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Cannabis Science & Research
Undated - News - Pot Might Blunt Damage of Binge Drinking.
2009 - Study - Cannabis as a substitute for alcohol and other drugs.
2005 - News - Role of cannabinoid receptors in alcohol abuse.2004 - Study ~ Overeating, Alcohol and Sucrose Consumption Decrease in Cb1 Receptor Deleted Mice.
2003 - Study ~ Cannabis as a Substitute for Alcohol.Cannabinoid Cb1 Receptor Knockout Mice Exhibit Markedly Reduced Voluntary Alcohol Consumption and Lack Alcohol-induced Dopamine Release in the Nucleus Accumbens.
2002 - Study ~ Association of a CB1 cannabinoid receptor gene (CNR1) polymorphism with severe alcohol dependence.
2001- Study ~ Alcohol and marijuana: effects on epilepsy and use by patients with epilepsy.
1994 - Study ~ Effects of Alcohol Pretreatment on Human Marijuana Self-administration.
1992 - Study ~ Marihuana attenuates the rise in plasma ethanol levels in human subjects.
1986 - Study ~ Concordant alcohol and marihuana use in women.1988 - Study ~ Alcohol use, marihuana smoking, and sexual activity in women.
1980 - Study ~ Effect of Alcohol and Marihuana on Tobacco Smoking.
1979 - Study ~ Interaction of cannabidiol and alcohol in humans.
Role of cannabinoid receptors in alcohol abuse
Article Date: 08 Sep 2005 - 11:00 PDT
A new set of experiments in mice confirms that a brain receptor associated with the reinforcing effects of marijuana also helps to stimulate the rewarding and pleasurable effects of alcohol.
The research, which was conducted at the U.S. Department of Energy's Brookhaven National Laboratory and was published online September 2, 2005, by the journal of Behavioral Brain Research, confirms a genetic basis for susceptibility to alcohol abuse and also suggests that drugs designed to block these receptors could be useful in treatment.
"These findings build on our understanding of how various receptors in the brain's reward circuits contribute to alcohol abuse, help us understand the role of genetic susceptibility, and move us farther along the path toward successful treatments," said Brookhaven's Panayotis (Peter) Thanos, lead author of this study and many others on "reward" receptors and drinking (see: bnl.gov/bnlweb/pubaf/pr/PR_display.asp and , bnl.gov/thanoslab).
Earlier studies in animals and humans have suggested that so-called cannabinoid receptors known as CB1 -- which are directly involved in triggering the reinforcing properties of marijuana -- might also stimulate reward pathways in response to drinking alcohol. Thanos' group investigated this association in two experiments.
In the first experiment, they measured alcohol preference and intake in mice with different levels of CB1 receptors: wild type mice with normal levels of CB1; heterozygous mice with approximately 50 percent levels; and so-called knockout (KO) mice that lack the gene for CB1 and therefore have no CB1 receptors.
All mice were given a choice of two drinking bottles, one with pure water and one with a 10 percent alcohol solution -- approximately equivalent to the alcohol content of wine. Mice with the normal levels of CB1 receptors had a stronger preference for alcohol and drank more than the other two groups, with the CB1-deficient mice showing the lowest alcohol consumption.
After establishing each group's level of drinking, the scientists treated animals with a drug known to block CB1 receptors (SR141716A) and tested them again. (These animals were also compared with animals injected with plain saline to control for the effect of the injection.) In response to the CB1 receptor-blocking drug, mice with normal and intermediate levels of receptors drank significantly less alcohol compared to their pre-treatment levels, while KO mice showed no change in drinking in response to the treatment.
In the second experiment, the scientists compared the tendency of wild type and KO mice to seek out an environment in which they had previously been given alcohol. Known as "conditioned place preference," this is an established technique for determining an animal's preference for a drug.
Animals were first conditioned to "expect" alcohol in a given portion of a three-chambered cage while being given an injection of saline in the opposite end, and then monitored for how much time they spent in the alcohol chamber "seeking" the drug. Wild type animals, with normal levels of CB1, spent more time in the alcohol-associated chamber than the saline chamber, showing a decided preference, while KO mice (with no CB1 receptors) showed no significant preference for one chamber over the other.
"These results support our belief that the cannabinoid system and CB1 receptors play a critical role in mediating the rewarding and pleasurable properties of alcohol, contributing to alcohol dependency and abuse," Thanos said.
