Health - Quitting marijuana as hard as quitting cigarettes

[Paracelsus]

http://www.news-medical.net/print_article.asp?id=34734

Paper referred to: Vandrey et al. A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances. Drug and Alcohol Dependence 2008 Jan 1;92(1-3):48-54.

Quitting marijuana as hard as quitting cigarettes

Medical Studies/Trials
Published: Monday, 28-Jan-2008

Research by a group of scientists studying the effects of heavy marijuana use suggests that withdrawal from the use of marijuana is similar to what is experienced by people when they quit smoking cigarettes.

Abstinence from each of these drugs appears to cause several common symptoms, such as irritability, anger and trouble sleeping - based on self reporting in a recent study of 12 heavy users of both marijuana and cigarettes.

"These results indicate that some marijuana users experience withdrawal effects when they try to quit, and that these effects should be considered by clinicians treating people with problems related to heavy marijuana use," says lead investigator in the study, Ryan Vandrey, Ph.D., of the Department of Psychiatry at the Johns Hopkins University School of Medicine.

Marijuana is the most widely used illicit drug in the United States. Admissions in substance abuse treatment facilities in which marijuana was the primary problem substance have more than doubled since the early 1990s and now rank similar to cocaine and heroin with respect to total number of yearly treatment episodes in the United States, says Vandrey.

He points out that a lack of data, until recently, has led to cannabis withdrawal symptoms not being characterized or included in medical reference literature such as the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, (DSM-IV) or the International Classification of Diseases, 10th edition (ICD-10).

Since the drafting of the DSM-IV in 1994, an increasing number of studies have surfaced suggesting that cannabis has significant withdrawal symptoms. What makes Vandrey's recent study unique is that it is the first study that compares marijuana withdrawal symptoms to withdrawal symptoms that are clinically recognized by the medical community - specifically the tobacco withdrawal syndrome.

"Since tobacco withdrawal symptoms are well documented and included in the DSM-IV and the IDC-10, we can infer from the results of this comparison that marijuana withdrawal is also clinically significant and should be included in these reference materials and considered as a target for improving treatment outcomes," says Vandrey.

Vandrey added that this is the first "controlled" comparison of the two withdrawal syndromes in that data was obtained using rigorous scientific methods - abstinence from drugs was confirmed objectively, procedures were identical during each abstinence period, and abstinence periods occurred in a random order. That tobacco and marijuana withdrawal symptoms were reported by the same participants, thus eliminating the likelihood that results reflect physiological differences between subjects, is also a strength of the study.

Interestingly, the study also revealed that half of the participants found it easier to abstain from both substances than it was to stop marijuana or tobacco individually, whereas the remaining half had the opposite response.

"Given the general consensus among clinicians that it is harder to quit more than one substance at the same time, these results suggest the need for more research on treatment planning for people who concurrently use more than one drug on a regular basis," says Vandrey.

Vandrey's study, which appears in the January issue of the journal Drug and Alcohol Dependence, followed six men and six women at the University of Vermont in Burlington and Wake Forest University School of Medicine in Winston-Salem, N.C., for a total of six weeks. All were over 18 (median age 28.2 years), used marijuana at least 25 days a month and smoked at least 10 cigarettes a day. None of the subjects intended to quit using either substance, did not use any other illicit drugs in the prior month, were not on any psychotropic medication, did not have a psychiatric disorder, and if female, were not pregnant.

For the first week, participants maintained their normal use of cigarettes and marijuana. For the remaining five weeks, they were randomly chosen to refrain from using either cigarettes, marijuana or both substances for five-day periods separated by nine-day periods of normal use. In order to confirm abstinence, patients were given daily quantitative urine toxicology tests of tobacco and marijuana metabolites.

Withdrawal symptoms were self reported on a daily basis Monday through Friday using a withdrawal symptom checklist that listed scores for aggression, anger, appetite change, depressed mood, irritability, anxiety/nervousness, restlessness, sleep difficulty, strange dreams and other, less common withdrawal symptoms. Patients also provided an overall score for discomfort they experienced during each abstinence period.

Results showed that overall withdrawal severity associated with marijuana alone and tobacco alone was of similar frequency and intensity. Sleep disturbance seemed to be more pronounced during marijuana abstinence, while some of the general mood effects (anxiety, anger) seemed to be greater during tobacco abstinence. In addition, six of the participants reported that quitting both marijuana and tobacco at the same time was more difficult than quitting either drug alone, whereas the remaining six found that it was easier to quit marijuana or cigarettes individually than it was to abstain from the two substances simultaneously.

Vandrey recognizes that the small sample size is a limitation in this study, but the results are consistent with other studies indicating that marijuana withdrawal effects are clinically important.
http://www.hopkinsmedicine.org/

[Matt The Funk]

SWIM always thought the withdrawls from cannabis are similar to discontinuing a medication abruptly. Maybe thats how all dependencys are.

