettes. THC is just a different drug than nicotine.
I've heard that THC isn't terribly physically addictive (i.e. you don't have to increase the dose to get high) but it is HIGHLY psychologically addictive. Like one's threshold for feeling adequately stoned increases over time. An ex-roommate told me I could put away a blunt and a few bowls by myself and still act perfectly lucid. Which is scary.
This is different from alcoholics who can drink 3-4 drinks and still not feel buzzed, blow below a 0.08% BAC, etc. because they are physically addicted. It takes more and more alcohol to get baseline drunk, unlike weed. Every pothead will feel the effects of THC after one hit, it's just a matter of when you're high enough.
Posted by: electronic janitor | April 29, 2008 11:46 PM
I would like to say, for my own sanity (and so drugmonkey doesn't think all of his commenters are idiots):
The plural of anecdote is not 'data'. This is why we do experiments. Don't like the results of this experiment? Explain why the methods / analysis / any aspect was flawed. Find other, better-done studies that contradict it.
I can dig that the 'psychological' withdrawal symptoms are caused by some physiological process. I can also dig that mild symptoms that relate primarily to mental state (cravings, irritability) could be categorized as a different type of withdrawal effect than effects detectable as a disturbance in the totality of bodily systems (DT's, nausea/vomiting).
Interesting stuff all around. (Except for pmont's proposed 'experiment' and related mary-jane glorification and tobacco demonization. That would just be stupid.)
Posted by: Muse142 | April 30, 2008 1:47 AM
A lot of these pot addicts in treatment centers are diverted there to escape the draconian drug laws. Hell yes, I would cop to a pot addiction if it meant I could avoid a prison sentence. Then the "alarming rise" in pot addicts in treatment is used to justify further draconian laws. Sweet system, huh? Wish I owed stock.
Posted by: BlindSquirrel | April 30, 2008 3:05 AM
Well, another long-term pot and tobacco smoker here to throw my anecdata into the ring...
These results don't seem particularly surprising to me. In fact, not surprising at all. In my experience, the major differences I notice between withdrawal from the two drugs are that nicotine withdrawal hits faster, and is harder to ignore by keeping busy. I have no trouble getting through the day at work without smoking dope, but if I tried to not smoke tobacco, I'd be tearing my hair out by lunchtime. However, put me in a study situation with somebody asking me about how I felt about not smoking dope, and it might be a different matter.
Posted by: Dunc | April 30, 2008 5:17 AM
Yeah, I'm gonna call shenanigans on this bullshit. Jacking off is fucking "addictive" and if you stop dudes from jacking off they will go through "withdrawal" symptoms. The idea that tobacco and marijuana are similarly "addictive" is just an absolute crock of shit.
Posted by: PhysioProf | April 30, 2008 5:20 AM
I'm with PhysioProf on this one (as with so much else it seems)...I'd offer my own anecdote in support but who cares? I'm not arguing with the data presented--data are data--but I guess I don't see that all of those variables are components of meaningful "withdrawal." Flood your cannabanoid receptors for 10 years and then stop abruptly, and of course there are going to be symptoms of de-flooding...but is that necessarily "withdrawal" in any meaningful clinical sense? Any different from jacking off or Twinkies?
Posted by: Sven DiMilo | April 30, 2008 7:08 AM
What an appropriate article for me this morning. Some background:
I have been a near daily pot smoker for 12+ years. Up until 15 weeks and three days ago, I smoked 1 1/2 - 2 packs of cigs a day for about that same amount of time. Three weeks ago, I stopped drinking as well (I typically got drunk 4-6 times a week, but was still able to hold a job, get A/B's in school, etc. - essentially I was a functional alcoholic - I've been that way for about 5 years) So I quit that too. (This has been my 'year of self improvement')
And despite what I want to say, I am having the hardest time with pot. I think it's because I used it to quit the others (when I wanted a smoke the first week, I'd just go get high. Eventually that's how I quit smoking cigs. Same thing with booze - when I wanted a drink, I'd get high.) I was substituting one substance for another. And now I've been reduced to coffee. Which is a poor substitute for weed. I've been 'clean' for 2 days now. Hence, I've been depressed as hell, bitchy, grumpy, and yeah, I've barely eaten the last few days.
