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Institute of social and preventive medicine - Faculty of Medicine - University of Geneva - Switzerland

Questionnaire on cannabis withdrawal symptoms



Please describe all signs, feelings and symptoms that you experienced after stopping using cannabis
(=withdrawal symptoms)
:

Mental signs , feelings and symptoms associated with stopping smoking cannabis (withdrawal symptoms)
Mental 1
Mental 2
Mental 3
Physical signs and symptoms associated with stopping smoking cannabis (withdrawal symptoms)
Physical 1
Physical 2
Physical 3

Here are a few questions about yourself:

Are you ?
When were you born? I was born in

Do you currently smoke cannabis?

Yes, I smoke cannabis every day = a
Yes, I smoke cannabis occasionally (not every day) = b
No, I have stopped smoking cannabis = c
No, I never was a cannabis smoker = d

Have you smoked at least 100 cannabis joints or pipes in your lifetime?  
In the last 30 days, on how many days have you smoked cannabis? On days/30
Did you ever make a serious attempt at stopping using cannabis?
How long is it since you last smoked cannabis? I smoked cannabis for the last time
ago
Questions for CURRENT cannabis smokers:
=> if you are a FORMER cannabis smoker, please click here.

Please rate your addiction to cannabis on a scale of 0 to 100:

- I am NOT addicted to cannabis at all = 0
- I am extremely addicted to cannabis = 100

Addiction

On average, how many cannabis joints or pipes do you smoke per day, on the days when you smoke cannabis ? Joints or pipes / day
Usually, how soon after waking up do you smoke your first cannabis joint or pipe? Minutes
Questions for FORMER cannabis smokers:
When did you stop smoking cannabis? I stopped smoking on:
Day:
Month:
Year:
Since then, have you smoked any cannabis?
Comments:

Please check that you have answered ALL the questions

Thank you + + +

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Created by par JF Etter, April 4, 2007.