Psychometric validation of the Cannabis Withdrawal Checklist in a Spanish sample with cannabis use disorder

Abstract

Introduction: Cannabis is used globally. In Spain, it is often used in combination with tobacco, which may exacerbate withdrawal severity. Currently, no validated instrument exists to assess cannabis withdrawal symptoms in Spanish populations. This study aimed to validate the 15-item Cannabis (Marijuana) Withdrawal Checklist (CWC) for Spanish-speaking individuals who co-use cannabis and tobacco.

Materials and methods: This psychometric validation study was nested within a multicenter longitudinal project conducted across 10 substance use treatment programs in Catalonia (Spain). The CWC was forward- and back-translated following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations. Internal consistency, construct validity, and sensitivity to change over time were assessed using Cronbach’s alpha, exploratory factor analysis (EFA), and mixed-effects analysis. Data from 82 participants were used to conduct the validation.

Results: The adapted CWC demonstrated high internal consistency (Cronbach’s α = 0.918 at baseline; 0.885 at 2 weeks of treatment). EFA supported a unidimensional structure explaining approximately 60% of the variance. Although symptom severity did not significantly change over follow-up, withdrawal intensity was positively associated with the level of cannabis use. The scale effectively captured clinically relevant symptoms such as irritability, craving, and sleep difficulties.

Conclusion: The Spanish CWC showed strong reliability and acceptable psychometric properties, supporting its use for assessing cannabis withdrawal symptoms in Spanish-speaking adults, particularly those who co-use tobacco products. The scale may be valuable in both research and clinical settings, particularly for monitoring withdrawal during treatment interventions. Further validation using larger, more diverse samples is warranted.