I 100% think pot should be legal, as long as cigs and booze are. It is, from everything I can tell, much safer than either. But I agree that it is addictive and certainly not harmless - just less harmful. In which sense, I'm not sure - perhaps humans just enjoy pleasure? What a novel idea! But it does differ than the chemical dependency that cigs and booze cause, IMHO. Anyways, great blog and it is synchronistically appropriate for me today. Thank you.
Posted by: Twi | April 30, 2008 10:24 AM
Granted this is all anecdote, but it seems like 80-90% of the posters here say that marijuana wasn't addictive to them and 10-20% say it was. This seems to match some of the data presented in past posts.
Are the people saying it's never "really" addictive willing to read the comments of those 10-20% here and accept that there really are serious addiction/withdrawal issues is a sizeable minority of users? The caveats that the symptoms aren't as serious as nicotine/alcohol/heroin/Pan Galactic Gargle Blasters, are irrelevant to accepting that marijuana can cause dependence problems.
Posted by: bsci | April 30, 2008 10:42 AM
These comments remind me of Intro Psych lectures. Lots of freshman arguing against data with personal anecdotes.
I thought the sleep disturbance result was most interesting though. I'll quote so you don't have to scroll up:
Cannabis discontinuation (alone) seemed to cause sleep disturbances for longer than did nicotine discontinuation (alone).
Maybe not unexpected when taken with other findings about the role of cannabinoids in controlling obstructive sleep apnea. Certainly cannabinoids have an effect on the body, and removing them after developing dependence would result in withdrawal. I don't see why people are so resistant to that.
AND if Gambling can be an addiction, then so too can twinkles and masturbation. Although I'll admit that withdrawal from these 'behavioral' addictions might depend on your definition of 'withdrawal.'
Posted by: Mitchell Harden | April 30, 2008 10:49 AM
The real question is: who funded this research?
This guy Alan J. Budney works for U-Arkansas.
Where did he get the cannabis? From the DEA?
There's no other legal source in the US.
The DEA has a history of funding research on
this with pre-determined outcomes. Sounds like
the kind of politically-motivated BS that
is passed off as science these days.
Posted by: Roland Latour | April 30, 2008 12:07 PM
Roland,
If you bothered to read the post you'd see that this study has nothing to do with giving people drugs. It was a withdrawal study, thus the DEA pot supply was not involved.
From the 2008 paper that is referenced here:
This research was supported by research grants from the National Institute on Drug Abuse: DA12471, T32DA07242, K02-00109, K05-00450, and in part by the Arkansas Biosciences Institute, the major research component of the Tobacco Settlement Proceeds Act of 2000. Parts of this study were conducted as a segment of the doctoral dissertation of Ryan G. Vandrey at the University of Vermont. Preliminary findings from this study were presented at the annual conference of the College of Problems on Drug Dependence, 2006.
From his 2006 review paper: This work was supported in part by National Institute on Drug Abuse grants, DA12471, DA12157, DA55186 and T32-DA07242.
Does NIDA also have a history of only funding research with predetermined outcomes? Is Drugmonkey biased because is probably also gets money from NIDA to study drug abuse?
Posted by: bsci | April 30, 2008 12:24 PM
@ Roland Latour:
Easy enough to check. All it takes is a glance at the article. Vandrey was supported by grants R01-DA12471, T32-DA07242 from the National Institute on Drug Abuse. Budney was supported by research grants from the National Institute on Drug Abuse: DA12471, T32DA07242, K02-00109, K05-00450, and in part by the Arkansas Biosciences Institute, the major research component of the Tobacco Settlement Proceeds Act of 2000.
In neither study were participants given marijuana.
