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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?
Cannabis: Evolution of a withdrawal model
• Organic/ home grown• Hydroponic: indoor grown, nutrients, pesticides• Skunk: selectively bred high potency• Synthetic: THC analogues added to vegetable
material
Cannabis: Evolution of a withdrawal model
“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?
Cannabis: Evolution of a withdrawal model
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?
Cannabis: Evolution of a withdrawal model
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.
Cannabis: Evolution of a withdrawal model
Audit of Clinical Practice
• Withdrawal • Synthetic v organic• Modified NCPIC Scale• 7/7
Cannabis: Evolution of a withdrawal model
Audit of Clinical Practice• N =28• Mainly inpatient• 2/3 male• Under 22• Single substance dependence
Cannabis: Evolution of a withdrawal model
• Audit of Clinical Practice• Linear decrease in symptom severity• Withdrawal lasts longer than 6 days
Cannabis: Evolution of a withdrawal model
Most common symptoms• Loss of appetite• Sleep disturbance• Low mood• Agitation• Cravings• Vivid dreams
Cannabis: Evolution of a withdrawal model
• Pragmatic• Client centred and driven• Staged reduction• Win-win paradox• Motivational
Cannabis: Evolution of a withdrawal model
• Diary• Negotiated reduction• Review• Further reduction• Cessation• Monitoring• Post withdrawal plan
Diary
Cannabis: Evolution of a withdrawal model
• Monitored: NCPIC Cannabis Withdrawal Scale• Plot severity, progress• Gauge adequacy of medication• Nutrition• Hydration
Cannabis: Evolution of a withdrawal model
Elements• Commitment• Diary• Pragmatic reduction• Frequent review• Cessation• Medication (Turning Point guidelines)• Symptom monitoring• Reinforcement and encouragement• Post withdrawal plan
Cannabis: Evolution of a withdrawal model
• Environment/ lifestyle• Sleep pattern (30/7+)• Dispose of drugs, paraphernalia• Alternatives• Social• Non compatible alternatives
Cannabis: Evolution of a withdrawal model
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.