Signs and Symptoms
Marijuana is a widely used drug that has been a topic of much debate, especially with regards to its long-term effects and addiction potential. However, long-term marijuana use has been known to cause people to experience cravings when they try to quit.
Cravings are persistent and intrusive thoughts and a strong desire to use a drug. Some people who use marijuana and experience cravings falsely believe that the only way to get rid of them is to use more marijuana. But cravings are a common experience when trying to quit marijuana, and they can be effectively managed.
For marijuana users, cravings have been found to be related to factors such as location, companionship and time of day.1
Cravings tend to be strongest:
- In situations where marijuana has previously been used.
- With peers who also use marijuana.
- In the evening hours.
Symptoms of cravings include:
- Difficulty sleeping.
- Vivid or “weird” dreams.
- Changes in appetite.
- Nausea or stomach pain.
- Low motivation.
- Depressed mood.
- Irritability or aggression.
When Do They Start?
Symptoms typically begin within 1 week of quitting marijuana and may persist for weeks to months.2 The intensity of symptoms depends on the amount of marijuana used, with heavier users usually experiencing stronger cravings and more severe symptoms.
Cravings in the Brain
Cravings can be experienced on both a physical and a mental level, and likely reflect several specific brain processes. Functional Magnetic Resonance Imaging (fMRI), which measures brain activity by looking at blood oxygen levels, has found that the reward pathway of the brain is heavily involved in the experience of cravings.3 Simply being exposed to a marijuana trigger – like a pipe or rolling papers – can increase activity in the following brain regions or structures:
- Ventral tegmental area. Houses some of the brain’s reward circuitry and is involved with motivation, as well as cognitive and emotional processing.
- Thalamus. Relay point for numerous sensory pathways.
- Amygdala. Responsible for emotions such as anger and fear.3
Long-term marijuana use also affects regions of the brain responsible for memory, such as the hippocampus. 4 The neural biochemical mechanisms that underpin a marijuana craving are similar to those that occur with cravings for other drugs – including cocaine, heroin and alcohol.3
When considering the impact of marijuana on the brain, it is no surprise that former marijuana users experience significant physical and mental discomfort when trying to quit, especially in the first 10 days. 5
Treatment and Medications
When cravings become overwhelming, the risk for relapse significantly increases. Fortunately, relapse prevention strategies from cognitive behavioral therapy are effective at helping people cope with marijuana cravings: 6
- Challenging beliefs about cravings. The first step in managing cravings is having an understanding of what they are and getting rid of any false beliefs. Many people see cravings as bad, which causes them to feel guilty when they have an urge. Instead, cravings are a normal experience that should not cause shame.
- Learning to control your cravings. It is important to remember that cravings may cause you to feel something, but they cannot cause you to do anything. Cravings will not harm you and cannot make you relapse. You have the power to decide how you will react to your cravings.
- Practicing urge surfing. Urge surfing is a tool that involves imagining cravings to be like waves. As the wave comes toward you it peaks in intensity, but if you ride it out it eventually passes. Though cravings will feel especially uncomfortable when the wave is at its peak, they will not stick around forever.
- Using delay and distraction techniques during the peak of the craving. Try to completely engage your mind with something non-marijuana related, such as watching television or reading a book. For some people, journaling or talking about the craving can actually make the craving feel worse. You can also delay by setting a timer for an hour, engrossing yourself in a distraction, and then reassessing your craving afterwards. Most likely your craving will not feel as intense.
Coping With Physical Symptoms
Marijuana cravings are often strongest in the first 10 days of quitting, when the body is also experiencing withdrawal symptoms. During this time cravings can also be managed by coping with the physical and psychological symptoms that arise:
- Insomnia, or the inability to sleep, is common when quitting marijuana. Many users have disrupted sleep patterns to begin with and use marijuana as a sleep aid. To ease sleeping issues avoid caffeine, exercise and watching television in the evening hours. Meditation and deep breathing exercises can be helpful before going to bed. If sleeping issues persist, consider seeing a doctor.
- Irritability and frustration can be managed by practicing deep breathing exercises to decrease your heart rate. Often irritability can result in saying or doing something based on a negative emotion, rather than rationally thinking about the situation. Exercise can also be beneficial for relieving frustrations and releasing endorphins.
- Depressed or unstable mood is common when quitting marijuana. This can be quite distressing for former marijuana users who have become accustomed to the euphoric feeling of being high. Brainstorm different activities that you have found enjoyable in the past, perhaps before using marijuana. Persistent, profoundly depressed mood may require further evaluation and management under the care of a medical or mental health professional.
Research on medications to treat marijuana cravings has produced mixed results. However, some medications may be beneficial:
- N-acetylcysteine is a medication used for a variety of purposes, but it has recently been found to reduce marijuana cravings in teenagers. 7 It may work better when combined with psychotherapy or other addiction treatment.
- Baclofen (a skeletal muscle relaxer) and mirtazapine (an antidepressant medication) have decreased physical withdrawal symptoms and people’s reports of cravings for marijuana. But they have not have any effect on relapse rates. 8
How Long Does It Take for Them to Go Away?
Marijuana cravings are often strongest during the first 2 weeks of abstinence. However, cravings may continue to persist for months or even 1 to 2 years after quitting. Often the intensity of cravings decreases over time. Stressors, such as the loss of a loved one or the loss of a job, may trigger cravings even after a prolonged period of abstinence.
Cravings are typically stronger for people who have used marijuana longer, with greater frequency and in larger amounts.