Posted by: Mitchell Harden | April 30, 2008 12:25 PM
Like a number of other posters, I am rather skeptical of the conclusions reached by these studies. Based on purely personal/anecdotal understanding of cannabis use, I hypothesize that symptoms/effects of introduction to cannabis use would include:
reduction of irritability
increase in appetite ('the munchies')
reduction of nervousness
sleepiness
The measurement of the removal of these effects would, of course, appear to be similar to withdrawal symptoms, but without studying the entire cycle of substance use, it is surely impossible to distinguish between the measurement of a withdrawal symptom and the simple removal of an effect.
Posted by: Neil | April 30, 2008 12:55 PM
in the second study, how recently had these folks quit? Do we have any info on the timeline that these symptoms might be expected?
18 or 19 days as an average for the two groups.
to quick and dirty the subject table, first number is for cannabis group, second for nicotine. variance indicators in parenthesis are quartiles and +/- are standard deviation.
I wonder if the persons suffering from "withdrawal" also exhibited addictive personalities.
ah yes, the old "addictive personality" dodge. As used by the advocate this is supposed to mean there can't be any effect of the drug itself, it is just a person who will be addicted to anything that is the problem. [I'll let you jackoff and Twinkie fans see where your favorite pleasures fit in...]. And you very quickly find some dismissive arguments that the problem is "psychological" in nature, as if it is some how less real.
But this is an interesting point when looked at appropriately. Yes, from a neurobiological perspective, much of what I talk about on the epidemiological front does indeed ask the question about why some individuals are more at risk for developing dependence. I think this is overwhelmingly clear although, as I also mention at times, I think some approaches to animal models seem to assume that the issue is only about sufficient drug exposure. I happen to think we can investigate drug abuse in more complex terms of both drug exposure and existing individual liability.
bsci at #25- BINGO! I love these threads that emerge for precisely this reason. blog comment anecdote recapitulates the published data...how fresh is that!?!?
The DEA has a history of funding research on
this with pre-determined outcomes. Sounds like
the kind of politically-motivated BS that
is passed off as science these days.
please, do explain this history to us if you would? And while you are at it, perhaps a data based critique or at least a scientifically informed critique of these papers that allows you to conclude that they are "politically-motivated BS"? Other than the fact that you simply don't like the outcome, because that is a good way to detect political motivations in dismissing scientific findings..."The outcome doesn't align with my political position therefore the science must be flawed" sounds very bushrovian to me. just sayin'
Posted by: DrugMonkey | April 30, 2008 1:54 PM
Way late to this party but anyway---I can't believe the number of "I have blah experience with blah drug and blah friends who do blah dope....and withdrawal is bullshit" arguments.
What part of "....informed by anecdote and personal experience ......instead of an understanding of the available evidence..." ----in the first paragraph of this post---is so freaking hard to understand?
Posted by: Anonymoustache | April 30, 2008 1:59 PM
Re Green Eagle #7
"marijuana consumption is virtually totally benign compared to the consequences of tobacco smoking"
Where on earth is your data to support this? Is marijuana smoke somehow less carcinogenic than cigarette smoke? Your brand of anecdotal evidence is exactly what fuels so much denialism in society.
Posted by: Mac | April 30, 2008 2:02 PM
Bottom Line is that both substances produce a mild self limiting withdrawal that probably can be greatly reduced by a slow taper, the physical withdrwal symptoms will go away within a month, this is nothing compared to the life threating withdrwals one can get from alcohol and benzos if they are stopped abruptly.
Posted by: paul | April 30, 2008 2:05 PM
Flood your cannabanoid receptors for 10 years and then stop abruptly, and of course there are going to be symptoms of de-flooding...but is that necessarily "withdrawal" in any meaningful clinical sense?
First, Sven, what on earth do you think withdrawal from any substance is other than "symptoms of de-flooding"!!??? Good gravy. But surely you are aware that the processes at work are usually considerably more involved, yes? That what happens is that the normal operation of the receptor systems (not just the primary or first-contact receptor but also other chemical signaling systems down-stream) gets altered by the continued 'flooding'. a very simplistic model of drug tolerance, for example, might be a decrease in the number of cannabinoid receptors expressed on a given neuron due to continued exo-cannabinoid exposure. If you remove the exogenous drug, the system is in a deficit state, compared with pre-exposure.
