Addiction, or substance use disorder (SUD), is a complex condition characterized by compulsive substance use despite harmful consequences. Medical cannabis may be useful for reducing the need for opioid, antidepressant, stimulant, and sedative (especially benzodiazepine) medications, as well as impact recreational alcohol use.
Addiction causes and treatment
The causes of addiction are multifactorial, often involving a combination of biological, psychological, social, and environmental factors.
- Genetics: Genetic predisposition can increase susceptibility to addiction
- Neurochemical imbalances: Dysregulation in dopamine and other neurotransmitter systems may enhance vulnerability
- Environmental factors: Exposure to substances, peer pressure, and stress can contribute
- Psychological factors: Mental health disorders, trauma, and unresolved emotional issues often co-occur with addiction
Addiction refers to a psychological and/or physical inability to stop doing an action or consuming a chemical, drug, or substance, even though it is causing significant mental and physical harm. Dopamine, the body’s reward chemical, is linked to addiction. Habitual intake of drugs decreases the concentration of dopamine receptors expressed in the brain, reducing interest in activities that do not provide the same rewards or “dopamine hit.”
Although addiction is often associated with drugs and alcohol, it can include activities like gambling, eating, or even exercise.
Addiction symptoms & health effects
Symptoms of addiction vary by substance but may include:
- Behavioral: Cravings, inability to stop using despite intent, and neglect of responsibilities
- Physical: Withdrawal symptoms, tolerance development, and physical health decline
- Mental:Depression, anxiety, paranoia, or mood swings
Health effects:
- Opioids: Respiratory depression, overdose risk, and chronic gastrointestinal issues
- Benzodiazepines: Cognitive impairment, risk of dependence, and withdrawal seizures
- Alcohol: Liver damage, cardiovascular issues, and neurological deficits
- Stimulants: Cardiovascular strain, insomnia, and psychosis
Addiction diagnosis
Diagnosing addiction typically involves:
- Comprehensive assessment: Medical history, substance use history, and co-occurring mental health conditions
- Clinical criteria: Meeting DSM-5 criteria for substance use disorder, which includes patterns of problematic use and associated impairments
- Laboratory testing: To detect substance use or complications like liver damage or infections
Addiction prognosis
The prognosis for addiction varies:
- Treatment adherence: Consistent engagement in a recovery program significantly improves outcomes
- Individual factors: Motivation, support systems, and the presence of co-occurring conditions play a role
- Relapse risk: High initially but decreases with long-term abstinence and therapeutic support
Addiction treatments
There are a number of different treatments for addiction, depending on the type of substance or behavior the patient is addicted to.
First-line treatments
- Behavioral therapies: Cognitive-behavioral therapy (CBT), motivational interviewing, and contingency management
- Medications:
- Opioid use disorder: Methadone, buprenorphine, and naltrexone
- Alcohol use disorder: Disulfiram, acamprosate, and naltrexone
- Benzodiazepine tapering: Gradual dose reduction under medical supervision
Other treatments
- Inpatient rehabilitation: For individuals requiring intensive support
- Outpatient programs: Flexible and suited for those with stable living conditions
Adjunctive therapy & alternative treatments
- Mindfulness and meditation: Effective in reducing cravings and stress
- Exercise therapy: Improves physical and mental health
- Nutritional support: Corrects deficiencies and supports recovery
- Psychedelic therapy: Early research suggests serotonin receptor agonists could play a significant role in fighting drug addiction
Cannabis for addiction treatment
Emerging evidence suggests medical cannabis may help in addiction treatment:
- Opioid substitution: Cannabis may reduce opioid consumption and dependency. Cannabinoids can interact with opioid receptors, theoretically reducing withdrawal symptoms and cravings. Several studies have also shown that medical cannabis can reduce or even replace the need for opioid medications for the management of chronic pain.
- Alcohol moderation: Patients report reduced alcohol cravings and withdrawal severity. Cannabis may help ease nausea and vomiting and deal with insomnia often linked to alcohol withdrawal. There is also some evidence that cannabis legalization reduces alcohol sales.
- Stimulants and sedatives: Benzodiazepines are often prescribed for anxiety, PTSD, insomnia, and epilepsy, whereas stimulants may be prescribed for ADHD. Cannabis, and in particular THC, CBD, CBN, beta-caryophyllene, and limonene, may alleviate withdrawal symptoms and cravings.
- Mechanisms: Cannabinoids like CBD exhibit anxiolytic (anti-anxiety), anti-inflammatory, and neuroprotective properties, aiding withdrawal and recovery
Using one substance to replace another is not uncommon in treating addiction. For instance, opiate and opioid addicts are often given opioid-based replacements, whereas alcoholics may need benzodiazepines to prevent dangerous withdrawal symptoms.
