Cannabis (hashish) withdrawal symptoms: how long they last and how addiction is treated

Cannabis withdrawal symptoms: what happens when you stop?

If you have stopped using hashish or bango (the Egyptian name for marijuana, or weed) after a period of regular use (both come from the cannabis plant, and in Tunisia and Algeria it is known as "zatla"), what you are feeling is most likely a medically described condition called cannabis withdrawal syndrome. It is not a character flaw and it is not in your head. It is not usually life-threatening, but it is unpleasant enough to push many people back to using in the first few days. The most common cannabis withdrawal symptoms are irritability and quick anger, trouble sleeping and disturbing dreams, loss of appetite, low mood and strong cravings.

The U.S. National Institute on Drug Abuse (NIDA) notes that withdrawal can appear after stopping, or sharply cutting down, heavy or long-term use, even in people who have not developed a cannabis use disorder, and that its symptoms include:

• Anger, irritability and a tendency toward aggression
• Nervousness, anxiety and restlessness
• Trouble sleeping, and strange or disturbing dreams
• Loss of appetite and weight loss
• Low or depressed mood
• Less common physical symptoms: headache, sweating, stomach pain and shakiness
• Cravings: the UK's FRANK drug information service notes that people who use heavily often get cravings and can find it hard to stop

Because many people believe cannabis "doesn't cause withdrawal," the numbers help here. In a systematic review and meta-analysis published in JAMA Network Open in 2020, covering 47 studies and more than 23,000 participants, cannabis withdrawal syndrome appeared in 47% of people with regular or dependent use when they stopped or cut down. The World Health Organization (WHO) notes that people who use cannabis over a long period are likely to develop a "dependence syndrome," in which they lose control over their use. If you are asking yourself whether you have reached that point, read Is hashish really addictive?.

How long does cannabis withdrawal last? The expected timeline

There is no schedule that fits everyone, but the medical sources paint a similar overall picture. Cleveland Clinic says symptoms usually begin within 24 to 48 hours of stopping or significantly cutting down after heavy, long-term use, typically peak by day three, and can last up to about two weeks; some symptoms can go on for three weeks or more in people who used very often.

1. Days one to two: tension, irritability and anxiety, disturbed sleep and the first cravings. Mild physical symptoms such as headache and sweating may appear.
2. Roughly days two to six: the peak. The worst nights of insomnia and disturbing dreams, and the strongest moments of anger, appetite loss and low mood.
3. Week two: physical symptoms usually start to ease gradually, but sleep problems, mood swings and cravings can still be hard, so this week may still feel heavy.
4. After two to three weeks: for most people, most of the withdrawal is over, but sleep and mood may need longer to settle.

A 2017 scientific review in the journal Substance Abuse and Rehabilitation notes that symptoms usually peak between days two and six after stopping and can last up to three weeks, and that physical symptoms and aggressive behavior start sooner and end sooner, while sleep problems and mood changes last longer. So you may notice that your body has improved while your sleep and mood are still unsettled. This is an expected part of withdrawal, not proof that your attempt has failed.

Who is more likely to have severe withdrawal?

Withdrawal does not affect everyone to the same degree. In the same JAMA Network Open analysis, withdrawal syndrome was clearly more common in treatment settings: about 87% among hospital inpatients and 54% among outpatients, compared with about 17% in general-population samples. It was also more common in people who used daily, in those diagnosed with cannabis use disorder, and in those who used tobacco or other substances at the same time.

According to Cleveland Clinic, withdrawal is more likely, or more severe, with:

• Daily use
• Using high-potency THC products
• Using cannabis together with cigarettes
• Having another substance use disorder alongside cannabis
• Having a mood disorder, anxiety, post-traumatic stress disorder (PTSD) or a personality disorder

Mood plays a part too. A 2018 study in Frontiers in Psychiatry of 90 young adults who used cannabis heavily found that depressive symptoms and use-related problems were linked to more severe withdrawal. The evidence is not fully consistent: the JAMA Network Open analysis did not find that having another mental illness made withdrawal more common. Still, someone who starts quitting while carrying untreated depression may face a harder road, which is why mood and substance use are assessed together at the first appointment, not one without the other.

Why insomnia, nightmares and low mood are the hardest part of quitting weed

Because they linger after many other symptoms have eased, and because going back to cannabis hides them for a while, so it looks like a quick "fix." The 2017 scientific review notes that trouble sleeping is thought to be the withdrawal symptom most linked to returning to use, and it cites a study in which symptoms were usually at least moderate and often led people to try to relieve them. Low mood adds to this pressure: depressive symptoms were linked to more severe withdrawal in the Frontiers in Psychiatry study mentioned above. In other words, many people go back not to get high, but to escape a sleepless night or a heavy day.