In addition, the fact that the mice with intermediate levels of CB1 exhibited alcohol preference and intake midway between those with high levels of receptors and those with none suggests that the genetic difference between strains quantitatively influences the preference for and the amount of alcohol consumed. "These results provide further evidence for a genetic component to alcohol abuse that includes the CB1 gene -- the same gene that is important for the behavioral effects of marijuana," Thanos said.
While it remains unclear exactly how CB1 triggers the rewarding effects of alcohol, one possibility is that activation of the CB1 receptor somehow blocks the brain's normal "stop" signals for the production of dopamine, another brain chemical known to play a role in addiction. Without the stop signal, more dopamine is released to produce a pleasure/reward response.
Since blockade of the CB1 receptor with SR141716A appears to effectively reduce alcohol intake and preference, this study also suggests that such CB1 receptor-blocking drugs might play an important role in the future treatment of alcohol abuse.
This study was funded by the Office of Biological and Environmental Research within the U.S. Department of Energy's (DOE) Office of Science; by the National Institute on Drug Abuse and the Intramural Research Program of the NIH, [National Institute on Alcohol Abuse and Alcoholism]. The DOE has a long-standing interest in research on addiction that builds, as this study does, on the knowledge of brain receptors gained through brain-imaging studies. Brain-imaging techniques such as MRI and PET are a direct outgrowth of DOE's support of basic physics research.
Note to local editors: Peter Thanos lives in Coram, New York.
One of ten national laboratories overseen and primarily funded by the Office of Science of the U.S. Department of Energy (DOE), Brookhaven National Laboratory conducts research in the physical, biomedical, and environmental sciences, as well as in energy technologies and national security. Brookhaven Lab also builds and operates major scientific facilities available to university, industry and government researchers. Brookhaven is operated and managed for DOE's Office of Science by Brookhaven Science Associates, a limited-liability company founded by Stony Brook University, the largest academic user of Laboratory facilities, and Battelle, a nonprofit, applied science and technology organization.
Karen McNulty Walsh
DOE/Brookhaven National Laboratory
Cannabidiol, Antioxidants, and Diuretics in Reversing Binge Ethanol-Induced Neurotoxicity
- Carol Hamelink
- Aidan Hampson
- David A. Wink,
- Lee E. Eiden and
- Robert L. Eskay
- Address correspondence to:
Dr. Robert Eskay, Bldg. 49, Room 5A-35, 9000 Rockville Pike, Bethesda, MD 20892. E-mail: [email protected]
Binge alcohol consumption in the rat induces substantial neurodegeneration in the hippocampus and entorhinal cortex. Oxidative stress and cytotoxic edema have both been shown to be involved in such neurotoxicity, whereas N-methyl-d-aspartate (NMDA) receptor activity has been implicated in alcohol withdrawal and excitoxic injury.
Article, publication date, and citation information can be found at http://jpet.aspetjournals.org.
ABBREVIATIONS: NMDA, N-methyl d-aspartate; MK-801, dizocilpine; CBD, cannabidiol; L-644,711, (R)-(+)-(5,6-dichloro2,3,9,9a-tetrahydro 3-oxo-9a-propyl-1H-fluoren-7-yl)oxy acetic acid; Alkamuls EL-620, polyoxyethylene 30 castor oil; BHT, butylated hydroxytoluene; TOC, α-tocopherol; PBS, phosphate-buffered saline; BAL, blood alcohol level; TNF, tumor necrosis factor.
These authors contributed equally to this work.
- Received March 4, 2005.
- Accepted May 3, 2005.
- The American Society for Pharmacology and Experimental Therapeutics
- Because the nonpsychoactive cannabinoid cannabidiol (CBD) was previously shown in vitro to prevent glutamate toxicity through its ability to reduce oxidative stress, we evaluated CBD as a neuroprotectant in a rat binge ethanol model. When administered concurrently with binge ethanol exposure, CBD protected against hippocampal and entorhinal cortical neurodegeneration in a dose-dependent manner.
- Similarly, the common antioxidants butylated hydroxytoluene and α-tocopherol also afforded significant protection. In contrast, the NMDA receptor antagonists dizocilpine (MK-801) and memantine did not prevent cell death. Of the diuretics tested, furosemide was protective, whereas the other two anion exchanger inhibitors, L-644,711 [(R)-(+)-(5,6-dichloro2,3,9,9a-tetrahydro 3-oxo-9a-propyl-1H-fluoren-7-yl)oxy acetic acid] and bumetanide, were ineffective. In vitro comparison of these diuretics indicated that furosemide is also a potent antioxidant, whereas the nonprotective diuretics are not.