Cannabis’s ability to influence dopamine and serotonin pathways provides an intriguing case as a potential “exit drug” for many substances. There are also several terpenes, like humulene, myrcene, beta-caryophyllene, and limonene, that have been shown to have anti-addictive properties. Additionally, cannabis’ safety profile and potential for fewer side effects compared to traditional medications make it a viable adjunct treatment.
Additional information for patients
- Medical supervision: Always consult a healthcare provider before integrating medical cannabis
- Tailored plans: Individualized treatment plans are essential for success
- Support groups: Programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) offer critical peer support
- Potential risks: Patients must be willing to change peer groups or lifestyle habits to ensure long-term success
Medical cannabis and addiction treatment FAQs
Can medical cannabis fully replace other treatments for addiction?
While promising, medical cannabis is typically used as an adjunct, not a replacement for evidence-based therapies. However, research does show that medical cannabis can have opioid-sparing properties.
Is medical cannabis safe for all individuals with SUD?
Not always. A thorough assessment is required to rule out contraindications, such as a history of cannabis use disorder or psychosis.
What forms of medical cannabis are most effective for addiction?
CBD-dominant products are often preferred due to their non-psychoactive nature and potential therapeutic benefits. However, THC:CBD ratios may vary depending on the substance being replaced.
What are effective ways to take medical cannabis for addiction treatment?
- Routes of Administration: Oral, sublingual, topical, transdermal, and inhalation (vaporizer)
- Special Formulations: Combining THC, CBD, beta-caryophyllene, and limonene
Are there risks associated with using cannabis for addiction treatment?
Potential risks include dependency, impaired cognition, and exacerbation of mental health conditions in vulnerable individuals. Cannabis’ effects as a central nervous system depressant require careful tapering, especially when replacing alcohol or opioids. Additionally, integration therapy and lifestyle changes are critical to prevent relapse.
Resources
- Motivational effects of cannabinoids are mediated by mu-opioid and kappa-opioid receptors: https://pubmed.ncbi.nlm.nih.gov/11826143/
- Can Cannabis be Considered a Substitute Medication for Alcohol?: https://pmc.ncbi.nlm.nih.gov/articles/PMC3992908/
- Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control: https://pubmed.ncbi.nlm.nih.gov/33249713/
- Contributions of Serotonin in Addiction Vulnerability: https://pmc.ncbi.nlm.nih.gov/articles/PMC3110503/
- Dopamine and Addiction: https://pubmed.ncbi.nlm.nih.gov/31905114/
- Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health: https://www.ncbi.nlm.nih.gov/books/NBK424849/
- Is cannabis a gateway to hard drugs?: https://www.york.ac.uk/media/economics/documents/herc/wp/07_01.pdf
- Psychedelic therapy in the treatment of addiction: the past, present and future: https://pmc.ncbi.nlm.nih.gov/articles/PMC10291338/
- Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample: https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00520-5
- Recreational cannabis legalization and alcohol purchasing: a difference-in-differences analysis: https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-021-00085-x
- Association between non-medical cannabis legalization and alcohol sales: Quasi-experimental evidence from Canada: https://www.sciencedirect.com/science/article/pii/S0376871624000589
- Role of Cannabinoid CB2 Receptor in Alcohol Use Disorders: From Animal to Human Studies: https://www.mdpi.com/1422-0067/23/11/5908
- β-caryophyllene inhibits heroin self-administration, but does not alter opioid-induced antinociception in rodents: https://www.sciencedirect.com/science/article/abs/pii/S0028390824001163
- Limonene Inhibits Methamphetamine-Induced Sensitizations via the Regulation of Dopamine Receptor Supersensitivity: https://pubmed.ncbi.nlm.nih.gov/30739426/
- Opioid-sparing effects of cannabinoids: Myth or reality?: https://www.sciencedirect.com/science/article/abs/pii/S027858462030381X
- Opioid-sparing effect of cannabinoids for analgesia: an updated systematic review and meta-analysis of preclinical and clinical studies: https://www.nature.com/articles/s41386-022-01322-4
- Reduction of Benzodiazepine Use in Patients Prescribed Medical Cannabis: https://pmc.ncbi.nlm.nih.gov/articles/PMC6757237/
- Clinical and cognitive improvement following full-spectrum, high-cannabidiol treatment for anxiety: open-label data from a two-stage, phase 2 clinical trial: https://www.nature.com/articles/s43856-022-00202-8
- Combined Antiseizure Efficacy of Cannabidiol and Clonazepam in a Conditional Mouse Model of Dravet Syndrome: https://pmc.ncbi.nlm.nih.gov/articles/PMC8301289/
Note that the information in this article does not constitute medical advice.
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