“The consequences of a cannabis detox are pretty much wishing you had some weed,” says Joe Schrank, a social worker, in a recent advice column by A.J. Daulerio. 

Said with a touch of jest, it underscores the common perception that weed can’t be a “real” addiction as Daulerio answers a query from someone who thought cannabis was not addictive, yet struggles to quit. Daulerio, a writer of The Small Bow, a newsletter of addiction and recovery stories, replies to the letter writer with kindness. Yes, he confirms:  Cannabis can be hard to quit. In a significant percentage of cases, it can lead to Cannabinoid Hyperemesis Syndrome, characterized by uncontrollable urges to vomit.

Withdrawal may not be life-threatening but the symptoms can be a dime bag of unpleasantness: anger, anxiety, disrupted sleep, depressed mood, headaches, stomach pains, nervous tension and/or sweating reports the National Library of Medicine. These symptoms typically begin within one to two days, peak within two to six days, and last for several weeks.

More people have problems discontinuing cannabis use than is commonly appreciated.

Cannabis Use Disorder

For a substance with a “chill” reputation, the potential for addictive use patterns — also known as “cannabis use disorder” — can impact three of 10 regular users, says the Centers for Disease Control.

David A. Gorelick, M.D., Ph.D., writes in The New England Journal of Medicine that “16.2 million persons met the diagnostic criteria for cannabis use disorder, which has as its core feature the use of cannabis despite adverse consequences,” adding:

Cannabis use disorder often occurs alongside other psychiatric conditions, including other substance use disorders. About two thirds of persons given a diagnosis of cannabis use disorder have at least one other current substance use disorder, most commonly alcohol or tobacco.

It is not uncommon to have multiple substance use disorders, especially if the substances are typically used at the same time and in similar settings. For example, approximately 90% of cannabis users are also tobacco smokers, report researchers in Substance Abuse and Rehabilitation.

Back to Daulerio’s advice column, where he confirms the legitimacy of both weed  addiction and withdrawal:

That addiction — the cravings, the time spent using — can lead to “a dramatic decrease in quality of life,” Christina Brezing, a psychiatrist at Columbia University, told [T]he New York Times. And unfortunately, according to that Times article, the best your doctor can do for you in terms of medication is probably just stuff to help manage the symptoms. “There is an urgent need to develop effective treatments, either behavioral or pharmacological, for cannabis use disorder,” psychiatrist Deepak Cyril D’Souza said in a Yale Medicine FAQ on cannabis use disorder, which also noted that various kinds of therapy can help in the meantime.

Note the last line: “various kinds of therapy.” In the absence of proven behavioral or pharmacological support, those who wish to quit must rely on therapy and/or devise their own therapeutic methods. 

Daulerio shares an account from his friend “C” (an alias) who breaks down her approach thusly: accepting the validity of the problem, reducing before eliminating, finding a support group, and preparing the mind to quit (in this case, by using the book, The Easy Way to Quit Cannabis by Allen Carr). She further advises: “People who tell you there’s nothing wrong with your habit or that you’re not really addicted don’t know you or what you’re going through, so avoid those folks or online communities.”

DIY behavioral approaches are not limited to cannabis cessation. In A Unified Theory of Addiction, Dr. Robert Pretlow, publisher of AddictionNews, posits that all addictions begin with the human need for stress release.

From this position, Dr. Pretlow outlines some of the elements of the universal treatment for addiction:

• Cue Avoidance
• Stress Management
• Just-in-Time Support
• Depth of Support
• Self-Directed
• Social Element
• Compensation
• Gamification

These elements are deceptively simple; yet, when used together, they can change a user’s mind and redirect behavior. In fact, you’ll notice that “C”’s advice touches on a few of them. How much better would “C”’s advice be if one could develop a self-directed program that included more of these elements?

A DIY approach is not unheard of given that the FDA has not approved any medications to support cannabis cessation. This may change; the explosive use of GLP-1 medications to control diabetes, and used off-label for weight-loss, have brought with them anecdotal reports of reduced alcohol and cannabis cravings.

Still, in the absence of pharmaceutical treatment many who wish to quit cannabis must rely on therapy.

Dr. Gorelick again in the NEJM:

The most robust evidence of efficacy is for cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET). CBT emphasizes identification and management of the patient’s thoughts, behaviors, and external triggers that promote cannabis use. MET is a directive, patient-centered form of psychotherapy that aims to enhance the patient’s motivation to reduce or stop cannabis use by using personalized feedback and education regarding the patient’s maladaptive patterns of cannabis use.

Concerns around cannabis use tend to focus on dangers associated with using while driving, accidental ingestion by children or pets, and damage to the lungs if smoked. These are valid, but they are not the only cannabis risks. Cannabis can trigger addictive use patterns, too. Cannabis use disorder benefits from CBT and/or MET therapies. Both therapies share elements outlined in Dr. Pretlow’s universal treatment for addiction.

Written by Katie McCaskey. First published October 14, 2024.

Sources:

“I Want to Quit Weed. My Doctor Can’t Seem to Help Me.,” Slate, September 30, 2024.

“Clinical management of cannabis withdrawal,” NIH, January 10, 2022.

“Cannabis-Related Disorders and Toxic Effects,” The New England Journal of Medicine, December 13, 2023.

“The cannabis withdrawal syndrome: current insights,” Taylor & Francis Online, April 27, 2017. 

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