A cannabis withdrawal syndrome has been characterized, but its clinical significance remains uncertain. One method of assessing the significance of cannabis withdrawal is to compare it directly with an established withdrawal syndrome.

In a recent study (the first to examine abstinence effects following cessation of both cannabis and tobacco in a within-subject design), researchers asked subjects to rate overall withdrawal discomfort for cannabis alone, tobacco alone, and tobacco and cannabis together, and to itemize significant symptoms for each withdrawal period. Subjects completed three 5-day periods of abstinence in randomized order separated by 9 days of usual substance use. They were asked to abstain from using illegal drugs (other than cannabis) and psychoactive medications and to make no significant changes to their diet and exercise habits.

Results indicated that withdrawal symptoms associated with cannabis were nearly as severe as those associated with tobacco. Overall, withdrawal discomfort and individual symptom severity were about the same during cannabis abstinence and tobacco abstinence, although sleep disturbances seemed to be more pronounced during marijuana abstinence, and anxiety and anger were more evident during tobacco abstinence. Interestingly, some people in the study found it easier to withdraw from both substances together than from one alone.

Comment by Tommie Ann Bower, MA:
Treatment professionals supporting patients after detox may find it useful to review the impact of cannabis withdrawal on sleep disturbance. Individuals withdrawing from both cannabis and nicotine can experience increased symptoms of anger and anxiety. Efforts to help during the early recovery period could easily include strategies for coping with discomfort in these areas.