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Marijuana withdrawal among adults seeking treatment for marijuana dependence.
Abstract
AIMS: The clinical relevance of marijuana withdrawal has not been established. This study is the first to document the incidence and severity of perceived marijuana withdrawal symptoms in a clinical sample of marijuana-dependent adults. MEASUREMENTS: Fifty-four people seeking outpatient treatment for marijuana dependence completed a 22-item Marijuana Withdrawal Symptom checklist based on their most recent period of marijuana abstinence. FINDINGS: The majority (57%) indicated that they had experienced > or = six symptoms of at least moderate severity and 47% experienced > or = four symptoms rated as severe. Withdrawal severity was greater in those with psychiatric symptomatology and more frequent marijuana use. CONCLUSIONS: This study provides further support for a cluster of withdrawal symptoms experienced following cessation of regular marijuana use. The affective and behavioral symptoms reported were consistent with those observed in previous laboratory and interview studies. Since withdrawal symptoms are frequently a target for clinical intervention with other substances of abuse, this may also be appropriate for marijuana.
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“six-session CBT produced superior results when compared with a single CBT session in another clinical trial 25.”
From Psychosocial and pharmacological interventions for the treatment of cannabis use disorder (2018) · cites this paper as [25]
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Budney, A. J., Moore, B. A., Vandrey, R. G., & Hughes, J. R. (2003) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.112.3.393 · Cited by 453
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“Cannabis withdrawal symptoms were assessed using the Marijuana Withdrawal Checklist.”
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MethodReliability and validity of a short form of the Marijuana Craving Questionnaire
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“In a separate treatment sample, 93% of marijuanadependent adults reported experiencing mild craving for marijuana, and 44% rated their past craving as severe (Budney et al., 1999).”
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Self-citationOral delta-9-tetrahydrocannabinol suppresses cannabis withdrawal symptoms
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“Clinically, marijuana smokers report using marijuana to alleviate withdrawal symptoms (Budney et al. 1999), suggesting withdrawal contributes to relapse and the maintenance of marijuana use.”
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BackgroundA Brain on Cannabinoids: The Role of Dopamine Release in Reward SeekingPreprint
Oleson, E. B., & Cheer, J. F. (2012) · Cold Spring Harbor Perspectives in Medicine · doi:10.1101/cshperspect.a012229 · Cited by 163
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BackgroundA review of the literature on marijuana and interpersonal violence
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“Previous studies had demonstrated that anxiety correlated with increased cannabis withdrawal (Budney et al, 1999) and was associated in the use of cannabis to cope (Buckner et al, 2008).”
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Cannabinoid Tolerance and Dependence
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“In another retrospective study, adults seeking treatment for marijuana dependence recalled similar symptoms upon their most recent period of abstinence that included craving for marijuana, irritability, nervousness, restlessness, depressed mood, increased anger, sleep difficulties, strange dreams, decreased appetite,…”
BackgroundCannabinoids, Endocannabinoids and Sleep
Kesner, A. J., & Lovinger, D. M. (2020) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2020.00125 · Cited by 142
Bupropion SR worsens mood during marijuana withdrawal in humans
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“A 15-item version of the Marijuana Withdrawal Checklist (MWC) (Budney et al., 1999) lists common as well as less frequently observed cannabis-withdrawal symptoms (items: craving for marijuana, depressed mood, decreased appetite, increased aggression, increased anger, headache, irritability, nausea, nervousness/anxiety…”
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Actions of delta-9-tetrahydrocannabinol in cannabis: Relation to use, abuse, dependence
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“…the prevalence of symptoms, and variations in intensity of withdrawal as a function of the strength of smoked cannabis or dose of oral THC (Budney et al., 1999; Budney, Hughes, Moore, & Vandrey, 2004; Haney, Ward, Comer, Foltin, & Fischman, 1999a, 1999b; Haney et al., 2004; Kouri & Pope,…”
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Functional Connectivity in Brain Networks Underlying Cognitive Control in Chronic Cannabis Users
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“Additionally, all cannabis users endorsed only mild, if any, symptoms of withdrawal as measured using the Marijuana Withdrawal Checklist (MWCL; Budney et al, 1999).”
Treatment of marijuana dependence: a review of the literature.