- The lack of efficacy of L-644,711 and bumetanide suggests that the antioxidant rather than the diuretic properties of furosemide contribute most critically to its efficacy in reversing ethanol-induced neurotoxicity in vitro, in our model. This study provides the first demonstration of CBD as an in vivo neuroprotectant and shows the efficacy of lipophilic antioxidants in preventing binge ethanol-induced brain injury.
Cannabis as a Substitute for Alcohol
By Tod Mikuriya, MD
Ninety-two Northern Californians using cannabis as an alternative to alcohol obtained letters of approval from the author. Their records were reviewed to determine characteristics of the cohort and efficacy of the treatment,defined as reduced harm to the patient. All patients reported benefit, indicating that for at least a subset of alcoholics, cannabis use is associated with reduced drinking. The cost of alcoholism to individual patients and society- at-large warrants testing of the cannabis-substitution approach and study of the drug-of-choice phenomenon.
Physicians who treat alcoholics are familiar with the cycle from drunkenness and disinhibition to withdrawal, drying out, and apology for behavioral lapses, accompanied over time by illness and debility as the patient careens from one crisis to another. (Tamert and Mendelsohn 1969)
"Harm reduction" is a treatment approach that seeks to minimize the occurrence of drug/alcohol addiction and its impacts on the addict/alcoholic and society at large.
A harm-reduction approach to alcoholism adopted by 92 of my patients in Northern California involved the substitution of cannabis, with its relatively benign side-effect profile as their intoxicant of choice.
No clinical trials of the efficacy of cannabis as a subtitute for alcohol are reported in the literature, and there are no papers directly on point prior to my own account (Mikuriya 1970) of a patient who used cannabis consciously and successfully to reduce her problematic drinking.
There are ample references, however, to the use of cannabis as a substitute for opiates (Birch 1889) and as a treatment for delirium tremens (Clendinning 1843, Moreau 1845), which were among the first uses to which it was put by European physicians.
Birch described a patient weaned off alcohol by use of opiates, who then became addicted and was weaned off opiates by use of cannabis. "Ability to take food returned. He began to sleep well; his pulse exhibited some volume; and after three weeks he was able to take a turn on the verandah with the aid of a stick. After six weeks he spoke of returning to his post, and I never saw him again."
Birch feared that cannabis itself might be addictive, and recommended against revealing to patients the effective ingredient in their elixir. "Upon one point I would insist the necessity of concealing the name of the remedial drug from the patient, lest in his endeavor to escape from one form of vice he should fall into another, which can be indulged with facility in any Indian bazaar." This stern warning may have undercut interest in the apparently successful two-stage treatment he was describing.
At the turn of the 19th century in the United States, cannabis was listed as a treatment for delirium tremens in standard medical texts (Edes 1887, Potter 1895) and manuals (Lilly 1898, Merck 1899, Parke Davis 1909).
Since delirium tremens signifies advanced alcoholism, we can adduce that patients who were prescribed cannabis and used it on a longterm basis were making a successful substitution.
By 1941, due to prohibition, cannabis was no longer a treatment option, but attempts to identify and synthesize its active ingredients continued (Loewe 1950). A synthetic THC called pyrahexyl was made available to clinical researchers, and one paper from the postwar period reports its successful use in easing the withdrawal symptoms of 59 out of 70 alcoholics. (Thompson and Proctor 1953).
In 1970 the author reported (op cit) on Mrs. A., a 49-year-old female patient whose drinking had become problematic. The patient had observed that when she smoked marijuana socially, on week-ends, she decreased her alcoholic intake.
She was instructed to substitute cannabis any time she felt the urge to drink. This regimen helped her to reduce her alcohol intake to zero. The paper concluded, "It would appear that for selected alcoholics the substitution of smoked cannabis for alcohol may be of marked rehabilitative value. Certainly cannabis is not a panacea, but it warrants further clinical trial in selected cases of alcoholism.â€
The warranted research could not be carried out under conditions of prohibition, but in private practice and communications with colleagues I encountered more patients like Mrs. A. and generalized that somewhere in the experience of certain alcoholics, cannabis use is discovered to overcome pain and depression target conditions for which alcohol is originally used, but without the disinhibited emotions or the physiologic damage. By substituting cannabis for alcohol, they can reduce the harm their intoxication causes themselves and others.
