Marijuana (Cannabis) withdrawal and mental health

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

During times of stress people may become vulnerable to using cannabis as a way to cope.

Previous posts have discussed the negative impact of cannabis on memory, cognitive performance, and PTSD.

Cannabis withdrawal can cause and worsen a variety of mental health symptoms.

It is important become aware of this connection for mental health.

What are some symptoms of cannabis withdrawal syndrome (CWS)?

CWS involves 3 or more of the following symptoms within 7 days of reduced cannabis use (1):

  • Anxiety
  • Depression
  • Changes in sleep
  • Irritability, anger, or aggression
  • Appetite or weight disturbance
  • Restlessness
  • Somatic symptoms, such as headaches, sweating, nausea, vomiting, or abdominal pain.

How common is cannabis withdrawal syndrome?

A meta-analysis(2) of 47 studies including 23,518 participants, found that the prevalence of cannabis withdrawal syndrome was found to be 47% (2).

What are some factors that were associated with higher cannabis withdrawal syndrome (2)?

Researchers (2) found that Daily cannabis use, concurrent tobacco use, and use of other substances was associated with higher CWS (2).

Other thoughts:

  • It bears repeating that daily users were more likely to have cannabis withdrawal syndrome.
  • Some people may report cannabis use helping with anxiety, depression, or insomnia when it may just be masking the withdrawal symptoms caused by previous cannabis use.
  • Research shows an association between cannabis use and several medical, cognitive, functional, and psychosocial problems(3).
  • Short-term risks of cannabis use include impaired short-term memory motor dis-coordination, altered judgment, paranoia, and psychosis (4).
  • Some long-term effects of cannabis use include addiction, altered brain development, poor educational outcomes, cognitive impairment, diminished quality of life, increased risk psychotic disorders, injuries, motor vehicle collisions, and suicide (4,5).
  • Further research is needed on cannabis and mental health.

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Resources for mental health support can be found here.

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association Publishing; 2013.
  2. Bahji A, Stephenson C, Tyo R, Hawken ER, Seitz DP. Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(4):e202370. doi:10.1001/jamanetworkopen.2020.2370.
  3. Crean  RD , Tapert SF , Minassian  A , Macdonald  K , Crane  NA , Mason  BJ .  Effects of chronic, heavy cannabis use on executive functions.   J Addict Med. 2011;5(1):9-15. doi:1097/ADM.0b013e31820cdd57
  4. Volkow  ND , Baler RD , Compton  WM , Weiss  SRB .  Adverse health effects of marijuana use.   N Engl J Med. 2014;370(23):2219-2227. doi:1056/NEJMra1402309
  5. Carvalho  AF , Stubbs B , Vancampfort  D ,  et al.  Cannabis use and suicide attempts among 86,254 adolescents aged 12-15 years from 21 low- and middle-income countries.   Eur Psychiatry. 2019;56:8-13. doi:1016/j.eurpsy.2018.10.006

Cannabis Might Worsen Memory and Stopping It Might Improve It

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

As of 2016, about 37 million individuals in the United States reported using cannabis / marijuana in the last year (1).

This is projected to increase in the future as many states move to legalize medicinal and or recreational cannabis or marijuana use.

As with many things like excessive junk food, excessive alcohol, tobacco, etc. being legal does NOT ALWAYS mean being  healthy.

For example, a recent study looked at cannabis and false memories (2), while another study looked at memory changes after stopping cannabis (3).

What was the first study? (2)

  • 23 healthy people aged 18 to 29 with and without tetrahydrocannabinol (THC).
  • They were asked to learn material while sober.
  • 2 days later, researchers compared memory recall among those who had used cannabis vs those who had not 2 hours before the test.

What were the study results of the first study (2)

In the first study, subjects who used cannabis 2 hours prior to the test were more likely to have false recognition of words and pictures that had not been presented during the sober study session (2).

What does this mean?

This small study suggests that cannabis use might impact academic performance (2), though further study is needed.