With respect to "clinical significance" I can again refer you to the Budney work but let us face it, it is difficult to agree on what a dependence "problem" really is. Ultimately it will be subjective. Does it matter that someone is "kinda snappish" if they haven't had their toke? Well, perhaps not at the job place if the individual works alone at a computer all day...at home with wife and kids? big problem.
some individual with independent wealth and no dependents or obligations wants to stay high all the time- no problem right? not so for others.
As I've commented elsewhere, the fact that people are themselves seeking treatment is a very good sign that there is a significant clinical problem. Whether you happen to think you would be treatment seeking in their shoes or not.
Posted by: DrugMonkey | April 30, 2008 2:09 PM
I find it interesting that the sample group in the second study was based on subjects who had already identified themselves as being dependent on cannabis/nicotine. It would perhaps be revealing to discover the proportion of all daily users of each substance who would identify themselves as dependent, in order to contextualize the conclusions.
Posted by: Neil | April 30, 2008 2:19 PM
bill @ #12
you have to track back to the original data source on that prior post but the nicotine data are there ( I think it was NeuroStudent who mentioned this in the comments)
http://oas.samhsa.gov/NSDUH/2k6NSDUH/2k6results.cfm#Ch4
That figure just seems way too low to me: why the fuck would you smoke 10/day for 10 years if you didn't have a jones?
The Donny and Dierker study was, if not gob-smacking, very salient to YHN as well. I'm assuming we'll be hearing more on this topic. And as you can tell, it is a little bit of a hobby of mine to look at what I call the conditional probability of dependence. i.e., "given that you take this drug [in pattern X and amount Y] what are your chances of becoming dependent". It is not an easy or obvious question to answer with hard data. This does not mean, however, that the available data aren't informative.
but yes, as I've mentioned in the comments above, the notion of meeting particular diagnostic criteria (DSM is not the only schema, btw) for "dependence" is not the be all / end all. It is necessary to have as operationalized and objective criteria as possible to generate scientific data that will be useful. These are, however, going to be population level analyses. Determining what is "a drug problem" for an individual user is in the realm of personalized clinical care.
Posted by: DrugMonkey | April 30, 2008 2:27 PM
My, you are a condescending asshole.
Have a fucking shitty day.
Posted by: Onkel Bob | April 30, 2008 2:31 PM
The proper link to above post.
Posted by: Onkel Bob | April 30, 2008 2:34 PM
Hey Author,
Smoke cigarettes for a year straight and then quit. Then smoke cannabis for a year straight then quit. See which one is harder and you will have your answer. Quitting Tobacco is much harder than weed. Try it!!!!
Posted by: Tim | April 30, 2008 2:34 PM
It would perhaps be revealing to discover the proportion of all daily users of each substance who would identify themselves as dependent, in order to contextualize the conclusions.
Are you asking whether people who are substance dependent know that they are? I am not really conversant with this literature but I'd be surprised if one couldn't dig up a little something.
Or are you suspecting for this particular study that those that have tried to quit cannabis are in some way further down the cannabis-addiction path than nicotine quitters are down the nicotine-addiction path? That is a very interesting point. It would bear some thinking on how to get at this question. Certainly a seat of the pants consideration, not to mention comments in this thread, would suggest that the population awareness that cigarettes are addicting is higher than the awareness that cannabis smoking is addicting. It would not be a great leap to think that there might be a higher threshold on the "this is causing problems, I need to quit" scale for cannabis smokers relative to cigarette smokers...
Posted by: DrugMonkey | April 30, 2008 2:38 PM
Quitting Tobacco is much harder than weed.
Tim, these papers addressed acute withdrawal in the first several days following substance discontinuation. The acute withdrawal is only one of many influences on "quitting". Is this not obvious?
Posted by: DrugMonkey | April 30, 2008 2:44 PM
You are a classic fraud, frankly, and a fit target for people fighting back against politicized science.
Cherrypicking crank results is not going to establish anything scientifically, but it works wonders clouding the water politically and legally. You're simply another shill providing cover for whatever pleases the right-wing corporate funders of the GOP War on Science.
