Tobacco dependence was associated with more severe cannabis withdrawal symptoms regardless of schizophrenia diagnosis, with the combined effect potentially explaining poor cannabis cessation outcomes in dual users.
Addiction clinicians treating dual tobacco-cannabis users, psychiatrists managing substance use in schizophrenia, and cessation program designers.
Tobacco dependence worsened cannabis withdrawal regardless of schizophrenia status
What the researchers found
Cannabis withdrawal severity was worse in tobacco-dependent individuals compared to non-tobacco-dependent individuals. This effect was present in both people with schizophrenia-spectrum disorders and those without, suggesting tobacco co-use universally complicates cannabis cessation.
Why it matters
Most people with cannabis use disorder also use tobacco. If tobacco worsens cannabis withdrawal, addressing both substances simultaneously may be necessary for successful treatment.
The numbers in context
Cannabis withdrawal severity assessed in relation to tobacco dependence. Tobacco-dependent individuals showed worse cannabis withdrawal regardless of schizophrenia diagnosis.
How the study worked
Cross-sectional study examining cannabis withdrawal severity as a function of tobacco dependence status and schizophrenia-spectrum disorder diagnosis.
What this study cannot tell us
Cross-sectional design cannot establish causation. Cannabis withdrawal severity was measured at a single point. Cannot determine whether tobacco cessation would improve cannabis withdrawal outcomes. Schizophrenia medication effects on withdrawal not fully controlled.
How to read the evidence
Cross-sectional study identifying an important clinical association. Cannot prove tobacco caused worse cannabis withdrawal.
When this study was published
Published 2023.
The bigger picture
Cannabis and tobacco co-use is extremely common but rarely addressed together in treatment. This finding suggests that treating cannabis dependence without addressing tobacco may be undermined by tobacco-related withdrawal exacerbation.
Questions still open
- Would concurrent tobacco cessation improve cannabis quit rates? Does nicotine replacement therapy reduce cannabis withdrawal severity in dual users?
Common questions
Does smoking cigarettes make it harder to quit cannabis?
Is cannabis withdrawal different in people with schizophrenia?
Read the original research
Does tobacco dependence worsen cannabis withdrawal in people with and without schizophrenia-spectrum disorders?
The American journal on addictions, 32(4), 367-375
Citation
Yeap, Zac J S; Marsault, Justine; George, Tony P; Mizrahi, Romina; Rabin, Rachel A. (2023). Does tobacco dependence worsen cannabis withdrawal in people with and without schizophrenia-spectrum disorders?. The American journal on addictions, 32(4), 367-375. https://doi.org/10.1111/ajad.13394
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