Tuesday, December 1, 2015

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Marijuana Detox: Withdrawal Symptoms and How to Cope

How to get past the first 2 weeks of marijuana withdrawal symptoms. Learn what to expect from marijuana withdrawal, with tips and suggestions for coping with individual withdrawal symptoms.

People who claim that marijuana is not addictive have obviously never spent a sleepless night of headaches and nausea lusting for just that little something to take the edge off.

Marijuana detox is tough, and the withdrawal pains are very real and strong enough to keep a lot of people using more than they want for longer than they want to. Because marijuana detox doesn’t present with an obvious physical syndrome of symptoms, and because enduring social perceptions about the drug were formed in decades past, when the potency of marijuana was nowhere near what it is today, there exists a lingering misperception about the severity of marijuana detox and withdrawal pains.

Marijuana Detox Is Real

Marijuana withdrawal symptoms are real, they are medically recognized as such, and have been for years. Marijuana detox is not physically dangerous but they can be very uncomfortable, and since the cravings during a period of marijuana detox can be so strong; marijuana detox presents a significant obstacle to sobriety and the bettering of a marijuana addiction.

Marijuana is addictive, the health risks of frequent use are many, and the benefits inherent in quitting make an attempt at detox a very good idea.

Research shows that a substantial percentage of heavy marijuana users will experience at least some withdrawal symptoms when quitting. In one major study of 500 heavy smokers, 59% experienced cravings and more than half experienced sleeping difficulties.¹
The cumulative discomfort of withdrawal symptoms is severe enough to cause many people to abandon their quit attempts and go back to chronic use.

So though marijuana withdrawal symptoms won’t hurt you directly, if they keep you from quitting, they still exert a profound influence on your lifelong health and wellbeing.

If you choose to quit, don’t let marijuana withdrawal symptoms stop you. Read on to learn:

What withdrawal symptoms to expect (and how long they last).
About marijuana withdrawal medication options.
Ways to manage individual withdrawal symptoms, to make it past the first difficult week.

Marijuana Withdrawal Symptoms

Not all heavy chronic marijuana users will experience withdrawal symptoms upon quitting. For those that do, marijuana withdrawal symptoms can include:²

Insomnia
Vivid dreams
Anxiety and feelings of nervousness
Depression
Moodiness
Irritability
Loss of appetite
Abdominal pains
Nausea
Headaches
Sweating
Fever
Chills
Restlessness
Marijuana cravings

Timeline

Symptoms typically emerge on the first quit day and peak within 2 or 3 days. Symptoms generally dissipate by a week or two, though insomnia can linger beyond this point for 30 days or longer.
Most people find that symptoms come and go over the first few days.
While many people find that no one symptom is overwhelming, the additive effect of a combination of symptoms can become quite distressing.

The APA’s DSM-5 Cannabis Withdrawal Diagnostic Guidelines

Do you meet the criteria for a medical diagnosis of cannabis withdrawal?

The American Psychiatric Association included cannabis withdrawal in its latest diagnostic manual, the DSM-5. To meet the APA’s diagnostic criteria you must:³

1. Have just quit marijuana after a period of heavy and prolonged use.

2. Experience 3 or more of the following symptoms within a week of quitting.

Anger, irritability or aggression.
Nervousness and anxiety.
Insomnia or other sleep difficulties (vivid dreams.)
Restlessness.
Reduced appetite.
Depressed mood.
Physical symptoms causing significant discomfort, like shakiness, headaches, fever, sweating, chills or abdominal pains.

3. Your withdrawal symptoms must cause you significant distress or interfere with normal social or occupation functioning.

4. Your symptoms must not be better explained by another physical or mental health disorder or from intoxication or withdrawal from another substance.

Do You Need Inpatient Detox?

Marijuana withdrawal symptoms may be uncomfortable, but they aren’t normally severe enough to warrant a need for hospitalization. Inpatient or residential detox treatment is rarely needed, except possibly when:⁴

There is a co-occurring severe uncontrolled mental or physical illness.
You are also withdrawing from other substances.
You have no safe or stable environment for the withdrawal process.
You have tried on multiple past occasions to make it through marijuana withdrawal without success.
You have a history of serious aggression or violence. Especially if past withdrawal attempts have prompted violent outbursts.