McRae, A. L., Budney, A. J., & Brady, K. T. (2003) · Journal of Substance Abuse Treatment · doi:10.1016/s0740-5472(03)00041-2 · Cited by 115
“Avalid and reliable marijuana withdrawal syndrome has recently been documented in controlled laboratory and clinical studies ( Budney, Novy, & Hughes, 1999; Budney, Hughes, Moore, & Novy, 2001; Kouri & Pope, 2000).”
BackgroundSelf-citationSolowij, N., Jones, K. A., Rozman, M. E., Davis, S. M., Ciarrochi, J., Heaven, P. C. L., Pesa, N., Lubman, D. I., & Yücel, M. (2011) · Psychopharmacology · doi:10.1007/s00213-011-2486-y · Cited by 116
“Cannabis users were also administered the Marijuana Withdrawal Checklist (MWC; adapted from Budney et al. 1999 and Vandrey et al. 2005) and the Severity of Dependence Scale (SDS; Swift et al. 1998) for cannabis.”
BackgroundMethodSleep disturbance and the effects of extended-release zolpidem during cannabis withdrawal
Vandrey, R. G., Smith, M. T., McCann, U. D., Budney, A. J., & Curran, E. M. (2011) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2011.01.003 · Cited by 116
“The Marijuana Withdrawal Checklist (MWC) (Budney et al., 1999) was used to assess the presence of cannabis withdrawal symptoms during prior periods of abstinence.”
BackgroundMethodInfluentialSelf-citationSex differences in cannabis withdrawal symptoms among treatment-seeking cannabis users.
Herrmann, E. S., Weerts, E. M., & Vandrey, R. G. (2015) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000053 · Cited by 127
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“The two most widely used cannabis withdrawal scales are the 16-item marijuana withdrawal checklist (MWC [23]), a revised version of the original 22-item scale [24], and the 19-item cannabis withdrawal scale (CWS [25]; see Supporting information).”
MethodSelf-citationThe marijuana withdrawal syndrome: Diagnosis and treatment
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“Withdrawal symptoms are among the most prevalent consequences of marijuana abstinence among treatment seekers, with 85% reporting increased irritability, aggressive behavior, depression, nervousness, and craving, and approximately 65% reporting using marijuana to alleviate symptoms [7, 30 ].”
BackgroundA review of the published literature into cannabis withdrawal symptoms in human users
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“” Marijuana withdrawal was assessed using the withdrawal checklist (Budney et al., 1999), a 10-item self-report instrument in which symptoms are rated either none, mild, moderate or severe (ranging respectively from 0-3) for a possible total score of 30.”
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“The Marijuana Withdrawal Checklist (Budney, Moore, Vandrey, & Hughes, 2003; Budney, Novy, & Hughes, 1999) has 15 items ranging from 0 (not at all) to 3 (severe) with 10 symptoms making up a withdrawal discomfort score (Budney et al., 1999).”
BackgroundThe dose effects of short-term dronabinol (oral THC) maintenance in daily cannabis users
Vandrey, R. G., Stitzer, M. L., Mintzer, M. Z., Huestis, M. A., Murray, J. A., & Lee, D. (2012) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2012.08.001 · Cited by 106
“The MWC assessed cannabis withdrawal symptoms during the prior 24 hours.”
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“Importantly, a cluster of withdrawal symptoms typically is experienced after cessation of regular marijuana smoking by adults (Budney et al., 1999) and adolescents (Vandrey et al.”
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“…impairment in life activities (e.g., interpersonal, family, financial; Stephens et al., 1993), are more apt to seek treatment for their drug use (SAMHSA, 2001), and experience withdrawal symptoms during periods of drug abstinence (Budney and Moore, 2002; Budney et al., 2003; Budney et al., 1999).”
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Effects of fixed or self-titrated dosages of Sativex on cannabis withdrawal and cravings.
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“Withdrawal symptoms and craving were assessed using the Cannabis Withdrawal Scale (CWS), Marijuana Withdrawal Checklist (MWC) and Marijuana Craving Questionnaire (MCQ).”