Posted by: Marion Delgado | April 30, 2008 2:52 PM
Just toke the fuck up! No more snappishness!
Posted by: PhysioProf | April 30, 2008 2:55 PM
I contend that it is likely that the group of cannabis users that have identified themselves as dependent have done so because they experience withdrawal symptoms when they try to stop. The study is therefore measuring withdrawal symptoms in a group more likely to experience those symptoms than the population of daily cannabis users as a whole. This is of course the same for nicotine users. Therefore it will have a lot to say to determine the proportion of the daily users of each substance as a whole that consider themselves dependent, in order to draw any meaningful conclusion whatsoever.
I would suspect that a random sampling of each group would identify nicotine users as being much more likely to admit to dependency than cannabis users.
I hypothesize that nicotine, statistically, induces far greater degrees of withdrawal symptoms than cannabis. This hypothesis is not falsified by the second study, for the reasons above. The first study involved such a tiny number of subjects, that I do not think that it can demonstrate anything at all.
Posted by: Neil | April 30, 2008 3:09 PM
I contend that it is likely that the group of cannabis users that have identified themselves as dependent have done so because they experience withdrawal symptoms when they try to stop. ... in order to draw any meaningful conclusion whatsoever....The first study involved such a tiny number of subjects, that I do not think that it can demonstrate anything at all.
The first bit you have here is great. Alternative testable hypotheses. Exactly the way skeptical knowledge seeking should work.
You then retreat to the denialist position- that the existing data are meaningless because the study wasn't done exactly the way you wish. And this is the part that I find to be denialist.
Posted by: DrugMonkey | April 30, 2008 3:23 PM
"..Certainly a seat of the pants consideration, not to mention comments in this thread, would suggest that the population awareness that cigarettes are addicting is higher than the awareness that cannabis smoking is addicting. It would not be a great leap to think that there might be a higher threshold on the "this is causing problems, I need to quit" scale for cannabis smokers relative to cigarette smokers..."
Surely the data collected in this study was, at least partially, based on the subjects' awareness of their withdrawal symptoms. Are you contending that cannabis smokers who state that they are not dependent and do not suffer significant withdrawal symptoms do really, but are just not aware of them?
Posted by: Neil | April 30, 2008 3:27 PM
Are you contending that cannabis smokers who state that they are not dependent and do not suffer significant withdrawal symptoms do really, but are just not aware of them?
I am contending that people who are drug dependent and do suffer significant and classic symptoms of withdrawal are frequently unaware of them.
You aren't seriously questioning this are you? Do you really think that every cannabis user is walking around thinking "Gee, I'm a little more aggressive with my email comments today, hm, how many hours ago did I last smoke out?". or "Hmm, slept like crap last night...OMG! I'm precisely 48 hours out from my last bong hit!". Do you think anyone walks around correlating fluctuations in mood state with their substance use...?
Surely the data collected in this study was, at least partially, based on the subjects' awareness of their withdrawal symptoms.
I'm not sure we know this. The subject pool was gated on a prior attempt to quit. It is your hypothesis that withdrawal symptoms motivate attempts to quit. A good hypothesis but not proven by this study (unless I overlooked something in the methods, which is possible).
Posted by: DrugMonkey | April 30, 2008 3:43 PM
You then retreat to the denialist position- that the existing data are meaningless because the study wasn't done exactly the way you wish. And this is the part that I find to be denialist.
N=12 is tiny. Also, the measurements of increased anger, aggression, irritability (pretty much the same thing) were in relation to SAU. If it were the case that an effect of cannabis were to reduce these things, then it would appear likely that stopping consumption would revert the subjects back to a normal level of anger, aggression and irritability. i.e. an increase. I don't believe that this is what most people understand as being a withdrawal symptom.
The conclusion of the Budney report indicated that a dependency to cannabis was similar in nature to nicotine dependency - there was no inference concerning the probability of dependency occurring.
I have two simple hypotheses: 1) Cannabis reduces irritability/anger etc. 2) Cannabis, in most cases, causes insignificant amounts of withdrawal symptoms compared to nicotine.
