How Cannabis and Tobacco Are Used Together in Spain — and What Withdrawal Looks Like

Cross-sectional study in substance use treatment programs in Catalonia, Spain. 94 participants initiating CUD treatment. Questionnaire assessing sociodemographics, cannabis and tobacco use characteristics, nicotine dependence (Fagerström), motivation to quit, and cannabis withdrawal symptoms. Hierarchical cluster analysis using Gower's distance to identify behavioral profiles.

The European pattern of mixing cannabis with tobacco in spliffs creates a dual dependence that's different from the North American pattern of using cannabis alone. Treatment programs designed for cannabis alone may miss the tobacco component, and tobacco cessation programs may not account for the cannabis dimension. Understanding these co-use patterns is essential for effective treatment in populations where mixing is the norm.

This connects to the prenatal cannabis-tobacco review (RTHC-00239), which examined how both substances affect fetal development through overlapping epigenetic mechanisms. It also links to the cannabis withdrawal literature (RTHC-00037, RTHC-00249) by adding the complication of concurrent nicotine withdrawal. The finding that women experience more severe withdrawal echoes sex differences documented across multiple studies in this database (RTHC-00222, RTHC-00236, RTHC-00252).

Cross-sectional design from a single treatment setting in Catalonia. The 94-participant sample is modest. Treatment-seeking individuals may not represent all dual users. European spliff culture differs from North American consumption patterns, limiting generalizability. Self-reported use measures may be imprecise.