[Euthanatos93420]

No way. Hands down. When swim stopped smoking MJ (After 4 years of daily use of roughly .5oz/wk) it was nothing. No withdrawals or cravings whatever. Quitting MJ wasn't like quitting at all really and it was easy as fuck. Swim is currently trying to quit tobacco and it's rough as fuck. He's always craving tobacco. He has physical feelings that, while not necessarily unpleasant or medical, remind him that he is craving tobacco.

Withdrawal can be applied to any substance. Swim made a deal with his mother that she would quit drinking diet pepsi if he quit smoking and her withdrawal symptoms are worse than his. She's been drinking diet pepsi for about 35 years though and he's only been smoking for 6 though. So yeah...some withdrawal may be expected from any substance used chronically. However, MJ is like a 1-2 on a scale of 1-10 with tobacco being about a 20 as far as difficulty quitting. At least in swim's experience.

[Mr. Giraffe]

This study is dishonest nonsense. Nicotine is a seriously addictive substance, which produces dependence, cannabis is not.

To suggest that cannabis and tobacco produce equally significant withdrawal symptoms flies in the face both of science and my cat's and his cat friend's experiences. Their reports indicate that quitting tobacco is hellish, while quitting cannabis produces no withdrawal symptoms at all. He has never encountered a tobacco smoker who said that quitting was easy.

Incidentally, my cat's study had a bigger sample than this joke of a study (12 users - I mean, really!)

My cats says this is more junk science trying to equate cannabis with tobacco.

[LSD-25]

My dad thinks it's addictive because I never stop doing it after he catches me. :P

[Euthanatos93420]

Originally Posted by LSD-25

My dad thinks it's addictive because I never stop doing it after he catches me. :P

Do the rest of us potheads a favour when you secure your life outside your parents and educate him that it's not the drug it's your own decision and disregard for his opinions. It's exactly what Swim told his dad.

@ Mr. Giraffe > I must agree. The article is just riddled with bullshit. The truth is that tobacco is bad for you. The only scientific evidence lending toward MJ bein' 'bad for you' as generally as tobacco is, is as spurious as this study.

[LEC]

Swim doesn't crave MJ after stopping periodically. Swim thinks about it, and remembers how nice it is, and might want it but it seems nothing compared to cigarettes. I'd like to think that my SO would quit cigarettes after I nagged enough..but to no avail. I've had to stop nagging so he wont hate me.

The only time Swim is irritable after not using MJ would be because of outside problems (which were present long before MJ was introduced) that surfaced once the brain was allowed to think of them more often. The desire or "craving" to smoke again swim attributes to the drug being able to stop the brain from dwelling on previous problems. After awhile this association might be confused with addiction instead of voluntary avoidance.

LEC

[ThirdEyeFloond]

I don't see what's so wrong with this study. Mr. Giraffe in what way do you find it to be 'dishonest nonsense'? Dependency and withdrawals are seperate issues and it seems to me that some SWIMmers have that confused. SWIM agrees that nicotine is alot harder to abstain from than cannabis but that's not the target of the study. The study suggests that withdrawals from cannabis in fact do occur and that they are of similar nature to nicotine withdrawals. SWIM has experienced sweating and has had trouble trying to fall asleep when abstaining from cannabis and several of SWIMs friends consider these withdrawal symptoms an inherent part of their detoxation when they stop smoking for a period. Some people stop toking with no problems, SWIM isn't one of them, some people quit tobacco with no problems, SWIM isn't one of them either.

[Mr. Giraffe]

Originally Posted by ThirdEyeFloond

I don't see what's so wrong with this study. Mr. Giraffe in what way do you find it to be 'dishonest nonsense'?

It is dishonest in the sense that it is trying to equate an addictive drug with a non-addictive drug. It is nonsense in the sense that it uses a sample size which is way too small to be clinically significant. 12 people is not a study, it's a chat.

Originally Posted by ThirdEyeFloond

Some people stop toking with no problems, SWIM isn't one of them, some people quit tobacco with no problems, SWIM isn't one of them either.

This is not the case; nicotine ceasation will always produce withdrawal, because the body becomes dependent on the nicotine. Cannabis ceasation only produces withdrawal symptoms in a small percentage of its users because the body does not crave cannabis. The withdrawal symptoms are therefore not applicable to cannabis, but to particular users of the drug who essentially convince themselves that they are addicted and therefore experience mild discomfort.

The fact that the vast majority of cannabis users experience no discomfort, and the fact that the vast majority of tobacco users experience serious discomfort when they quit tells its own story.

People are inherently subjective. If you give me funding, I'll do a 12 person study which 'proves' that abstention from apples causes as much irritation in heavy users as abstention from heroin.

