The relationship between cannabis and alcohol management has long been a subject of debate. With the increasing legalization and normalization of marijuana use, understanding its impact on alcohol intake is more critical than ever. Recent studies have explored how cannabis use influences drinking patterns, particularly among individuals with alcohol use disorder (AUD) and those undergoing alcohol treatment. These studies raise questions about whether THC and/or CBD can be used as a safe alternative for alcohol.
Two recent studies provide intriguing insights into this complex interaction. One study examined how within-day cannabis use affects alcohol intake and binge drinking episodes among individuals receiving alcohol treatment. The second study analyzed long-term alcohol-related harms among cannabis users with a history of AUD, comparing heavy, moderate, and also non-users. These findings contribute to the ongoing discussion on whether cannabis acts as a substitute or a complementary substance to alcohol.
Study 1: Effects of Cannabis Use on Alcohol Consumption in Individuals Undergoing Treatment
Background and Study Objectives
The first study investigated the effects of cannabis use on alcohol intake among individuals engaged in alcohol treatment. Specifically, researchers aimed to determine whether cannabis use on a given day was associated with reduced alcohol consumption and binge drinking episodes.
Given the growing use of marijuana among people who drink alcohol, understanding this relationship is crucial for tailoring alcohol treatment strategies. The study sought to explore whether these effects varied by gender or by cannabis use frequency.
Study Design and Methods
This observational study was a subset of a larger randomized controlled trial (RCT) conducted between 2016 and 2020. Participants were recruited from community and university settings in Denver and Boulder, Colorado.
Key details:
- Out of 182 individuals enrolled in the RCT, 96 cannabis-using participants were included in this analysis.
- Participants were categorized based on their cannabis use frequency.
- Data were collected using the Timeline Follow-Back (TLFB) method at baseline, 4, 8 (end of treatment), and 20 weeks.
- Researchers compared alcohol consumption and binge drinking episodes on marijuana-use and non-use days.
Key Findings
The study yielded several significant findings:
- On days when cannabis was used, participants consumed 29% fewer alcoholic drinks (95% CI = 18-39%, P < 0.001).
- The likelihood of a binge-drinking episode decreased by 2.06 times (95% CI = 1.37-3.08, P < 0.001) on cannabis-use days.
- These patterns held true across males, females, and both infrequent and frequent cannabis users.
- There were no conclusive differences between gender or marijuana use frequency groups in the relationship between cannabis use and alcohol intake.
Interestingly, other research has shown that cannabis’ impact on alcohol consumption may depend on its cannabinoid content. A study found that high-THC cannabis users drank more alcohol on cannabis-use days compared to those using lower-THC strains, while high-CBD cannabis users consumed fewer drinks per drinking day and had fewer alcohol and cannabis co-use days (Karoly et al., 2021).
Interpretation
These findings suggest that among individuals engaged in alcohol management, cannabis use is associated with reduced alcohol consumption. However, the study does not determine whether marijuana is actively replacing alcohol or whether external factors influence these patterns.
Study 2: The Impact of Cannabis on Persistent Alcohol Problems
Background and Study Objectives
The second study focused on long-term alcohol-related harms among cannabis users with a history of AUD. Specifically, researchers analyzed how different levels of cannabis use influenced alcohol consumption and alcohol-related problems.
The study aimed to determine whether cannabis use helped reduce alcohol-related harms or exacerbated them.
Study Design and Methods
Researchers analyzed data from the 2005, 2010, and 2015 cycles of the National Alcohol Survey (NAS), a nationally representative survey of adults aged 18 and older. Participants were categorized based on their cannabis use:
- Heavy users: Used cannabis weekly or more.
- Moderate users: Used cannabis more than monthly but less than weekly.
- Abstainers: Did not use cannabis.
Key Findings
- Moderate cannabis users experienced significantly worse alcohol-related outcomes than abstainers:
- They drank 2.83 times more alcohol.
- They had 6.82 times greater odds of alcohol-related harms, such as negative effects on relationships, work, finances, and health.
- They reported more frequent heavy drinking episodes and increased odds of alcohol dependence.
- Heavy cannabis users showed no significant difference from abstainers in drinking patterns, frequency of heavy drinking episodes, or alcohol-related harms.
Moreover, recent research highlights that cannabis use may drive alcohol consumption more than the reverse. A 2022 study found that cannabis use was more strongly linked to increased alcohol consumption than alcohol use was to increased cannabis consumption. This link was twice as strong in men and four times stronger in women, underscoring gender differences in how these substances interact (Airagnes et al., 2022).
Interpretation
These results highlight a paradox: moderate cannabis users exhibited the highest alcohol-related harms, whereas heavy cannabis users showed no increased risk compared to abstainers.
One possible explanation is the context in which cannabis is used:
- Moderate cannabis users may use cannabis in social settings where alcohol is prevalent, increasing their alcohol intake.
- Heavy cannabis users may use cannabis medicinally or in non-social settings, potentially reducing their alcohol consumption.
