New Cannabis Withdrawal Scale developed: nightmares were most diagnostic, angry outbursts caused the most distress | Research

The takeaway

The Cannabis Withdrawal Scale was developed with excellent reliability (Cronbach's alpha = 0.91), finding nightmares as the most diagnostic symptom and angry outbursts as the most distressing.

Read this if you are experiencing cannabis withdrawal or want to understand what the most common withdrawal symptoms are.

Nightmares: most diagnostic. Angry outbursts: most distressing.

What the researchers found

Researchers developed and validated the Cannabis Withdrawal Scale using 49 dependent cannabis users who provided daily symptom scores during one baseline week and two weeks of abstinence.

The scale demonstrated excellent psychometric properties: internal reliability (Cronbach's alpha = 0.91) and test-retest stability (average intra-class correlation = 0.95).

Nightmares and strange dreams were the most statistically valid withdrawal indicator (Wald chi-squared = 105.6) but caused relatively little distress. Angry outbursts were both intense (Wald chi-squared = 73.69) and highly distressing (Wald chi-squared = 45.54). Difficulty falling asleep was also intense (Wald chi-squared = 42.31) and distressing (Wald chi-squared = 47.76).

Scores on the Severity of Dependence Scale predicted the severity of cannabis withdrawal symptoms.

Why it matters

Having a validated withdrawal measure was essential for clinical trials of cannabis dependence treatments and for establishing cannabis withdrawal as a clinically recognized condition.

The numbers in context

49 dependent cannabis users. Cronbach's alpha = 0.91. Intra-class correlation = 0.95. Nightmares: Wald chi-squared = 105.6. Angry outbursts: Wald chi-squared = 73.69. Sleep onset difficulty: Wald chi-squared = 42.31.

How the study worked

Prospective validation study with 49 dependent cannabis users providing daily Cannabis Withdrawal Scale scores during 1 week of baseline use and 2 weeks of monitored abstinence. Psychometric analysis included internal reliability, test-retest stability, content validity, and predictor analysis.

What this study cannot tell us

Volunteer sample of 49 participants may not represent all cannabis-dependent populations. Two weeks of abstinence may not capture the full withdrawal timeline. Self-reported symptoms.

How to read the evidence

Well-designed psychometric validation study with excellent reliability statistics, though with a moderate sample size.

When this study was published

Published in 2011. The Cannabis Withdrawal Scale has been widely used in subsequent research.

The bigger picture

This scale became an important tool for cannabis dependence research and clinical practice, contributing to the eventual inclusion of cannabis withdrawal as a diagnosis in the DSM-5.

Questions still open

How does the Cannabis Withdrawal Scale perform in clinical treatment settings? Do withdrawal severity scores predict treatment outcomes?

Common questions

What is the worst cannabis withdrawal symptom?

While nightmares/strange dreams were the most diagnostically useful symptom, angry outbursts and sleep onset difficulty caused the most distress. Different symptoms peaked in intensity versus causing the most suffering.

Is cannabis withdrawal a real medical condition?

This study provided validated measurement tools for cannabis withdrawal. The syndrome was subsequently included as a diagnosis in the DSM-5. Symptoms include nightmares, angry outbursts, sleep difficulties, and irritability.

Read the original research

The Cannabis Withdrawal Scale development: patterns and predictors of cannabis withdrawal and distress.

Drug and alcohol dependence, 119(1-2), 123-9

View on PubMed ↗Publisher’s paper ↗

Citation

Allsop, David J; Norberg, Melissa M; Copeland, Jan; Fu, Shanlin; Budney, Alan J. (2011). The Cannabis Withdrawal Scale development: patterns and predictors of cannabis withdrawal and distress.. Drug and alcohol dependence, 119(1-2), 123-9. https://doi.org/10.1016/j.drugalcdep.2011.06.003