Why is this specific topic important?
Among alcohol users, cannabis is the most widely consumed psychotropic substance. Approximately 75% of cannabis users report consuming alcohol. Studies suggest cannabis users can engage in simultaneous cannabis use at a rate of somewhere from 30-50%. This means there is a lot of concurrent (use during the same time period) and simultaneous (use at the same time) use of the substances.
Is using cannabis and alcohol a bad thing? A good thing?
A bit of both. There are studies that suggest using cannabis and alcohol simultaneously puts people at greater risk for negative events. This includes increased impairment if operating motor vehicles, increased somnolence, higher risk of passing out and greater chances for developing substance use disorders.
On the other hand, there are some studies that show that many people use cannabis as a substitute for, or a mechanism to decrease alcohol use. Many patients in Alcohol abuse treatment programs report that cannabis use helps decrease cravings and use of alcohol after discharge.
Sometimes substitution with cannabis can help with complete abstinence.
I’ve had several patients who were either in substance treatment programs who reported to me that using cannabis allowed them to handle their cravings, body aches and some of their mental health issues much better than drugs like methadone or buprenorphine. They also have a justified fear of pharmaceuticals so they like having a natural option.
Let’s say I don't want to drink because of my new years resolution or my fitness goals, how can I do that while I’m high?
One of the misconceptions that we have about cannabis use is that it automatically involves getting high. That is not necessary in order to get the benefits that many people substituting cannabis for alcohol are looking for. The effect of THC- the substance in cannabis that makes you high is dose dependent. That is, the more of it you consume the greater the psychotropic effect/ high will be. Very low doses, starting at
approximately 2.5mg are often enough to “take the edge off” which is a big reason many of my patients report they drink.
Many of my patients report that they have an evening routine of grabbing a drink or two (or a bottle!) to help them unwind. I had a patient last week who had lost 30 lbs in the last 6 months, and when I asked her how she did it- the first thing she said was “I stopped drinking”. She had been coping/ self medicating with alcohol and realized the alcohol was harming her more than it was helping. She started drinking more water, exercising and sleeping better- none of which she was able to do while she was drinking.
What if I don't want to get drunk or high but I want to relax after a long day or want to chill when I’m out
As mentioned earlier, THC is the molecule that makes you high but there are other molecules in the plant that help you without making you high. The major one, which happens to be the one I spend most of my time researching and working with, is CBD (cannabidiol). The good thing about CBD is that it can give a lot of the relaxation and anxiety relieving effects of weed/ cannabis without the high. This decreases your chances of some of the negative events mentioned earlier like polysubstance abuse or passing out. There have even been studies that show that blood alcohol level is lower in people who consume alcohol versus those who consume alcohol with CBD.
Most of my patients that are looking to decrease their alcohol intake usually wind up using more CBD than THC alone. This is because they want to relax but keep a clear mind and sometimes they feel THC makes them a little too relaxed when they're trying to be active!
Remember, CBD is not without risks. Doses above 40-50mg can make you sleepy and if you're consuming alcohol or another sedative, it will increase the effects.
Most important, unlike THC, CBD isnt habit forming or addictive. For those looking to substitute alcohol or are weary of habit forming substances, it is a very good option.
1 Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, Borges GL, Bromet EJ, Demytteneare K, de Girolamo G, de Graaf R, Gureje O, Lepine JP, Haro JM, Levinson D, Oakley Browne MA, Posada-Villa J, Seedat S, Watanabe M. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008 Oct;9(10):883-91. doi: 10.1016/j.jpain.2008.05.005. Epub 2008 Jul 7. Erratum in: J Pain. 2009 May;10(5):553. Demytteneare, K [added]. PMID: 18602869.
2Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, Alexander GC. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015 Mar 18;36:559-74. doi: 10.1146/annurev-publhealth-031914-122957. Epub 2015 Jan 12. PMID: 25581144..
3The fifth vital sign: A complex story of politics and patient care
Website title:Cleveland Clinic Journal of Medicine
Date published:June 1, 2016
Date accessed:December 14, 2022
Author:Brian F . and Brian F Mandel
4Domenichiello AF, Ramsden CE. The silent epidemic of chronic pain in older adults. Prog Neuropsychopharmacol Biol Psychiatry. 2019 Jul 13;93:284-290. doi: 10.1016/j.pnpbp.2019.04.006. Epub 2019 Apr 17. PMID: 31004724; PMCID: PMC6538291.
5Macfarlane GJ, Barnish MS, Jones GT. Persons with chronic widespread pain experience excess mortality: longitudinal results from UK Biobank and meta-analysis. Ann Rheum Dis. 2017 Nov;76(11):1815-1822. doi: 10.1136/annrheumdis-2017-211476. Epub 2017 Jul 21. PMID: 28733474.
6National Research Council (US) Panel on DHHS Collection of Race and Ethnic Data. Eliminating Health Disparities: Measurement and Data Needs. Ver Ploeg M, Perrin E, editors. Washington (DC): National Academies Press (US); 2004. PMID: 25009872.
7 Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. PMID: 22553896.
8Chronic Pain: In Depth | NCCIH
Website title:National Center for Complementary and Integrative Health
Date accessed:December 14, 2022.
9Crocq MA. History of cannabis and the endocannabinoid system. Dialogues Clin Neurosci. 2020 Sep;22(3):223-228. doi: 10.31887/DCNS.2020.22.3/mcrocq. PMID: 33162765; PMCID: PMC7605027.
10Piper BJ, Beals ML, Abess AT, Nichols SD, Martin MW, Cobb CM, DeKeuster RM. Chronic pain patients' perspectives of medical cannabis. Pain. 2017 Jul;158(7):1373-1379