Although the increasing use of marijuana starting in the late '60s had renewed interest its medical properties, including possible use as an alternative to alcohol (Scher 1971) meaningful research was blocked until the 1990s, when the establishment of "buyers clubs" in California created a potential database of patients who were using cannabis to treat a wide range of conditions. The medical marijuana initiative passed by voters in 1996 mandated that prospective patients get a doctorâ€™s approval in order to treat a given condition with cannabis, resulting in an estimated 30,000 physician approvals as of May 2002. (Gieringer 2002) As this goes to press a year later, the estimate stands at abut 50,000.
In a review of my records in the spring of 2002 by Jerry Mandel, PhD, 92 patients were identified as using cannabis to treat alcohol abuse and related problems. This paper describes characteristics of that cohort and the results of their efforts to substitute cannabis for alcohol.
The initial consultation (20 minutes) provided multiple opportunities to identify alcoholism as a problem for which treatment with cannabis might be appropriate. The intake form asked patients to state their reason for contacting the doctor, and enabled them to prioritize their present illnesses and describe the course of treatment to date. The form also asked patients to identify any non-prescribed psychoactive drugs they were taking (including alcohol), and invited remarks. A specific question concerned injuries incurred "while or after consuming alcohol." My reading of patients" medical records provided an additional opportunity to identify alcohol abuse, as did the taking of a verbal history.
At follow-up visits (typically at 12-month intervals) patients were asked to list the conditions they had been treating with cannabis and to evaluate their status as "stable", "improved," or "worse." Patients were asked to evaluate the efficacy of cannabis (five choices from "very effective to "ineffectual") and to describe any adverse events. Patients were also asked to describe any changes in their "living and employment situation," and if so, to elaborate.
The question about use of non-prescribed psychoactive drugs, including alcohol, was repeated. Comparison of responses in a given patient's initial and follow-up questionnaires enabled us to assess the utility of cannabis as an alternative to alcohol.
Gieringer (op cit) notes that "Many patients who find marijuana helpful for otherwise intractable complaints report that their physicians are fearful of recommending it, either because of ignorance about medical cannabis, or because they fear federal punishment or other sanctions."
"This is especially true in regions where the use of marijuana is less familiar and accepted." The patients whose records form the basis for this study were all seen in ad hoc settings arranged by local cannabis clubs, 72 in rural counties of Northern California, 4 in San Francisco. They form a special but not unique subset, having intentionally sought out a physician whose clinical use of cannabis and confidence in its versatility and relative safety was extensive and well known in their communities.
A majority of the patients identified themselves as blue-collar workers: carpenter (5), construction (3), laborer (3), waitress (3), truck driver (3), fisherman (3), heavy equipment operator (3), painter (2), contractor (2) cook (2), welder (2), logger (2), timber faller, seaman, hardwood floor installer, bartender, building supplies, house caretaker, ranch hand, concrete pump operator, cable installer, silversmith, stone mason, boatwright, auto detailer, tree service handyman cashier, nurseryman, glazier, gold miner, carpet layer, carpenterâ€™s apprentice, landscaper, river guide, screenprinter, glassblower.
Eleven were unemployed or didnâ€™t list an occupation; four were disabled, two retired, and two patients defined themselves as mothers. Others were in sales (5), musicians (5), clerical workers (3), paralegal, teacher, actor, actress, artist, sound engineer, computer technician.
Eighty-two of the patients were men.
Patients' ages ranged from 20 to 69. Twenty-nine were in their twenties; 16 in their thirties; 24 in their forties; 20 in their fifties; three in their sixties.
Exactly half 46 patients had taken some college courses, but only four had college degrees. Five did not complete high school.
Thirteen were veterans, all branches of the Armed Forces being represented.
All but six five native-Americans, one African-American were Caucasian.
Slightly more than half (49) reported being raised by at least one addict/lcoholic parent.
Fifty-seven of the patients identified alcoholism or cirrhosis of the liver as their primary medical problem. Secondary problems reported by this group were Depression (15), Pain (14), Arthritis (7), PTSD (6), Insomnia (6), Cramps (4) Hepatitis C (4) Anxiety (3), Stress (2), gastritis, and ADHD.
