Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

The Prevalence of Cannabis Withdrawal and Its Influence on Adolescents' Treatment Response and Outcomes: A 12-Month Prospective Investigation

Greene, M. Claire MPH; Kelly, John F. PhD

doi: 10.1097/ADM.0000000000000064
Original Research

Background: Withdrawal, a diagnostic indicator of cannabis use disorder, is often minimized or ignored as a consequence of cannabis use, particularly among adolescents. This study aims to characterize cannabis withdrawal among adolescents in outpatient treatment for substance use disorder and evaluate the clinical significance of withdrawal as a predictor of substance-related outcomes.

Methods: Adolescent outpatients (N = 127) reporting cannabis as their drug of choice (n = 90) were stratified by the presence of withdrawal and compared on demographic and clinical variables at treatment intake. Hierarchical linear models compared the effect of withdrawal on percentage days abstinent (PDA) and related outcomes over a 1-year follow-up period.

Results: Adolescents reporting withdrawal (40%) were more likely to meet criteria for cannabis dependence, have higher levels of substance use severity, report more substance-related consequences, and have a mood disorder. Withdrawal was not associated with PDA over the follow-up period; however, this relationship was moderated by problem recognition such that adolescents reporting withdrawal and a drug problem improved at a greater rate with respect to PDA than those who did not recognize a problem with drugs and did not report withdrawal.

Discussion: Withdrawal is common among adolescent outpatients and is associated with a more clinically severe profile. In this sample, all adolescents reporting withdrawal met criteria for cannabis dependence, suggesting that withdrawal is a highly specific indicator of cannabis use disorder. Although withdrawal does not seem to be independently associated with substance use outcomes posttreatment, moderating factors such as drug problem recognition should be taken into account when formulating treatment and continuing care plans.

From the Center for Addiction Medicine (MCG, JFK), Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

Send correspondence and reprint requests to M. Claire Greene, MPH, Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 60 Staniford St, Boston, MA 02114. E-mail:

This research was funded by the National Institute of Alcohol Abuse and Alcoholism (NIAAA; R01AA015526).

The authors declare no conflicts of interest.

Received February 26, 2014

Accepted June 13, 2014

© 2014 American Society of Addiction Medicine