What was the second study (3)?

  • 88 individuals (Average age 21 years) who used cannabis at least weekly were randomized to 30 days of abstinence or to a control group, abstinence confirmed through biochemical testing (3).
  • Participants underwent cognitive testing at baseline and then weekly for 4 weeks.

What were the results of the second study? (3)

This 4 week study showed that improvements in memory started at week 1 and continued improvement through week 4. (3)

What does this mean?

  • This small study implies stopping cannabis may improve memory; and further longer, larger studies are underway (3).
  • Subjects used cannabis atleast weekly, and it is unclear if there is a difference in benefit among heavy vs light users.
  • These studies suggest that Cannabis or Marijuana may impact your ability to remember, and may cause false recall during tests; as well as memory improvement after stopping cannabis use.  A previous post showed that cannabis may increase alcohol intake (4).

How else is cannabis impacting you?

What are some useful resources regarding cannabis?

Drug treatment group at OSU Office of Student Life Counseling and Consultation Service.

Treatment Facilities in the Columbus, Ohio area:

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. Center for Behavioral Health Statistics and Quality, 2016 National Survey on Drug Use and Health: Detailed Tables, Substance Abuse and Mental Health Services Administration, Rockville 2017.  http://www.samhsa.gov
  2. Doss MK et al. Δ9-Tetrahydrocannibinol at retrieval drives false recollection of neutral and emotional memories. Biol Psychiatry 2018 May 9; [e-pub]. (https://doi.org/10.1016/j.biopsych.2018.04.020) .
  3.  Schuster RM, Gilman J, Schoenfeld D, et al. One month of cannabis abstinence in adolescents and young adults is associated with improved memory. J Clin Psychiatry. 2018;79(6):17m11977 .
  4. https://u.osu.edu/emotionalfitness/2017/02/08/study-impact-of-cannabis-on-alcohol/

Study: Impact of Cannabis on Alcohol

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

As of 2015, about 22 million individuals in the United States reported using cannabis / marijuana in the last month (1). In 2011, almost 70 million Americans reported binge drinking in the last month ( binge drinking defined by the survey as 5 or more drinks on one occasion) (2).

Some individuals may consider marijuana use as they are reducing alcohol use. A recent study looked at how cannabis use might impact alcohol use.

What was the study? (3)

1,383 newly abstinent alcohol dependent individuals were  participating in a multi-site randomized control trial for treatment options of alcohol use disorder in the landmark COMBINE study (4-5).

Researchers compared alcohol use among those who used cannabis versus those who did not use cannabis.

What were the study results?

The authors (3) found that compared to no cannabis use, ANY cannabis use during treatment for alcohol use disorder was related to LESS alcohol abstinence at end of treatment.

They found that each additional day of cannabis use was associated with approximately 4–5 fewer days of abstinence from alcohol (3).

In this study, cannabis use impacted how often the participants drank, but not how many drinks they had (3).

Further study in this area is needed.

What does this mean?

This study suggests that it may not be a good idea to use cannabis if you are trying to abstain from alcohol.

What are some useful resources regarding cannabis?

Drug treatment group at OSU Office of Student Life Counseling and Consultation Service.

Treatment Facilities Here in Columbus

 

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. Center for Behavioral Health Statistics and Quality. Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). 2016. http://www.samhsa.gov.proxy.lib.ohio-state.edu/data/
  2. Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50); 2015.
  3. Subbaraman, M. S., Metrik, J., Patterson, D., and Swift, R. (2016) Cannabis use during treatment for alcohol use disorders predicts alcohol treatment outcomes. Addiction, doi: 10.1111/add.13693.
  4. Anton R. F., O’Malley S. S., Ciraulo D. A., Cisler R. A., Couper D., Donovan D. M.et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA 2006; 295: 20032017.
  5. Combine Study Research Group. Testing combined pharmacotherapies and behavioral interventions in alcohol dependence: rationale and methods. Alcohol Clin Exp Res 2003; 27: 11071122.