Thirty-one patients identified themselves as alcohol abusers, but reported other problems as primary: Pain (12), Depression (8), Headache (4), Bipolar Disorder (2) Anxiety (2), Arthrtitis (2), Asthma (2) Spinal Cord Injury/Disease (2), Paraplegia, PTSD, Crushed skull, Aneurysms aggravated by stress, ADHD, Multiple broken bones.
Eighteen patients reported having been injured while or after drinking heavily.
Fourteen had incurred legal problems or been ordered into rehab programs.
Awareness of Medicinal Effect
Patients were asked when they started using cannabis and when they realized it exerted a medicinal effect.
Three reported first using at age 9 or younger; 61 between ages 10 and 19; nine began using in their 20s; three in their 30s; six in their 40s; two at age 50; and one at age 65.
Twenty-four patients reported realizing immediately upon using cannabis that it exerted a beneficial medical effect. Some of their responses still seem to reflect their relief at the time.
"In 1980 I had quit drinking for a month. My niece asked me if I ever tried marijuana to calm me down. So I tried it and it worked like a miracle."
"Helped pain very much! Helped sleep, excellent."
Thirty-five patients answered ambiguously with respect to time "When realized preferred to alcohol," for example, or, "when I smoked when suffering."
Seven reported becoming aware of medical effect within a year of using cannabis. Ten became aware within one to five years.
Three became aware of medical effect 12-15 years after first using. Ten became aware between 20 and 30 years after first using. All but one of these patients had resumed using cannabis after years of abstinence.
As could be expected among patients seeking physician approval to treat alcoholism with cannabis, all reported that they'd found it "very effective" (41) or "effective" (38).
Efficacy was inferred from other responses on seven questionnaires. Two patients did not make follow-up visits.
Nine patients reported that they practiced total abstinence from alcohol and attributed their success to cannabis. Their years in sobriety: 19, 18, 16, 10, 7, 6, 4 (2), and 2.
Twenty-nine patients reported a return of symptoms when cannabis was discontinued. Typical comments:
"I quit using cannabis while I was in the army and my drinking doubled. I was also involved in several violent incidents due to alcohol.â€
Use of Other Drugs
Patients were asked to list other drugs prescribed, over-the-counter, and herbal, that they were currently using or had used in the past to treat their illnesses. Most common of the prescription drugs were SSRIs (31), opiates (23) NSAIDs (18) disulfaram (15) and Ritalin (8).
Seventy-eight patients smoked joints â€”the average amount being one joint a day (assuming 3.5 joints per 1/8 ounce of high-quality marijuana).
All were strongly advised that smoking involves an assault on the lungs, and that vaporization is a safer method of inhaling cannabinoids.
Twelve patients reported using a pipe, and three owned vaporizers. All were strongly advised that smoking involves an assault on the lungs, and that vaporization is a safer method of inhaling cannabinoids.
That a slight majority patients (51) reported being raised by at least one alcoholic parent was not surprising. The children of alcoholics enter adulthood with two strikes.
They have endured direct emotional abuse and/or abandonment by parent(s); and they lack role models for coping with uncomfortable feelings other than by inebriation. It is to be expected that many, when encountering problems early in life, are treated with, or seek out, mind-altering drugs.
Cannabis for Analgesia
The large number of patients using cannabis for pain relief (28) reflects the high percentage of blue-collar workers who suffer musculoskeletal injury during their careers. As expressed by a carpenter, "Nobody gets to age 40 in my business without a bad back." Nurses who must lift gurneys, farmworkers, desk-bound clerical workers, and many others are also prone to chronic back and neck pain.
Fights and accidents vehicular, sports- and job-related, also create chronic pain patients, many of whom self-medicate with alcohol.
Eighteen patients reported having been injured while or after drinking heavily. This comment by Jamie R., a 26-year-old truck driver, describes a typical chain-reaction of alcohol-induced trouble: "Injured in a fight after consuming alcohol, resulted in staph infection of right knuckle, minor surgery and four days in hospital." Injuries suffered while drunk add to pain and the need for relief by alcohol â€¦or a less destructive alternative.
A total of 26 patients reported using cannabis for both pain relief and as an alternative to alcohol. Mike G., a 47-year old landscaper who was run over by a vehicle at age 5, requiring multiple surgeries and leaving him with pins in his right ankle, first used cannabis at age 16 and appreciated its benign side-effect profile: "Given pain pills for my right ankle, I got too drowsy. Smoked herb to relieve pain." And when he had to discontinue cannabis use, "was unable to ease pain in ankle without herb, and drink when unable to have cannabis to smoke."