This underscores the importance of understanding why and how cannabis is used among individuals with a history of AUD.
Cannabis vs. Alcohol for Anxiety: Which Is Safer?
Cannabis, especially CBD-dominant strains, has gained popularity as a natural remedy for anxiety. Unlike alcohol, which can initially reduce anxiety but often worsens it over time, CBD may offer more sustainable, non-intoxicating relief. However, THC-heavy strains can sometimes heighten anxiety, so the choice of strain is crucial.
Can CBD Replace Alcohol for Stress Relief?
Many people turn to alcohol to unwind, but CBD is emerging as an alternative. It interacts with serotonin receptors in the brain, promoting a sense of calm without impairing judgment or causing hangovers. This makes it a viable option for those seeking stress relief without the risks associated with alcohol.
Implications for Alcohol Management and Treatment Centers
These findings have significant implications for alcohol treatment programs:
- Many alcohol treatment centers have strict abstinence-only policies, expelling patients who test positive for marijuana use.
- Given that cannabis use is linked to reduced alcohol intake in some individuals, treatment centers may need to reconsider their policies and explore more flexible, harm-reduction approaches.
- Furthermore, the cannabinoid content (THC vs. CBD) may play a role in alcohol consumption patterns. This suggests that treatment strategies can be more personalized.
Conclusion
Recent research highlights the complex relationship between cannabis and alcohol management:
- Among individuals in alcohol treatment, cannabis use is linked to reduced alcohol consumption and also lower binge drinking rates.
- However, among individuals with a history of AUD, moderate cannabis use is associated with increased alcohol-related harms, while heavy cannabis use is not.
- The context and motivation for marijuana use play a critical role in determining whether marijuana serves as a substitute or complementary substance to alcohol.
FAQs
1. Can cannabis help manage alcohol consumption?
Studies suggest that cannabis use on a given day is associated with lower alcohol intake and reduced binge drinking episodes among individuals in alcohol treatment. However, effects vary depending on individual patterns of use.
2. Why do moderate cannabis users experience more alcohol-related harms?
Moderate cannabis users may consume cannabis in social environments where alcohol is also present, leading to increased drinking.
3. Should alcohol treatment centers allow cannabis use?
Findings suggest that cannabis may help reduce alcohol intake for some individuals, so treatment centers might reconsider strict abstinence-only policies.
4. Does cannabis affect alcohol metabolism?
Yes. Marijuana can alter alcohol metabolism by affecting liver enzymes. This interaction may slow down alcohol processing, leading to prolonged intoxication.
5. What happens if you mix CBD and alcohol?
Combining CBD and alcohol can amplify their sedative effects, making you feel more relaxed or drowsy. However, CBD might also reduce alcohol-related inflammation and oxidative stress.
6. Is cannabis safer than alcohol for long-term health?
Research suggests that marijuana may pose fewer long-term health risks than alcohol, which is linked to liver disease, heart problems, and cancer. Cannabis, especially CBD, has fewer toxic effects, though long-term studies are still ongoing.
Further Reading
Cannabis and Alcohol Cross-Tolerance
Understanding how marijuana and alcohol interact on a biological level is crucial, especially for those managing their intake. Both substances affect the brain’s reward system, primarily through the release of dopamine, but they do so in different ways. Alcohol enhances GABA activity (a neurotransmitter that calms the nervous system), while marijuana interacts with the endocannabinoid system, which regulates mood, memory, and pain perception. Cross-tolerance can develop, meaning someone who uses both may need higher doses of either substance to achieve the same effects — potentially complicating efforts to control their use.
Cannabis Strains and Their Effect on Alcohol Use
Different cannabis strains can influence drinking behavior in unexpected ways. Research suggests that high-THC strains (like OG Kush or Girl Scout Cookies) may increase alcohol consumption by amplifying euphoric sensations, leading some users to drink more. In contrast, high-CBD strains (such as ACDC or Harlequin) have links to reduced alcohol intake by promoting relaxation and reducing anxiety without the intoxicating high. Understanding these differences can help individuals make informed choices when combining these substances.
Cannabis as a Harm-Reduction Tool
Harm reduction strategies focus on minimizing the negative consequences of substance use rather than insisting on abstinence. Marijuana is emerging as a potential tool for people looking to cut back on alcohol without quitting entirely. Some treatment programs now explore allowing controlled marijuana use as a substitute for alcohol, especially for those with Alcohol Use Disorder (AUD). High-CBD products, in particular, show promise in helping individuals reduce their alcohol intake by easing withdrawal symptoms and cravings.
Gender Differences in Mariijuana and Alcohol Co-Use
Gender plays a notable role in how cannabis and alcohol interact. Studies reveal that men tend to partake in both substances more frequently and in larger quantities, often in social settings where drinking is common. Women, on the other hand, may use marijuana as a means of coping with stress or anxiety — sometimes leading to less alcohol consumption. Interestingly, some research indicates that cannabis has a stronger impact on increasing alcohol intake for women than for men, suggesting gender-specific responses that merit further study.