BackgroundMethodInfluentialTobacco smoking in marijuana-dependent outpatients
Moore, B. A., & Budney, A. J. (2001) · Journal of Substance Abuse · doi:10.1016/s0899-3289(01)00093-1 · Cited by 95
Self-citationAttributes of long-term heavy cannabis users: a case–control study
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“Although cannabis withdrawal is less severe than opioid or alcohol withdrawal, our subjects frequently reported prominent withdrawal symptoms (Kouri & Pope, 2000), as have subjects in other studies (Jones et al. 1981; Wiesbeck et al. 1996; Budney et al. 1999, 2001; Haney et al. 1999).”
Blunted stress reactivity in chronic cannabis users
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Self-citationDodge, R., Sindelar, J., & Sinha, R. (2005) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2004.12.005 · Cited by 89
Chung, T. A., Martin, C. S., Cornelius, J. R., & Clark, D. B. (2008) · Addiction · doi:10.1111/j.1360-0443.2008.02158.x · Cited by 87
“Proponents of including cannabis withdrawal emphasize research on its neurobiological basis [4], delineation of the typical time–course and symptoms of a cannabis abstinence syndrome [5–7] and reports of functional impairment due to cannabis withdrawal [8,9].”
BackgroundDSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults
Livne, O., Shmulewitz, D., Lev‐Ran, S., & Hasin, D. S. (2018) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2018.09.005 · Cited by 87
“, 2015), but not others (Allsop et al., 2011; Budney et al., 1999), suggest that women experience higher rates of some cannabis withdrawal symptoms than men.”
BackgroundResultInfluentialA placebo-controlled trial of buspirone for the treatment of marijuana dependence
McRae‐Clark, A. L., Carter, R. E., Killeen, T. K., Carpenter, M. J., Wahlquist, A. E., Simpson, S. A., & Brady, K. T. (2009) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2009.06.022 · Cited by 84
“Weekly assessments included scales to assess marijuana craving (Marijuana Craving Questionnaire (MCQ); Heishman et al., 2001), and marijuana withdrawal symptoms (Marijuana Withdrawal Checklist; Budney et al., 1999).”
BackgroundMethodfMRI study of neural sensitization to hedonic stimuli in long‐term, daily cannabis users
Filbey, F. M., Dunlop, J. P., Ketcherside, A., Baine, J., Rhinehardt, T., Kuhn, B. N., DeWitt, S. J., & Alvi, T. (2016) · Human Brain Mapping · doi:10.1002/hbm.23250 · Cited by 86
“First, variations in reward expectancies may have confounded our observed effects. r 3441 r Correlations between cannabis cue (vs. fruit cue) and Marijuana Craving Questionnaire (MCQ), Marijuana Withdrawal Checklist (MWC), creatinine-weighted THC ng/ml in cannabis users.”
MethodInfluentialMarijuana use among adolescents
Gruber, A. J., & Pope, H. G. (2002) · Pediatric Clinics of North America · doi:10.1016/s0031-3955(01)00011-6 · Cited by 90
“Although some individuals experience very mild withdrawal symptoms, others experience more severe symptoms and almost all habitual users experience some degree of craving [26,81,94,95,103].”
BackgroundCui, S.-S., Bowen, R. C., Gu, G.-B., Hannesson, D. K., Yu, P. H., & Zhang, X. (2001) · The Journal of Neuroscience · doi:10.1523/jneurosci.21-24-09867.2001 · Cited by 84
“Many chronic cannabis users report an average of 6.4 withdrawal symptoms of at least moderate severity (Budney et al., 1999), a number that exceeds the criteria for DSM-IV substance-withdrawal disorders (i.e., 2–4) (American Psychiatry Association, 1994).”