The UK's NHS recommends simple sleep habits that take commitment but help many people:

• Getting up at the same time every day, even after a bad night, and not napping during the day to make up for it
• Avoiding coffee, tea, energy drinks and cigarettes in the six hours or so before bed
• Regular exercise during the day (a daily walk is a good start), but not in the four hours before bed
• Relaxing for at least an hour before bed with screens switched off, and going to bed only when you feel sleepy

And when nightmares come, call them what they are: strange or disturbing dreams are a known withdrawal symptom that usually eases with time, not a sign that something bad is going to happen.

When should you get medical help right away?

Cleveland Clinic says cannabis withdrawal does not cause life-threatening symptoms, but that medically supervised detox may help people who have a mental health condition, a physical illness that withdrawal could make worse, a severe cannabis use disorder, or other substances used alongside cannabis. That last point matters: it is not rare for people to use other substances with hashish. According to Cleveland Clinic, withdrawal from alcohol, sedatives (benzodiazepines) and opioids (tramadol is one of the opioids) can be dangerous and even life-threatening, and MedlinePlus warns that stopping pregabalin suddenly can cause withdrawal symptoms, including seizures. All of these need medically supervised detox, not quitting at home on your own.

Get medical help now, and don't wait, if any of the following appear: in Egypt, call an ambulance on 123 or go to the nearest emergency department; elsewhere, call your local emergency number. Most of them are not typical of cannabis withdrawal alone and may point to withdrawal from another substance or to another medical or mental health problem:

• Severe shaking, heavy sweating, a racing heart or seizures
• Confusion, delirium, seeing or hearing things that aren't there, or paranoid thoughts
• Persistent vomiting, being unable to drink fluids, or obvious dehydration
• Very low mood, or thoughts of harming yourself or of death
• Withdrawal from alcohol, sedatives, pregabalin, tramadol or other opioids alongside cannabis

And if you are pregnant, have a long-term physical illness that withdrawal could make worse, or have a known mental illness, it is best to start quitting with a plan made by a doctor from day one.

If psychotic symptoms appear, such as intense suspicion or hallucinations, they need a medical assessment at the time, not weeks later. The WHO notes that cannabis use can worsen schizophrenia in people who have it.

Why quitting alone at home often stalls, and what medical supervision adds

Many people start quitting with strong determination, then stumble in the peak days (roughly days two to six), when lack of sleep, irritability and easy access to the substance all come together. Medical follow-up doesn't offer a "magic pill": according to NIDA, there is still no medication approved by the U.S. Food and Drug Administration (FDA) to treat cannabis use disorder or cannabis withdrawal, and research is ongoing. But it does offer practical things:

• A full medical and psychological assessment that shows whether you are also using substances whose withdrawal is dangerous, or have a mental illness that needs treatment at the same time
• Relief for the most troublesome symptoms, especially sleep, anxiety and mood, decided by a doctor rather than by trial and error
• Close follow-up in the first days and weeks, when withdrawal is usually at its hardest
• A psychological program that starts early, not after withdrawal is over
• Support for the family that reduces arguments and blame, and turns the home into a help rather than an extra source of pressure

If you are trying to decide between quitting at home and a structured program, calmly compare the two in Home detox or a specialized treatment center? before you start, not after you stumble.

Hashish addiction treatment: how the plan works from the first appointment

Treating hashish addiction is not a single event but a clear path. It starts with a medical appointment where what you actually need is worked out, then a stage of detox and medical monitoring if the symptoms are severe or other substances are involved, then psychological rehabilitation, which is the core of treatment for cannabis in particular.

NIDA notes that three psychological approaches can be effective in treating cannabis use disorder: cognitive behavioral therapy (CBT), motivational enhancement therapy, and contingency management (a system that rewards staying off the substance with tangible incentives). The program is built on these: recognizing the situations that come before use, learning alternatives for stress and sleeplessness, and rebuilding a day with meaning instead of the emptiness the substance used to fill.

Then comes the stage many people neglect: life after the program. A relapse is not the end of the road or proof of failure, but it is easier to handle with a plan written in advance than with an in-the-moment reaction, which is why the plan includes aftercare within the rehabilitation program and regular follow-up after treatment ends.

At Oxygen Center in Damanhour, the plan starts with an appointment and an assessment, then an inpatient or outpatient program depending on your situation, in confidence and with follow-up for the family. Inpatient stays at the center are for males aged 15 and over (under 18 with a guardian's consent); women are welcome for outpatient appointments, therapy sessions, behavior-modification sessions and drug tests. If you want to know what fits your situation, call or WhatsApp the center on +20 101 687 0711; for anything urgent, use the 24/7 emergencies line +20 100 006 6752. In Egypt there is also the hotline of the Fund for Drug Control and Treatment of Addiction on 16023, which offers confidential treatment through its partner centers.