Legaliseringsguiden, genomgång av ... - PDF Archive

Här är exempel på kritiken i en metastudie från Neil Smith (2001):
The methods used in measuring abstinence effects have been inconsistent: selfreport,
observation and a variety of scales are used to assess symptoms. What the
majority of these measures do have in common is that they fail to measure
adequately the severity of symptoms. Although Wiesbeck and colleagues attempted
to model the DSM-IV criteria for substance withdrawal, when constructing a list for
cannabis withdrawal symptoms they ignored the other DSM-IV criteria for
withdrawal states, which requires ‘. . . clinically significant distress or impairment . . .’
(American Psychiatric Association 1994). Severity of symptoms is not measured in
that study (Wiesbeck et al. 1996). When severity is measured many of the symptoms
reported are mild and do not reach a clinically significant level. The approach to the
issue of severity in these studies is typified by Jones and colleagues’ method of
recording symptoms occurring ‘at least once’ (Jones et al. 1976). However, these
researchers did add that the withdrawal symptoms that they observed were ‘mild
and short-lived’. Where standardized clinical instruments are used to measure
severity, results again reveal mild symptom patterns. Kouri and colleagues found a
significant increase in depression, as measured by the Hamilton rating scale for
depression (Hamilton 1960), between abstinent cannabis smokers and controls
(Kouri et al. 1999) However, this score peaked at only six, a subclinical rating on the
scale. The variability of symptoms in terms of severity is also clearly observable in
Table 1. In the Budney and colleagues study ‘severe’ symptoms were reported by a
minority of individuals in every category, and this in a group of individuals meeting
current dependence criteria (Budney et al. 1999).
...
“
It is a necessary criterion of most disorders included in DSM-IV that the presence of
other mental conditions/alternative explanations are ruled out before a diagnosis is
made. All withdrawal studies made some form of psychiatric evaluation prior to
selection of their samples. However, Budney et al. (1999) reported that 41% of their
sample had a history of psychiatric diagnosis and 79% of Stephens et al. (1993)
sample had a diagnosis of a ‘psychological disorder’ according to the SCL-90R
(symptoms checklist-90 revised, Derogatis 1983). Crowley and colleagues studied
dependence and withdrawal in a population of adolescents with conduct disorders.
Although they did find withdrawal symptoms in abstinent users, they recommended
that ‘. . . findings from this severely affected clinical population should not be
generalised broadly to other adolescents’ (Crowley et al. 1998) (for this reason, the
study has been omitted from the list of withdrawal studies described above). Only
one study thus far has reported the use of a standardised instrument (current and
past psychopathology scales: CAPPS; Endicott & Spitzer 1972) to preselect and omit
participants: this study found no withdrawal effects (Greenberg et al. 1976). Other
studies reported only that clinical examinations had been conducted by psychiatrists
with no further details of past psychiatric history (Babor et al. 1976; Cohen 1976;
Jones et al. 1976; Georgotas & Zeidenberg 1979; Haney et al. 1999a, b; Kouri et al.
1999).
Although personality differences do not always reach the level of ‘disorder’, they
have been implicated in withdrawal onset and severity in individuals ceasing
benzodiazepine use (Tyrer, Owen & Dawling 1983; Rickels et al. 1986; Golombok et
al. 1987). The only study to investigate the possible effects of personality on the
appearance of withdrawal symptoms following cessation of cannabis use utilized the
Minnesota multiphasic personality inventory (MMPI; Hathaway & McKinley 1951) to
discover a particular group of traits that appeared to be related to the effects of
abstaining from the drug, including anxiety, dependency and ego strength (Bachman
& Jones 1979). Factor analysis of the results revealed a trait of ‘ego weakness’ in
those experiencing withdrawal symptoms. These results concur with studies into
benzodiazepines which link withdrawal severity and treatment outcome to
‘dependent personality’ traits (Rickels et al. 1988; Rickels et al. 1999).
...
”
269