And it will be dishonest nonsense, just like this report.

Reputation Comments on this post:

good points

[ThirdEyeFloond]

Originally Posted by Mr. Giraffe

It is dishonest in the sense that it is trying to equate an addictive drug with a non-addictive drug. It is nonsense in the sense that it uses a sample size which is way too small to be clinically significant. 12 people is not a study, it's a chat.

It's only pointing out that there are similarities between the withdrawal symptoms of both which is true in SWIMs opinion (and probably would be for the hardcore apple abusers as well). I don't see it stating that they're equally addictive, ketamine for instance is highly addictive for some although it produces zero withdrawal symptoms so there's no direct link between withdrawals and addictivity. I agree the study is pretty much worthless with only 12 subjects but I don't find the inductions that far off from what I would expect a larger study to show so I wouldn't call it dishonest.

This is not the case; nicotine ceasation will always produce withdrawal, because the body becomes dependent on the nicotine. Cannabis ceasation only produces withdrawal symptoms in a small percentage of its users because the body does not crave cannabis. The withdrawal symptoms are therefore not applicable to cannabis, but to particular users of the drug who essentially convince themselves that they are addicted and therefore experience mild discomfort.

The fact that the vast majority of cannabis users experience no discomfort, and the fact that the vast majority of tobacco users experience serious discomfort when they quit tells its own story.

In SWIMs world most heavy users experience some mild withdrawal symptoms when they quit cannabis but I understand it's different in SWIYs. I think alot of the danish kids that come asking for help on a harm reduction site I spend some time on would appreciate if you could teach them the trick how to convince themselves that they are in fact neither experiencing cravings nor withdrawals. Don't get SWIM wrong, he is not trying demonize cannabis but he would have to put on the blindfolds to be able to deny that it causes withdrawals in many subjects. Nothing like opioid withdrawal etc. but mild withdrawals like the subjects in the study have.
You do have a point about the body getting dependent on nicotine which isn't the case with cannabis and nicotine definately is a lot more harmful than cannabis but still there is a similarity between the psychosomatic symptoms that probably is the body's standard response to any abrupt change after prolonged exposure to whatever.

(Apologizes if SWIM makes little sense, his ketamine ferry forced him down the hole a few mins ago.)

[Metomni]

As someone majoring in Psychology, SWIM doesn't really like this study.

First of all, they used self-report. While that's a respected way of doing studies, SWIM doesn't believe it to be the most accurate when done over this long of a time period. Just last year SWIM did a study similar to this relating to alcohol where he had to answer random questionnaires and journal when he drank, both done with a palm pilot device. The only way they can get thorough results is to monitor the participants very often, after a while that gets pretty annoying. The people either start to mindlessly answer the questions being ask or they start to not even care about the study. Or they could get innaccurate answers thinking the study is looking for something in particular. There's lots of things that happen with something like this.

Also, their sample size was very very very small. 12 people? That's simply not going to be conclusive, for a study like this there needs to be a much larger sample.

I'm not questioning their methodology, doctor's from john's hopkins don't typically do bad research, I just don't think this experiment can show enough evidence to make this claim.

[Hyperspaceblastoff]

Originally Posted by Metomni

As someone majoring in Psychology, SWIM doesn't really like this study.

First of all, they used self-report. While that's a respected way of doing studies, SWIM doesn't believe it to be the most accurate when done over this long of a time period. Just last year SWIM did a study similar to this relating to alcohol where he had to answer random questionnaires and journal when he drank, both done with a palm pilot device. The only way they can get thorough results is to monitor the participants very often, after a while that gets pretty annoying. The people either start to mindlessly answer the questions being ask or they start to not even care about the study. Or they could get innaccurate answers thinking the study is looking for something in particular. There's lots of things that happen with something like this.

Also, their sample size was very very very small. 12 people? That's simply not going to be conclusive, for a study like this there needs to be a much larger sample.

I'm not questioning their methodology, doctor's from john's hopkins don't typically do bad research, I just don't think this experiment can show enough evidence to make this claim.

indeed very good points
this study is full of flaws, not very accurate indeed
i quit smoking for a few days after being high 24/7
it was mainly hard at night because i couldnt sleep, and had no appetite
but its nothing compared to cigarettes

[Zhadow7tysix]

Originally Posted by ThirdEyeFloond

I don't see what's so wrong with this study. Mr. Giraffe in what way do you find it to be 'dishonest nonsense'? Dependency and withdrawals are seperate issues and it seems to me that some SWIMmers have that confused. SWIM agrees that nicotine is alot harder to abstain from than cannabis but that's not the target of the study. The study suggests that withdrawals from cannabis in fact do occur and that they are of similar nature to nicotine withdrawals. SWIM has experienced sweating and has had trouble trying to fall asleep when abstaining from cannabis and several of SWIMs friends consider these withdrawal symptoms an inherent part of their detoxation when they stop smoking for a period. Some people stop toking with no problems, SWIM isn't one of them, some people quit tobacco with no problems, SWIM isn't one of them either.

swim wonders if thirdeye was using any other substances that he quit simultainiously? swim has used, stopped, used, and never felt any form of withdrawl, however, swim doesnt drink or smoke ciggarettes. this discussion is common among swims group of friends and every time they conclude that pot withdrawl is completly in the persons head, comperable to a hypochondriac. and there is almost always another substance in play that the person leaves out.

