cannabis: evolution of a withdrawal model - 2017 vaada conference

Cannabis

Evolution of a withdrawal model

Cannabis: Evolution of a withdrawal model

• Dependence inducing?• Cannabis withdrawal?• What does it look like?• How do we deal with it?


• Organic/ home grown• Hydroponic: indoor grown, nutrients, pesticides• Skunk: selectively bred high potency• Synthetic: THC analogues added to vegetable

material


“Although most people are tolerant to the repeated use of cannabis, there are those who develop a pattern of cannabis dependence, made even more difficult by

withdrawal symptoms.“

Psychology Dictionary: What is cannabis dependence?


Prior to the publication of DSM 5, there was not enough scientific evidence to ascribe these types of effects to withdrawal from the use of marijuana or hashish.

However, times have changed, and the APA now officially recognizes the fact that at least some of the people who withdraw from these substances meet the mental health criteria for substance withdrawal.

Doctors can now use the cannabis withdrawal diagnosis to identify these people.

Psychology Dictionary: What is cannabis dependence?


DSM 5 292.0 diagnostic criteria:A: Cessation of use that has been heavy and prolongedB: 3 of the following signs and symptoms develop within 1 week of cessation

1. Irritability, anger or aggression 2. Nervousness or anxiety3. Sleep difficulty 4. Decreased appetite or weight loss5. Restlessness 6. Decreased mood7. At least one of the following: abdo pain, shakes, sweating, fever, chills, headache

C: Signs, symptoms of Crit B cause significant distress/ impairment in social, occupational or other areas of functioning

D: Signs/ symptoms not attributable to other causes.


Audit of Clinical Practice

• Withdrawal • Synthetic v organic• Modified NCPIC Scale• 7/7


Audit of Clinical Practice• N =28• Mainly inpatient• 2/3 male• Under 22• Single substance dependence


• Audit of Clinical Practice• Linear decrease in symptom severity• Withdrawal lasts longer than 6 days


Most common symptoms• Loss of appetite• Sleep disturbance• Low mood• Agitation• Cravings• Vivid dreams


• Pragmatic• Client centred and driven• Staged reduction• Win-win paradox• Motivational


• Diary• Negotiated reduction• Review• Further reduction• Cessation• Monitoring• Post withdrawal plan


• Monitored: NCPIC Cannabis Withdrawal Scale• Plot severity, progress• Gauge adequacy of medication• Nutrition• Hydration


Elements• Commitment• Diary• Pragmatic reduction• Frequent review• Cessation• Medication (Turning Point guidelines)• Symptom monitoring• Reinforcement and encouragement• Post withdrawal plan


• Environment/ lifestyle• Sleep pattern (30/7+)• Dispose of drugs, paraphernalia• Alternatives• Social• Non compatible alternatives


Summary• As cannabis has evolved so has our understanding of

cannabis withdrawal• It’s in the DSM 5 so it must be real• Manifests as a cluster of symptoms of variable type

and intensity• No specific medication• Syndrome lasts longer than funded inpatient episode• Lends itself to step up/ down• Non medical techniques successful in aiding clients

decrease/ cease use = The power of the diary.

cannabis: evolution of a withdrawal model - 2017 vaada conference

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