Factors That Affect Withdrawal Severity

The severity of marijuana withdrawal can vary greatly, even between people with seemingly similar use histories. Factors known to influence marijuana withdrawal include:

Your degree of dependence – the more addicted you are, the more likely you are to experience withdrawal symptoms.
Your past and recent use history – a longer history of regular use and heavier recent use are both associated with more difficult withdrawal symptoms.
Expecting difficult withdrawals – your expectations also play a role. Like a self-fulfilling prophecy, if you expect the worse, you’re more likely to experience difficult withdrawals.
Having a co-occurring mental illness.
Getting forced into an involuntary withdrawal – such as when you can’t access any marijuana.

In general, adults tend to experience more severe symptoms than adolescents, most likely due to longer use histories.⁵

Medications for Marijuana Withdrawal Symptoms

Unfortunately, the one medication that effectively reduces withdrawal symptoms is one medication you’re not likely to get prescribed – oral THC (like Marinol.)⁶

Since you can’t access medications to reduce withdrawal intensity, you can only treat the individual symptoms. As always when considering new medications, talk to your doctor first.

Medications sometimes used to treat marijuana withdrawal symptoms include:

For insomnia and anxiety – Sedating antihistamines such as Benadryl (diphenyhydramine), Z-drugs, like zolpidem (Ambien) and various benzodiazepines (clonazepam, diazepam etc.). Sedating antihistamines will only work for a short period as you grow quickly tolerant to the sedation. Both the Z drugs and the benzodiazepines are extremely habit forming.⁷
For headaches and muscle pains and spasms – Paracetemol or ibuprofen.
For nausea and vomiting - Metoclopramide or promethazine.

Though medications may help to take the edge off, behavioral techniques can help more to reduce discomfort. Read on for coping suggestions for various withdrawal symptoms.

Coping with Individual Withdrawal Symptoms

Once you make it past the first period of intense withdrawals (usually the first week or so) your odds of staying quit go up substantially. With preparation and education, you improve your odds of making it through, Read on to learn how to manage the worst of the withdrawal symptoms.

Marijuana Insomnia

Marijuana insomnia is one the most common and enduring withdrawal symptoms, and unfortunately, a lack of sleep tends to worsen the severity of other symptoms. You may never sleep well during the first period of withdrawal, but anything that improves your situation helps reduce your overall discomfort.

Cut out or cut-back on caffeine (this can also help to reduce your anxiety.) If you are addicted to caffeine, complete abstinence could lead to headaches and other caffeine withdrawal symptoms, so you can just cut back a bit and limit caffeinated drinks after mid afternoon.
Avoid stimulating vigorous exercise for a couple of hours before bed time.
Avoid staring at screens (TV, tablet, phone, computer, etc.) for a couple of hours before bed time (the blue light emitted by these devises mimics daylight and tricks your body into wakefulness.)
Make your bed and bedroom comfortable and inviting. Avoid spending time in bed for anything or than sleep or sex.
Eliminate extraneous light and sound from your sleeping environment.
If you really can’t sleep, don’t just lay in bed agonizing about it, get out of bed and do something relaxing for a half hour so – reading is great – and then try again.
Consider herbal medications such as valerian root or melatonin.

Insomnia for a month or more = a possibly unrelated sleep disorder. Marijuana withdrawal insomnia may last longer than other typical symptoms, however, according to the APA, if insomnia persists for longer than about a month after your quit day, you may have an independent – non-marijuana related, sleep disorder.

Marijuana Withdrawal Irritability

When you feel moody, take a deep breath and remind yourself your irritability is just a passing symptom of withdrawal and that you don’t have to act on any aggressive impulses.⁸
Try deep breathing exercises, or just focus on taking slow controlled breaths.
Count slowly to 10 in your head before responding to anyone with negativity.
Remove yourself from an anger-provoking situation before you do something you’ll regret.
Respond to feelings of anger with aerobic exercise. This helps you bleed-off nervous energy.
Ask for patience and understanding from loved ones for your cranky behaviors during the first few days!
Apologize quickly to anyone you treat poorly when irritable. This will make both you and your ‘victim’ feel better.