Cravings After Being Sober
Cravings are common even after a person has been sober for a period of time. When marijuana has been a significant part of your life, it can be difficult to cope with life’s stressors without it. Using healthy coping skills and resources may feel unnatural, especially in the beginning. It can take frequent practice to replace the habit of using marijuana with relapse prevention tools.
In a long-term study of addiction and recovery, researchers found that even after 5 years of sobriety, the chance of relapse is close to 15%. 9 Being sober for a period of time does not necessarily make cravings go away.
Former marijuana users may continue to crave marijuana for many reasons:
- Using marijuana can be a habit that is difficult to unlearn.
- Marijuana has an impact on the reward centers of the brain. This pleasurable feeling leaves the user wanting more.
- The positive effects of marijuana, such as euphoria, become associated with different cues in the environment—e.g., being in a certain place, hearing a song on the radio, or seeing a friend. When a person is exposed to those cues, the desire for marijuana can come rushing back.
- When a person becomes sober there is a tendency to remember the positive aspects of the drug and forget or ignore its negative aspects. This is often called “romanticizing.”
- Many marijuana users begin using drugs to cope with a feeling, such as social anxiety or depression. When a person becomes sober these feelings do not necessarily go away, and in some cases initially become worse.
Though cravings for marijuana can persist well into sobriety, cravings can feel less distressing over time by using the tools described above. The more often that you are able to overcome an urge without using, the greater your sense of control over cravings, and the more likely that you will continue to use healthy tools to manage cravings in the future.
Detox and Withdrawal Risks
Quitting marijuana can result in a pattern of physical and mental withdrawal symptoms, including: 10
- Loss of appetite.
- Weight loss.
- Lack of sleep.
- Stomach problems.
Many people detoxing from marijuana also experience significant cravings that can feel unbearable at times. In heavy users, withdrawal symptoms typically begin within 1 to 3 days after stopping and reach their greatest intensity during the first week.2
For most people severe symptoms will go away within 2 weeks.2 However, milder symptoms can persist for months after quitting marijuana. This is because THC, the active chemical in marijuana, is stored in fat cells and can take several months to be completely removed from the body.
When to Seek Medical Attention
Treatment centers can provide education, tools, and support for managing cravings.
Marijuana withdrawal symptoms are generally not dangerous, and many people detox from marijuana on their own. However, those who have been diagnosed with depression or bipolar disorder may be at greater risk for experiencing depression during detox. If you feel you may be at greater risk, you should consult with a medical and/or mental health professional.
Treatment programs are available to assist with the detox process and can closely monitor your symptoms. Detoxing at a treatment center is highly recommended if:
- You have a history of a mood disorder or other mental health diagnosis.
- You have ever had suicidal thoughts.
- You were a frequent user.
- You used large amounts of marijuana.
- You used other drugs with marijuana.
- You are experiencing significant cravings.
In addition to detox, treatment centers can provide a safe environment to manage marijuana cravings when they are at their highest intensity. After detox, treatment centers can provide education, tools, and support for managing cravings and preventing relapse.
Frequently Asked Questions
Where Can I Take the Marijuana Craving Questionnaire?
The Marijuana Craving Questionnaire is a well-researched tool used to measure marijuana cravings.11 It has been translated into several different languages, and it can be easily scored using pen and paper.
. Shrier, L. A., Walls, C. E., Kendall, A. D., & Blood, E. A. (2012). The context of desire to use marijuana: Momentary assessment of young people who frequently use marijuana. Psychology of Addictive Behaviors, 26(4), 821-829.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
. Filbey, F. M., Schacht, J. P., Myers, U. S., Chavez, R. S., & Hutchison, K. E. (2009). Marijuana craving in the brain. Proceedings of the National Academy of Sciences, 106(31), 13016-13021.
. Block, R. I., O’Leary, D. S., Hichwa, R. D., Augustinack, J. C., Ponto, L. L. B., Ghoneim, M. M., & Nathan, P. E. (2002). Effects of frequent marijuana use on memory-related regional cerebral blood flow. Pharmacology Biochemistry and Behavior, 72(1), 237-250.
. Kouri, E. M., & Pope Jr, H. G. (2000). Abstinence symptoms during withdrawal from chronic marijuana use. Experimental and Clinical Psychopharmacology, 8(4), 483-492.
. Rees, V., Copeland, J. and Swift, W. (1998). A brief cognitive-behavioural intervention for cannabis dependence: Therapists’ treatment manual. NDARC Technical Report No. 64.
. Gray, K. M., Carpenter, M. J., Baker, N. L., DeSantis, S. M., Kryway, E., Hartwell, K. J., & Brady, K. T. (2012). A double-blind randomized controlled trial of N-acetylcysteine in cannabis-dependent adolescents. American Journal of Psychiatry, 169(8), 805-812.
. Haney, M., Hart, C. L., Vosburg, S. K., Comer, S. D., Reed, S. C., Cooper, Z. D., & Foltin, R. W. (2010). Effects of baclofen and mirtazapine on a laboratory model of marijuana withdrawal and relapse. Psychopharmacology, 211(2), 233-244.
. Dennis, M. L., Foss, M. A., & Scott, C. K. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.
. Budney, A. J., Moore, B. A., Vandrey, R. G., & Hughes, J. R. (2003). The time course and significance of cannabis withdrawal. Journal of Abnormal Psychology, 112(3), 393-402.
. Heishman, S. J., Singleton, E. G., & Liguori, A. (2001). Marijuana Craving Questionnaire: development and initial validation of a self-report instrument. Addiction, 96(7), 1023-1034.
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