Cannabis withdrawal symptoms in adults with ADHD looked similar to those in people without ADHD | Research

The takeaway

Among 23 cannabis-dependent adults with ADHD, 96% reported at least one withdrawal symptom during their most serious quit attempt, with symptom patterns similar to non-ADHD populations despite expectations of worse withdrawal.

Read this if you have ADHD and use cannabis regularly and want to know what quitting might feel like.

96% experienced withdrawal symptoms; 87% were motivated to quit by saving money

What the researchers found

Researchers studied 23 cannabis-dependent adults with ADHD who described their most serious quit attempt without formal treatment. Nearly all (96%) experienced at least one cannabis withdrawal symptom, and 30% met full DSM-5 diagnostic criteria for cannabis withdrawal syndrome.

The withdrawal experience was remarkably similar to what has been reported in cannabis-dependent adults without psychiatric comorbidity. This was somewhat surprising, given that ADHD involves dysregulation of attention and mood that might be expected to amplify withdrawal symptoms.

The most common motivation for quitting was financial, with 87% citing saving money as a reason. The most common strategy for maintaining abstinence was avoiding people who smoke marijuana (43%). These practical motivations and strategies differed from the clinical reasons typically assumed to drive quit attempts.

The finding that ADHD does not appear to worsen cannabis withdrawal contrasts with ADHD's known effect of amplifying tobacco withdrawal, suggesting different neurobiological mechanisms underlie withdrawal from these two substances.

Why it matters

ADHD patients have high rates of cannabis use and dependence. Understanding that their withdrawal experience is not unusually severe (contrary to what might be expected) can inform treatment planning. The practical nature of their quit motivations (money, social pressure) can help clinicians frame cessation conversations.

The numbers in context

23 adults with ADHD and cannabis dependence. 82.6% male. Mean age 27.4 years. 96% reported at least 1 withdrawal symptom. 30% met DSM-5 cannabis withdrawal criteria. Most common quit motivation: saving money (87%). Most common abstinence strategy: avoiding marijuana-using peers (43%).

How the study worked

Twenty-three adults with ADHD enrolled in a clinical trial of atomoxetine for cannabis dependence completed the Marijuana Quit Questionnaire about their most serious previous quit attempt made without formal treatment. Study conducted between November 2005 and June 2008.

What this study cannot tell us

The sample was very small (23 participants) and predominantly male. Withdrawal was assessed retrospectively about a past quit attempt rather than prospectively. All participants were enrolled in a treatment trial, which may not represent the broader ADHD-cannabis population. The comparison to non-ADHD populations was indirect rather than within-study.

How to read the evidence

This is a small cross-sectional study with retrospective self-report, providing preliminary evidence about cannabis withdrawal in ADHD.

When this study was published

Published in 2018 with data from 2005-2008.

The bigger picture

This study adds to our understanding of how cannabis dependence presents in people with psychiatric comorbidities. The finding that ADHD does not amplify cannabis withdrawal (unlike tobacco withdrawal) suggests that different neurotransmitter systems underlie these withdrawal syndromes, with implications for treatment approaches.

Questions still open

Why does ADHD amplify tobacco but not cannabis withdrawal? Would formal treatment-assisted quit attempts produce different withdrawal profiles? Are the financial motivations for quitting specific to the ADHD population or generalizable?

Common questions

Is cannabis withdrawal worse if you have ADHD?

This study found that cannabis withdrawal in adults with ADHD was similar to what is reported in people without ADHD. This contrasts with tobacco withdrawal, which ADHD is known to worsen, suggesting different mechanisms are involved.

What motivated ADHD adults to quit cannabis?

The most common motivation was saving money (87%), followed by practical and social reasons. The most common strategy for staying abstinent was avoiding peers who used marijuana (43%).

Read the original research

Cannabis Withdrawal in Adults With Attention-Deficit/Hyperactivity Disorder.

The primary care companion for CNS disorders, 20(1)

View on PubMed ↗Publisher’s paper ↗

Citation

Chauchard, Emeline; Hartwell, Karen J; McRae-Clark, Aimee L; Sherman, Brian J; Gorelick, David A. (2018). Cannabis Withdrawal in Adults With Attention-Deficit/Hyperactivity Disorder.. The primary care companion for CNS disorders, 20(1). https://doi.org/10.4088/PCC.17m02203