Marijuana Withdrawal Anxiety and Depression

A hot bath can ease anxiety – and a number of other marijuana withdrawal symptoms.
A half an hour of moderate exercise can ease anxiety and depression, tire you out physically to help with insomnia, stimulate appetite and help you manage periods of intense craving. You probably won’t feel like getting off the couch, but it will make you feel better.⁹

Marijuana Withdrawal Nausea and Loss of Appetite

Avoid overly spicy or fatty foods.
Since cooking smells can turn a queasy stomach, have someone else prepare your food for you.
Try eating cold foods, as these tend to smell less strongly than hot foods.
Do not eat and drink at the same time. Drink after you’re done your meal.
Don’t lie down while eating or for a few minutes after finishing.
A popsicle can sometimes help to reduce feelings of nausea.

Marijuana Withdrawal Headaches

Take OTC pain relievers, like acetaminophen or ibupforen.
Stay hydrated.
Stave off tension headaches with relaxation techniques, such as slow breathing, progressive muscle relaxation or meditation.
Eat at least small amounts of food on a regular basis.
Get out of your stuffy room and get some fresh air.

Managing Marijuana Cravings

Marijuana cravings can be intense during the first week after quitting. It can feel as though they’ll never stop or ease-up, but they will. If you can hold out for a week, you’ll find that cravings dissipate substantially.

You can manage cravings with a technique called the 4 D’s.¹⁰

Distracting
Delaying
De-Catastrophizing
De-Stressing

1. Distracting

Though at the outset, a craving can feel like it will never end, in reality, virtually all cravings disappear within 30 minutes, and the more often you resist your cravings, the weaker they become.

When you feel a craving coming on, distract yourself by getting busy doing something else (washing the dishes, walking the dog – whatever!) by the time you’re done, your craving will be gone.

2. Delaying

You don’t have to delay forever – just for 30 minutes.

If you feel like you can’t hold on any longer and you’re about to give-up, delay lighting up for 30 minutes. Promise yourself that if after 30 minutes you still need to smoke, you’ll do so (fortunately, by 30 minutes your craving will have passed.)

To increase your odds of success, plan in advance what you’ll do while you wait – for example, walk around the block, call a friend, take a shower or tidy your room.
It’s a lot easier to wait while engaged in something active than it is when staring at a ticking clock.

3. De-Catastrophizing

In the midst of a strong craving it’s easy to get caught up in ‘end-of-the-world’ type thinking. For example, “I can’t take it any longer.” Or, “I’ll die if I don’t smoke right now.” Or, “these cravings are never going to go away.”

Fortunately, none of these exaggerated statements are true, so when you catch yourself moiled in catastrophic thinking, reexamine and reframe - change:

“I can’t take it any longer” to “this is really uncomfortable, but I know it won’t last forever.”

4. De-Stressing

Cravings cause stress and stress makes everything worse – including the intensity of your cravings!¹¹ Therefore, anything you can do to relax before and during a craving reduces the intensity of the experience. Ideas to try include exercise, getting into nature, a hot bath, yoga or massage and many others.

Besides stress, getting overly tired, hungry or thirsty can also increase the severity of your cravings, so try to eat regularly, stay hydrated and get as much sleep as you can (it can be challenging).

Another great way to manage cravings is to ‘surf them’ with a technique called urge surfing.

Long Term Withdrawal Symptoms

Though marijuana insomnia can persist for longer than a month, most withdrawal symptoms should disappear by about 2 weeks after your quit date. If you still feel withdrawal symptoms after this point, you may want to see a counselor or doctor to get checked for underlying conditions.

In some cases, people turn to marijuana to self-medicate mood disorders and other problems. With abstinence, mood disorder symptoms can return.

Finding Success

If you decide to quit marijuana, you increase your chances of success by learning about marijuana withdrawal, preparing to cope with symptoms and accepting your symptoms as transient signs of change - withdrawal symptoms aren’t fun, but they won’t last forever.

If you find that even with planning and coping efforts you cannot get past the discomfort and you continually relapse back to use, consider seeking professional help.

There is nothing wrong with getting help to achieve a life-changing goal and everything wrong with ignoring help and continuing to use a drug that you no longer want to use.

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