CONSUMPTION PATTERNS AND WITHDRAWAL SYMPTOMS IN DUAL CANNABIS-TOBACCO USERS IN SPAIN: CROSS-SECTIONAL STUDY

Background

Cannabis use has increased worldwide, with over 188 million users annually. In Spain, past-year prevalence among people aged 15–64 is 10.6%. Dual use of cannabis and tobacco is common, increasing health risks and complicating cessation. This study examines consumption patterns and cannabis withdrawal severity among dual users undergoing treatment for cannabis use disorder (CUD).

Methods

A cross-sectional study was conducted in substance use treatment programs in Catalonia, Spain. Participants were cannabis users initiating CUD treatment. A questionnaire collected sociodemographic data, cannabis and tobacco use characteristics (e.g., number of spliffs, tobacco amount), nicotine dependence, motivation to quit, and cannabis withdrawal symptoms. Descriptive and bivariate analyses were used to examine consumption differences. A hierarchical cluster analysis using Gower's distance identified behavioral patterns among participants.

Results

Data from 94 participants seeking CUD treatment were included. Daily tobacco use was reported by 91.5%, with a mean Fagerström score of 4.2/10. Most participants (88.1%) co-used cannabis with tobacco, and 75.8% experienced cannabis withdrawal symptoms, with women reporting greater severity. Cluster analysis revealed two profiles: Cluster 1 (71.0%) included mostly older males with higher motivation to quit and fewer withdrawal symptoms; Cluster 2 (29.0%) was younger, more gender-balanced, and showed higher nicotine dependence, and more severe withdrawal symptoms.

Conclusions

Co-use of cannabis and tobacco is highly prevalent among individuals entering CUD treatment. Higher nicotine dependence is associated with more severe withdrawal symptoms. Older males with higher motivation and fewer withdrawal symptoms may have better prognosis, highlighting motivation as cessation predictor. Findings are directly applicable to respiratory care, as identifying high-risk dual users can guide integrated cessation strategies and potentially reduce chronic respiratory disease.

Key words: Cannabis use disorder; tobacco use; co-use; nicotine dependence; cannabis withdrawal; motivation to quit; hierarchical clustering; substance use treatment

Funding

The DuCATA_GAM-CaT study was partially funded by the Spanish National Plan on Drugs (Grant 2020I034) and by the Instituto de Salud Carlos III (ISCIII; Grant FI21/00699). JS holds a predoctoral contract funded by ISCIII (Grant FI22/00017), co-funded by the European Social Fund (ESF; “Investing in your future”). JS, ME, EF, YC, MB, MF, and CM are partially supported by the Ministry of Universities and Research of the Government of Catalonia (Grant 2021SGR00906). We also acknowledge institutional support from the CERCA Programme of the Government of Catalonia to IDIBELL.

Acknowledgments

We are grateful to the individuals who participated in this study for their time and valuable contribution.