[Paracelsus]

Don't forget that cannabis and tobacco can both be psychologically addictive. This study isn't "full of flaws," it has just the single (yet admittedly major) setback of a very small sample.

Withdrawal is not only limited to physical symptoms, but also includes psychological discomfort and cravings. There is no better way to assess this than self-report.

[Mr. Giraffe]

Originally Posted by Paracelsus

Don't forget that cannabis and tobacco can both be psychologically addictive.

As can apples.

I think psychological addiction is a fairly catch-all term which I don't like because it is not particularly precise. It leads you to all sorts of irrational conclusions, such as some people considering cannabis and tobacco to be equally addictive. If we reduce it to the level of subjective self-reporting, we can 'prove' anything.

In terms of dishonesty, it is definitely dishonest to say that we can infer from the results of this comparison that marijuana withdrawal is clinically significant, as the researcher did.

This study is about the opposite of clinically significant.

[Paracelsus]

As can apples.

Anyone who has had real a addiction (drugs, alcohol, tobacco) or has known (really known) somebody with one, will find this utterly ridiculous.

[Mr. Giraffe]

Originally Posted by Paracelsus

Anyone who has had real a addiction (drugs, alcohol, tobacco) or has known (really known) somebody with one, will find this utterly ridiculous.

My cat both has personal experience with tobacco addiction and 'really' knows several people with addiction problems.

I was not talking about addiction. I am aware that addiction is A Bad Thing.

I was talking about the notion of psychological addiction, which is so subjective as to be meaningless. One could be psychologically addicted to absolutely anything, even apples.

[Mint boi]

Originally Posted by mr giraffe

One could be psychologically addicted to absolutely anything, even apples.

But its different when what your addicted to plays with the dopamine in your brain

[Paracelsus]

Mr.Giraffe: I was referring to addiction (psychological), not physical dependence. Basically what mint boi said.

[Mint boi]

EDIT: NVM didn't see Paracelsus was addressing Mr Griaffe

[Mr. Giraffe]

Cannabis does not stimulate the release of dopamine. To some extent, it prevents the brain from inhibiting its own release of dopamine, but it does not act directly on dopamine like addictive drugs do.

Lots of things impact on dopamine. Chocolate has a more direct and dramatic effect on dopamine than cannabis, for example.

Regarding apples, the point is that anybody can be psychologically addicted to anything if you're going to be totally subjective about it. Certain people exhibit what might be termed clinically significant withdrawal symptoms when they are unable to obtain their morning newspaper. This does not mean that stopping reading The Guardian is as hard as quitting tobacco.

[Paracelsus]

Cannabis does not stimulate the release of dopamine. To some extent, it prevents the brain from inhibiting its own release of dopamine, but it does not act directly on dopamine like addictive drugs do.

Lots of things impact on dopamine. Chocolate has a more direct and dramatic effect on dopamine than cannabis, for example.

Any citations?

The rest of your post reaffirms the point made in post #19.

[Mr. Giraffe]

Here's one study, Chocolate: Food or Drug?

http://www.ncbi.nlm.nih.gov/pubmed/10524390

If you're interested just google dopamine and chocolate, it's accepted that chocolate contains dopamine, it's also got seretonin.

[Mint boi]

That doesn't prove that chocolate has a more dramatic effect on dopamine than cannabis.

Chocolate does not contain dopamine or serotonin. It DOES contain small amounts of the neurotransmitter Anandamide which acts the same way as THC but is broken down by the body alot faster. And probably contains tryptophan too.

[Paracelsus]

I am well-aware of the existence of chocolate cravings. I meant citations for all the claims you quoted, especially the first and second sentences, which are contradictory (between each other) and self-contradictory (second one). A drug that counteracts the brain's dopamine release inhibitors is essentially a dopamine releaser, much like amphetamines. While I am not trying to equate psychological addiction to cannabis with that of amphetamines (potency differs), but the point had to be made.

Back on topic: This study evaluated subjective withdrawal symptoms. Because in the end, the person going through withdrawal is subjective and not objective, cannabis withdrawal can be of the same intensity as tobacco withdrawal according to this study.