The cannabis withdrawal syndrome: current insights.

IF 5.1 Q1 SUBSTANCE ABUSE
Substance Abuse and Rehabilitation Pub Date : 2017-04-27 eCollection Date: 2017-01-01 DOI:10.2147/SAR.S109576
Udo Bonnet, Ulrich W Preuss
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Abstract

The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.

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大麻戒断综合征:当前的见解。
大麻戒断综合征(CWS)是大麻使用障碍(CUDs)(《精神疾病诊断与统计手册-第五版》)和大麻依赖(《国际疾病分类》[ICD]-10)的一项标准。来自动物和人体研究的一些证据表明,长期和定期停止使用大麻会引发一种特殊的戒断综合征,主要表现为轻度至中度的情绪和行为症状,通常可以在门诊环境中得到治疗。经常吸食大麻与人脑大麻素 1(CB1)受体的脱敏和下调有关。这可能构成 CWS 持续时间的神经生物学时限,但不考虑戒断前长期吸食大麻引起的细胞和突触长期神经可塑性,例如,这可能是大麻渴求的原因。CWS 的严重程度取决于戒烟前的大麻使用量、性别、遗传因素和若干环境因素。因此,CWS 的自然严重程度差异很大。女性报告的 CWS 比男性严重,包括恶心和胃痛等身体症状。合并精神或躯体疾病、严重的 CUD 和社会功能低下可能需要住院治疗(最好是合格的戒毒治疗)和急性期后康复治疗。加巴喷丁和δ-9-四氢大麻酚类似物在治疗 CWS 方面取得了可喜的成果。米氮平可用于治疗 CWS 失眠症。根据小规模研究,文拉法辛会加重 CWS,而其他抗抑郁药、阿托西汀、锂、丁螺环酮和地丙戊酸则没有相关影响。当然,还需要进一步研究 CWS 治疗环境对长期 CUD 预后的影响,以及治疗 CWS 的精神药理学或行为学方法,如有氧运动疗法或心理教育。建议对最新的 ICD-11 Beta 草案进行扩充,增加 CWS 的物理症状、CWS 强度和持续时间的具体说明以及性别影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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