Despite early evidence from animal studies and human observations, medical experts doubted the existence of marijuana addiction until the 1990s. Skepticism focused on whether cannabis can result in ‘physiological’ dependence, and whether withdrawal symptoms were of clinical significance.
Due to this early reluctance and the recent legalization of medical and recreational marijuana in many states, a prevailing misconception that marijuana is not addictive persists throughout America.
The truth is that particular compounds in marijuana are addictive, and quitting after regular, long-term use can cause withdrawal symptoms. These physical and psychosocial withdrawal symptoms are collectively known as Cannabis Withdrawal Syndrome.
Cannabis Withdrawal Syndrome
Cannabis withdrawal syndrome is now officially recognized on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 ) with a list of defined diagnostic criteria. The withdrawal symptoms are typically not as severe as those induced by other substances, like alcohol, opioids, and heroin. Still, the implications of marijuana withdrawal are severe and include an increased risk of relapse and reduced wellbeing.
According to the Centres for Disease Control and Prevention (CDC), 1 in 10 people who use marijuana will become addicted. That number increases to 1 in 6 when users start before the age of 18.
Symptoms of Marijuana Withdrawal
Symptoms of marijuana withdrawal can range from mild to severe and vary according to the individual’s degree of cannabis dependence before quitting. Smoking marijuana occasionally is unlikely to cause withdrawal symptoms. However, those who regularly consume for extended periods of time are likely to experience physical and psychological withdrawal symptoms.
For example, an individual with mild dependence may experience light anxiety and sleep disturbance but will function normally at work or school and feel confident in his/her ability to abstain from using marijuana. In comparison, those with severe dependence or addiction are likely to experience more intense withdrawal symptoms, including sweating, fever, chills, and insomnia. Generally speaking, the longer a person has used marijuana, the more intense their symptoms will be.
According to the DSM-5, the clinical symptoms of marijuana withdrawal syndrome include:
- Sleep disturbance, including insomnia and vivid dreams
- Diminished appetite/weight loss
- Depressed mood
- Abdominal pain
- Muscle tremors
These symptoms occur in 55% – 89% of patients who quit cannabis after long-term and regular use.  Some research shows that women are more likely to report stronger symptoms, particularly nausea and stomach pain. However, overall, research suggests that the side effects of marijuana withdrawal are usually of light to moderate intensity. 
Timeline of Marijuana Withdrawal Symptoms
Marijuana withdrawal onset typically occurs within 24–48 hours after abrupt reduction or cessation. Most symptoms reach peak magnitude within 2–5 days of abstinence and will begin to reside and return to baseline levels within 2–3 weeks on average. 
The physical symptoms of marijuana withdrawal tend to reside once the drug has cleared from the person’s system, although psychological symptoms, including sleep disturbances, can persist longer.
Importantly, several lines of evidence indicate that cannabinoid receptors begin to reverse after two days of cessation and return to normal functioning within four weeks. However, less is known about the recovery of cellular and synaptic changes elicited by long-term cannabis use.
Cause of Marijuana Withdrawal Syndrome
When someone uses marijuana regularly for an extended period of time, their nervous system undergoes complex adaptations that lead to diminished response— e.g. the development tolerance.
Tetrahydrocannabinol (THC), the psychoactive cannabinoid in marijuana, works by stimulating cannabinoid receptors on the brain and spinal cord. A resulting abnormal increase in the activity of CB1 receptors produces the psychological ‘high’ typically associated with marijuana,
With repeated and prolonged exposure to THC, the brain takes action to preserve normal activation patterns through desensitization and downregulation of CB1 receptors. It achieves this by reducing the number of CB1 receptors on the surface of cells (internalization), interfering with G-protein coupling between THC and CB1 receptors (uncoupling), and reducing gene expression of CB1 receptors. 
Fortunately, these neural adaptations begin to reverse after two days of quitting and return to normal functioning after four weeks of abstinence. However, the nervous system will undergo THC withdrawal. 
Marijuana Withdrawal Treatment
The vast majority of marijuana withdrawal cases are mild-to-moderate and resolve without the need for formal intervention. Individuals with this mild level of withdrawal can typically self-manage their symptoms with daily exercise, relaxation techniques, and over-the-counter medications.
