DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults

Drug Alcohol Depend. 2019 Feb 1;195:170-177. doi: 10.1016/j.drugalcdep.2018.09.005. Epub 2018 Oct 22.


Background: Cannabis withdrawal syndrome (CWS) was newly added to the Diagnostic and Statistical Manual of Mental Disorders in its most recent edition, DSM-5. With cannabis use increasing among U.S. adults, information is needed about the prevalence and correlates of DSM-5 CWS in the general population. This study presents nationally representative findings on the prevalence, sociodemographic and clinical correlates of DSM-5 CWS among U.S. adults.

Method: Participants ≥18 years were interviewed in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) in 2012-2013. Among the sub-sample of frequent cannabis users in the prior 12 months (≥3 times a week; N = 1527), the prevalence and demographic and clinical correlates of DSM-5 CWS were examined.

Results: In frequent cannabis users, the prevalence of CWS was 12.1%. The most common withdrawal symptoms among those with CWS were nervousness/anxiety (76.3%), hostility (71.9%), sleep difficulty (68.2%) and depressed mood (58.9%). CWS was associated with significant disability (p < 0.001), and with mood disorders (adjusted odds ratios [aOR] = 1.9-2.6), anxiety disorders (aOR = 2.4-2.5), personality disorders (aOR = 1.7-2.2) and family history of depression (aOR = 2.5) but not personal history of other substance use disorders or family history of substance use problems.

Conclusions: CWS is highly comorbid and disabling. Its shared symptoms with depressive and anxiety disorders call for clinician awareness of CWS and the factors associated with it to promote more effective treatment among frequent cannabis users.

Keywords: Cannabis; Cannabis withdrawal; DSM-5; Epidemiology; Marijuana.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / psychology
  • Cannabis
  • Comorbidity
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Female
  • Health Surveys / methods*
  • Humans
  • Male
  • Marijuana Abuse / diagnosis*
  • Marijuana Abuse / epidemiology
  • Marijuana Abuse / psychology*
  • Marijuana Smoking / adverse effects
  • Marijuana Smoking / epidemiology
  • Marijuana Smoking / psychology
  • Middle Aged
  • Personality Disorders / diagnosis
  • Personality Disorders / epidemiology
  • Personality Disorders / psychology
  • Substance Withdrawal Syndrome / diagnosis*
  • Substance Withdrawal Syndrome / epidemiology
  • Substance Withdrawal Syndrome / psychology*
  • United States / epidemiology
  • Young Adult