Marijuana withdrawal syndrome: There is none

There is no withdrawal syndrome mentioned in the DSM though it says that there have been reports of symptoms, but that they have not yet been shown to be "clinically significant" (American Psychiatric Association, 1994, Diagnostic and Statistical Manual of Mental Disorders, 4th ed., p. 216).  A criteria for withdrawal (within the scope of dependence in the DSM) is a withdrawal syndrome that causes "significant distress" (p. 185) psychosocially or occupationally.

One study shows that craving was a withdrawal symptom, and that it can, under certain circumstances, prevent a user from stopping use (Ehlers, Gizer, Vieten & Wilhelmsen, 2010), which is a criteria for a withdrawal syndrome.  Other criteria, such as tolerance and loss of social activities, are only specific to dependence.

Hasin created two groups of symptoms:  "anxiety, restlessness, depression, and insomnia" and  "weakness, hypersomnia, and psychomotor retardation" (Hasin, et al., 2008, para. 1).  Anxiety-related symptoms, which are much more commonly cited as a withdrawal symptom, were associated in Hasin's study with panic and personality disorders.  Bonn-Miller and Moos (2010) suggest that anxiety predicts long-term relapse, but does not mediate high relapse rates predicted by previous heavy use, which would probably go to the craving symptom.  Therefore this research suggests that the anxiety component of withdrawal is due to another disorder, and therefore may not be contributing to marijuana withdrawal syndrome as specified in the DSM (Copeland & Swift, 2009; Preuss, Watzke, Zimmermann, Wong, Schmidt, 2010).  Reuptake-inhibiting anti-depressants had no effect beyond placebo in a study that filtered preexisting psychiatric conditions from the test group, further supporting the idea that the anxiety-related symptoms either describe a separate disorder, or are too clinically insignificant to be affected by a reuptake inhibitor that reduces anxiety  (Carpenter, McDowell, Brooks, Cheng, 2009).

This material supports the DSM's present assertion that there is no clinically-significant marijuana withdrawal syndrome.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.

Bonn-Miller, M., Moos, R., (2011). Marijuana discontinuation, anxiety symptoms, and relapse to marijuana. Addictive Behaviors 34 (pp. 782–785). Retrieved February 21, 2011 from http://dionysus.psych.wisc.edu/Lit/Articles/Bonn-MillerM2009a.pdf

Carpenter, K.M., McDowell, D., Brooks, D., Cheng, W., (2009). A Preliminary Trial: Double-Blind Comparison of Nefazodone, Bupropion-SR and Placebo in the Treatment of Cannabis Dependence.  American Journal of Addiction. 18(1). (pp 53-64).

Copeland, J. & Swift, W. (2009). Cannabis use disorder: epidemiology and management. International Review of Psychiatry. 21(2) (pp. 96-103).

Hasin,  D., Keyes, K., Alderson,  D., Wang, S., Aharonovich, E. & Grant, B. (2008). Cannabis withdrawal in the United States: results from NESARC.  Journal of Clinical Psychiatry 69(9). (pp. 1354-63).

Preuss, U.W, Watzke, A.B., Zimmermann, J., Wong, J.W., Schmidt, C.O. (2010). Cannabis withdrawal severity and short-term course among cannabis-dependent adolescent and young adult inpatients. Drug and Alcohol Dependency 106(2-3) (pp. 133-41).