BackgroundInfluentialBoileau, I., Mansouri, E., Williams, B., Le Foll, B., Rusjan, P., Mizrahi, R., Tyndale, R. F., Huestis, M. A., Payer, D. E., Wilson, A. A., et al. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2016.04.012 · Cited by 82
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript Table 2 Drug use profile of cannabis users (N=10) mean (SD) range (min-max) Cannabis age of onset (years) 16.1 (3.9) 10–22 Current cannabis use/week (grams) 7.5 (4.7) 3.5–14 Current cannabis use/week (joints) 20.4 (10.2) 2.3–35 Years of ca…”
InfluentialBudney, A. J. (2006) · Addiction · doi:10.1111/j.1360-0443.2006.01582.x · Cited by 80
“The only clinical study that assessed for specific cannabis withdrawal symptoms reported that 85% of out-patients acknowledged at least four symptoms of at least mild severity [16], with greater than 70% endorsing the presence of cravings, irritability, nervousness, depressed mood, restlessness, sleep difficulty and a…”
BackgroundSelf-citationMinozzi, S., Davoli, M., Bargagli, A. M., Amato, L., Vecchi, S., & Perucci, C. A. (2010) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2009.00132.x · Cited by 80
Sigmon, S., Steingard, S., Badger, G., Anthony, S., & Higgins, S. (2000) · Experimental and clinical psychopharmacology · doi:10.1037/1064-1297.8.4.509 · Cited by 83
Reactivity to Cannabis Cues in Virtual Reality Environments
Bordnick, P. S., Copp, H. L., Traylor, A. C., Graap, K. M., Carter, B. L., Walton, A. P., & Ferrer, M. (2009) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2009.10399903 · Cited by 77
Cannabis Withdrawal and Sleep: A Systematic Review of Human Studies
Gates, P., Albertella, L., & Copeland, J. (2015) · Substance Abuse · doi:10.1080/08897077.2015.1023484 · Cited by 77
“In addition, a total of 9 studies reported the index withdrawal discomfort score from the Marijuana Withdrawal Checklist (referred to as the MWC), a scale developed by Budney and colleagues(37) that gives an numerical indication of the overall severity of withdrawal experienced (although 3 of these studies reported th…”
BackgroundIncreasing treatment options for cannabis dependence: A review of potential pharmacotherapies
Hart, C. L. (2005) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2005.03.027 · Cited by 77
Development and Consequences of Cannabis Dependence
Budney, A. J., & Moore, B. A. (2002) · The Journal of Clinical Pharmacology · doi:10.1002/j.1552-4604.2002.tb06000.x · Cited by 75
Self-citationCannabis use during a voluntary quit attempt: An analysis from ecological momentary assessment
Buckner, J. D., Zvolensky, M. J., & Ecker, A. H. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.04.013 · Cited by 75
Marijuana Withdrawal Syndrome in the Animal Model
Lichtman, A. H., & Martin, B. R. (2002) · The Journal of Clinical Pharmacology · doi:10.1002/j.1552-4604.2002.tb05999.x · Cited by 78
Alexander, D. (2003) · The American Journal of Drug and Alcohol Abuse · doi:10.1081/ada-120023462 · Cited by 72
Buspirone treatment of cannabis dependence: A randomized, placebo-controlled trial
McRae‐Clark, A. L., Baker, N. L., Gray, K. M., Killeen, T. K., Wagner, A. M., Brady, K. T., DeVane, C. L., & Norton, J. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.08.013 · Cited by 77
“Further, the anxiolytic effects of buspirone may be helpful in preventing relapse to cannabis use, as high anxiety scores have been correlated with increased cannabis withdrawal (Budney et al., 1999), anxiety has been shown to be related to use of cannabis to cope with negative affect (Buckner et al.”
BackgroundLitt, M. D., Kadden, R. M., & Petry, N. M. (2013) · Addictive Behaviors · doi:10.1016/j.addbeh.2012.08.011 · Cited by 71
Metadata
- Authors
- Budney, A. J., Novy, P. L., & Hughes, J. R.
- Affiliations
- University of Vermont (US)
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 1999-09
- Volume
- 94
- Issue
- 9
- Pages
- 1311-1322
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- OpenAlex
- W2119758521
- Cited by
- 348
- References
- 0
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 11 · 2023: 15 · 2022: 12 · 2021: 11 · 2020: 18 · 2019: 12 · 2018: 22 · 2017: 15 · 2016: 10 · 2015: 17 · 2014: 15 · 2013: 11 · 2012: 16
- FWCI
- 3.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r29da008655-05)
- National Institute on Drug Abuse (R-29DA08655)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Keywords
- cannabis use disorder, withdrawal symptom severity, psychiatric comorbidity, addiction treatment, cannabis
- MeSH terms
- Adult, Analysis of Variance, Marijuana Abuse, Female, Humans, Male, Patient Acceptance of Health Care, Regression Analysis, Stress, Psychological, Substance Withdrawal Syndrome
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