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More Americans are using cannabis than ever before, thanks to the legalization of medicinal and recreational use in many states in the country. In the past, the negative effects of marijuana use have been greatly exaggerated, but that doesn’t mean abusing the drug is without consequences.

Case in point: psychiatrists found that 12% of frequent marijuana smokers experienced Cannabis Withdrawal Syndrome (CWS), whose symptoms include emotional, behavioral, and physical changes.

CWS was officially recognized in 2013 when it was included in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, which is used by clinicians and psychiatrists to diagnose psychiatric illnesses.

In a new study, researchers at Columbia University performed the first large-scale assessment linking CWS to psychiatric disorders among frequent cannabis users in the United States. To qualify as a frequent cannabis user, the researchers define as using the drug three or more times a week during the last 12 months.

Deborah Hasin, a professor of Epidemiology at Columbia Mailman School of Public Health, along with colleagues, analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. The survey involved face-to-face interviews with 36,309 participants about their substance use.

The researchers zoomed in on 1,527 participants from the survey which were identified as frequent cannabis users. They found that among those who quit, the most commonly reported withdrawal symptoms included nervousness/anxiety (76%), hostility (72%), sleep difficulty (68%) and depressed mood (59%). Physical withdrawal symptoms included headaches, shakiness/tremors, and sweating, though these were less prevalent than behavioral and emotional symptoms.

Writing in the journal Drug and Alcohol Dependence, the authors reported that CWS symptoms were associated with a family of psychiatric disorders, including mood disorders, anxiety disorders (social phobia, agoraphobia, and panic disorder), personality disorders, and post-traumatic stress disorder.

There was no association between CWS and a family history of drug and alcohol abuse. A family history of depression, however, could predict CWS to some degree.

“Cannabis withdrawal syndrome is a highly disabling condition,” noted Hasin, who is also a professor in the Department of Psychiatry. “The syndrome’s shared symptoms with depressive and anxiety disorders call for clinician awareness of cannabis withdrawal symptoms and the factors associated with it to promote more effective treatment among frequent cannabis users.”

As attitudes and laws surrounding marijuana continue to change, it is important that the public is made more aware of the potential ill-effects they might be exposing themselves to. As a new disorder, there is much to be learned about CWS.

“Most users of the newer modes of administration–vaping and edibles–also smoke cannabis. Therefore, for users in modes other than smoking, the amount of consumption could be underestimated,” said Hasin. “Given the increase in cannabis potency in recent decades, developing reliable measures to investigate the effect of cannabis concentration and mode of administration will be important in advancing our understanding of cannabis withdrawal syndrome.”