However, chronic users who have built up a tolerance may require further assistance through inpatient or intensive outpatient services and post-rehabilitation care. We recommend medically supervised marijuana detox programs for individuals with comorbidities, particularly mental health disorders, such as addiction. Addiction to alcohol or other types of drugs, including prescription pain or sleep medications, can make abstaining from marijuana more challenging.
Inpatient services are also especially helpful for individuals who have attempted to quit marijuana multiple times without success and those living in an unstable environment that encourages substance use.
Below is a list of facilities and professional services for the safe management of cannabis withdrawal syndrome:
Inpatient Rehabilitation Centers
Inpatient rehabilitation centers can play an instrumental role in helping dependent marijuana users break their addiction and restart their life in a powerfully positive way. These residential programs require participants to reside onsite for 30 to 90 days of medically monitored abstinence. Each participant typically has a private room and partakes in daily individual and group therapy sessions, in addition to complementary and recreational activities.
Like inpatient rehabilitation centers, detoxification centers require patients to remain onsite, although they are typically less than 28-days in duration. They offer short-term programs with around-the-clock medical supervision specifically designed to aid with physical withdrawal symptoms. Daily activities usually include a range of physical and psychosocial approaches, including cognitive-behavioral therapy and family groups.
Intensive Outpatient Programs (IOPs)
Intensive outpatient programs are specially designed to treat addictions that don’t require detoxification or constant supervision. These flexible programs enable participants to continue living at home while undertaking therapy sessions at a hospital or therapeutic facility. Although outpatient programs will vary from facility to facility, participants are generally required to attend 10-12 group and individual therapy sessions each week and partake in a 12-step program.
Post-Rehabilitation Services and Support Groups
Setting patients up for success after leaving their program is essential to preventing relapse and promoting a positive lifestyle free from cravings. Therefore, we recommend that recovering addicts commit to ongoing therapy sessions or join a peer support group. Social support from individuals going through the same thing can be immensely helpful. Two highly-regarded programs include Marijuana Anonymous (MA) and SMART Recovery.
Cognitive-behavioral therapy is common to all of the above services. It encompasses a range of psychosocial interventions designed to improve emotional regulation and coping strategies such as:
- Stress management training
- Skill-development groups
- Refusal training
- Relapse prevention
- Relaxation techniques, such as yoga and meditation
There are no pharmacological treatments currently approved for the management of marijuana withdrawal syndrome. Nonetheless, several pharmaceuticals have been studied in small, laboratory studies of short duration (typically 3–4 days).
Thus far, the only medication to successfully suppress withdrawal symptoms is a single oral dose of 10mg/day of synthetic THC (dronabinol) has been. Most other clinical trials have sown inconsistent results.
Entacapone reduced cannabis cravings in one clinical trial while Mirtazapine proved effective at treating withdrawal-induced insomnia. Anticonvulsants (Divalproex) and most antidepressants (Nefazodone, Fluoxetine, and Escitalopram) had no relevant effects, while Bupropion and Venlafaxine actually exacerbated symptoms. 
Further clinical trials are needed to evaluate the efficacy of these medications and to make any recommendations regarding the pharmacological treatment of marijuana withdrawal.
Independently Detoxing from Marijuana
When suffering from mild withdrawal symptoms, many individuals can safely manage their symptoms at home there are. Below are a few marijuana withdrawal tips that may help reduce the discomfort when detoxing from home:
- Hydration: drinking plenty of water will help clear fluids and facilitate the detoxification process.
- Daily exercise: research shows that daily cardiovascular exercise can reduce cannabis cravings in chronic users with dependency. Exercise can increase natural mood-regulating chemicals, including serotonin and dopamine, helping to ameliorate negative emotions, such as irritability, anxiety and depression 
- Relaxation techniques: engaging in regular, scheduled relaxation can help take the edge off cravings. You may like to try a yoga or meditation class or simply take a long, hot bath.
- Drink cranberry juice: drinking cranberry juice is a strategy used in many inpatient rehabilitation centres to facilitate the detoxification process.
Although the symptoms of marijuana withdrawal are mild in comparison to those inflicted by other drugs, such as cocaine, heroin and opioids, marijuana withdrawal can still be challenging, and supports are available to facilitate safe recovery. For further information and support with marijuana dependence and withdrawal, visit American Addiction Centers.