These hypotheses are consistent with the results of both reports.
Posted by: Neil | April 30, 2008 4:21 PM
It is your hypothesis that withdrawal symptoms motivate attempts to quit.
No, it is my hypothesis that withdrawal symptoms induce awareness of dependency.
Posted by: Neil | April 30, 2008 4:28 PM
Do you think anyone walks around correlating fluctuations in mood state with their substance use...?
yes.
Posted by: Neil | April 30, 2008 4:30 PM
@ Neil +1.
You mean, there are people who *don't* correlate fluctuations in mood state with substance use??!
When I get cranky, the first thing I think- "Have I eaten today?" and "How long ago was it?"
Next thing I check is whether I've slept. Next is whether I might have had too much- or too little- caffeine (Caffeine is first if I notice myself jittery, hyper, excitable or shaky- which is quite common- I'm definitely dependent to some degree). In the past, when I've taken oral contraceptives, I consistantly used to wonder if my cuddle to sex drive ratio was being affected... even without it, I wonder how *unspecified endogenous female hormones* are affecting my mood- I try charting my cycle to get a hold of this one, as it can be *very* important in answering the "Why am I having a crummy day?" question.
In the past, while I was on anti-depressants, I made a serious habit of trying to correlate those with my mood (otherwise, what would be the point of those check-in-with-your-prescriber meetings?!).
When I drink, I wonder about my inhibitions and coordination.
Does anyone seriously not do this? Am I some kind of hyper-analytic self-fixated-psychopharmacolgically obsessed weirdo?
Posted by: Becca | April 30, 2008 4:41 PM
Awesome post, DrugMonkey. You really brought out the deniers/conspiracy theorists/anti-everything types. And it is always fun when they get stirred up.
Posted by: Mike | April 30, 2008 5:04 PM
Becca @ #52: umm. wow. and do I take it you are not training in any sort of psychopharm discipline? geez.
( and i'm not touching your last question lest you smack me around like you have been poor Greggie lately. "stick to sheep"! w00t!)
Posted by: DrugMonkey | April 30, 2008 5:29 PM
I am contending that people who are drug dependent and do suffer significant and classic symptoms of withdrawal are frequently unaware of them.
We are talking about cannabis, specifically, here. Report 1, based on a sample of 12 people - these 12 smoked cannabis 25 or more days per month. If, as I contend, cannabis is normally fairly benign as far as withdrawal symptoms are concerned, then most users would not be concerned about consuming it almost every day - these 12 are relatively heavy cannabis users. If someone does something every day that they enjoy and then they're not allowed to do it, they will tend to be more irritable; you could probably plot similar graphs for internet gamers or gambler or reality TV addicts - by definition, the sample group are habitual users and withdrawal from the thing they do habitually will cause them irritation.
By picking out a particular drug for this analysis immediately implies that there is some physiological cause for the symptoms.
Report 2 is very guarded about inferring any such link:
The differentiation between �physical�
and �psychological� dependence is arbitrary and merely
contributes to misconceptions about the nature and
severity of substance dependence disorders.
Posted by: Neil | April 30, 2008 5:35 PM
Flood your cannabanoid receptors for 10 years and then stop abruptly, and of course there are going to be symptoms of de-flooding
I'm not so sure. I've seen people smoke absolutely massive amounts for years (say 1/4 oz of top-of-the-line stuff a week), and then because of job or other requirements, stop cold turkey and have no problems whatsoever. Yeah, I know, and George Burns smoked cigars for nearly 100 years.
The bigger point was made by another poster here: all of the "common symptoms" of marijuana withdrawel are the polar opposite of marijuana effects. It's akin to listing dehydration as an effect of gatorade withdrawel, or headaches as a symptom of aspirin withdrawel. A a bare minimum I want to know why these particular traits were chosen as symptoms.
I lack time to go through the details of the study at the moment, but plan to. I must say I am not optimistic, since I've never seen a study of this type that didn't have severe methodological flaws. However, it is important that we do not dismiss a study merely because it MIGHT have flaws. That's the surest way to make our mistakes permanent.
Posted by: Science Avenger | April 30, 2008 5:42 PM
Mike
Denier?
I am not denying the results of the studies at all: the 1st study I don't have access to and the 2nd study is of subjects who have already admitted a dependency. I am not proposing Noahs Ark here, I have a subjective opinion that is entirely consistent with both anecdotal and empirical sources.
The 2nd report concludes only that there is a qualitative similarity between withdrawal symptoms for cannabis and nicotine in subjects who have recognized a dependency. There is no way that it can be implied from this study what the frequency of dependencies are for these substances or that they are comparable.
Conspiracy Theory?
These tend to be utterly infeasible - It is possible that DrugMonkey has some kind of political motivation - people often do when illegal drugs are the issue.
Anti-everything?
Posted by: Neil | April 30, 2008 6:08 PM
I must say I am not optimistic, since I've never seen a study of this type that didn't have severe methodological flaws
Dude, just about every study of consequences of long-term exposure to "X" in humans is flawed by a lack of random assignment, numerous correlative variables of interest, interplay of environmental and genetic contributions, etc. From one way of looking at it all humans studies have "severe" flaws. The animal studies, OTOH, can have random assignment, controlled exposure to "X", multiple control groups, etc. ...and yet there is always the problem that they are not humans. Aha! Flawed!
It is a science-denialist position to refuse to come to a reasonable synthesis of all the available evidence. It is a science-denialist position to assert that scientific findings on one particular topic are all irretrievably flawed just because the reasonable synthesis points away from your gut level or anecdote supported hypotheses.
all of the "common symptoms" of marijuana withdrawel are the polar opposite of marijuana effects. It's akin to listing dehydration as an effect of gatorade withdrawel, or headaches as a symptom of aspirin withdrawel. A a bare minimum I want to know why these particular traits were chosen as symptoms.
If I have this right you are arguing that acute marijuana has lowered these supposed withdrawal signs below a "normal" baseline to which they return once abstinent? So the first place to start is Budney et al 2003 for a comparison of users withdrawn from cannabis with ex-users (similar prior profiles of use except one year of abstinence or more. to my mind the ex-user group is the control requiring the least hand waving but i'll look around for study with a matched never-cannabis control group to sort of bracket this issue.
Posted by: DrugMonkey | April 30, 2008 6:20 PM
I don't think it's obvious. Off the top of my head, I couldn't name any other factors involved in quitting. Many of your readers have little or no scientific training, and fewer still are versed in the study of addiction. It helps me, and surely others, if you're as thorough as you can be.
I'm sure there are people who get mad at any suggestion that weed isn't wonderful for the body. I'm not one of them, and I smoke weed. I'm not at all bothered by evidence that it can cause dependency; I already knew that.
Here's my issue. If you don't add a specific political perspective to your discussion of this topic, your coverage will be used to uphold the status quo. You didn't say "cannabis and tobacco have similar withdrawal effects, so perhaps cannabis should be treated similarly to tobacco: legalization, with treatment programs available for those who wish to quit."
I know, you probably wish you could just talk about the science and leave out the politics, but there is no such thing as a depoliticized discussion on this topic. If you don't say anything political, you have effectively said "we must keep it illegal." Hence the reactions. I'd be angry too if I didn't think you had just casually overlooked this factor.
Posted by: Grammar RWA | April 30, 2008 6:24 PM
The Vandrey data you supply does seem to support a hypothesis of cannabis withdrawal being less severe or shorter in length. All the markers checked are either stable or decreasing in days 3-5. Cannabis also stays below all other groups for 3+ days out of the 5 total in 4 out of the 6 categories.
Not that I am an apologist for cannabis-smoking, I have no interesting anecdotes like anyone else, except for my underwhelming first and only experience. It just seems to me that the data isn't making as clear a case for equivalence as you are suggesting. Or perhaps I'm inferring you're suggesting.
Posted by: AtheistAcolyte | April 30, 2008 6:26 PM
It is possible that DrugMonkey has some kind of political motivation - peo