Cannabis for Mood Disorders
Twenty-three patients reported using cannabis to treat depression,39 if the category is expanded to include anxiety, stress, and PTSD, and their comments frequently touched on the negative synergies between mood disorders and alcoholism.
Wendy S., a 44-year-old paralegal, suffering from depression, alcoholism, and PMS noted simply, "Alcohol causes more depression." When she does not have access to cannabis, "Alcohol consumpion increases and so does depression." At her initial visit she reported consuming 5-10 drinks/day. At a follow-up (16 months) she had reduced her consumption to week-ends.
Albert G., a 33-year-old river guide (and decorated Army vet) put it this way: "I have had a problem with violence and alcohol for a long time and I have a rap sheet to prove it. None of the problems occurred while using cannabis. Not only does cannabis prevent my violent tendencies, but it also helps keep me from drinking." On his follow-up visit (12 months) Albert reported improved communication with family members and fewer problems relating to other people. His alcohol consumption had decreased from 36 drinks/week to zero (one month of sobriety).
Carol G. presented initially at age 35 as homeless and unemployed, suffering "severe depression. Anxiety. Pain." Her problem with alcohol was inferred from her response concerning non-medical-psychoactive drug use: "I drink and smoke too much started when I couldn't get marijuana."
Carol had shyly requested a recommendation for cannabis from a Humboldt County physician but, as she recounted, "I'm paranoid and local Drs are scared, too. They gave me paxil & stop smoking pamphlet."
At a follow-up visit (14 months) Carol reported a change in circumstance: "Now have a room. But am on G.R. and am paying too much." She was still using alcohol "a little. I'm doing good dealing with not drinking. Being able to medicate with cannabis has helped a lot." Eighteen months later the pattern hadn't changed: "Alcohol several times/week. Depends on if I have cannabis, stress still triggers."
Fewer Adverse Effects
Patients made negative comments with respect to the efficacy of their prescribed analgesics and anti-depressants (22), side-effects (26), and cost (11) not surprising, perhaps, in a cohort seeking an herbal alternative.
Lance B. presented as a 41-year-old alcoholic also suffering from arthritis, pain from knee- and ankle surgeries, and depression, for which he had been prescribed Librium, Valium, Buspar, Welbutrin, Effexor, Zoloft, and Depakote over the years; "No help!," he wrote bluntly. On his return visit (one year) he reported â€œ"ew relapses" and that he was able to take some classes.
The dulling effects of Vicodin and other opiates were mentioned by seven patients. As Harvey B. put it, "When I can get Vicodin it helps the pain but I don't like being that dopey." Clarence S., whose skull was badly damaged in an accident, also appreciated the pain relief provided by opiates, but asserted that opiates "make me paranoid and mean."
Alex A., who was diagnosed with ADHD in ninth grade, touches on some recurring themes in describing the treatment of his primary illness: "I was prescribed Ritalin and Zoloft. The Ritalin helped me concentrate slightly but caused me to be up all night. The Zoloft made me sick to my stomach and never relieved my stress or depression. I have never been prescribed anything for my insomnia but I usually have to drink some liquor to get to sleep."
"I think that is a bad thing as I have now begun to drink excessive amounts of whisky, which has really started to affect my stomach." Alex first used cannabis at age 19 and became aware of benefits immediately. "I found myself running to the refrigerator and then sleeping better than I had for years." At age 21 he fears permanent damage. "From drinking (I believe) my stomach has been altered, along with my appetite...I cannot really eat that much and feel malnourished and weaker than a 21-year-old should. My joints ache constantly and I am not as strong as I used to be. I also fear that I will become or am an alcoholic and I do not want to see myself turn into my dad."
At his follow-up visit (12 months) Alex reported cannabis to be "very effective." He was employed, "not partying," doing well socially, and trying to give up cigarettes.
No negative interactions between cannabis and other drugs were reported. Several patients (3) indicated that cannabis had a welcome amplifying effect on the efficacy of prescription and OTC medications. "I hurt a lot more without cannabis and can't function as well," reported Liz J. "It seems to relax me so the medicines work better and faster." "Additionally, cannabis is natural, and all these other drugs, Vicodin, Soma, Aleve, Librium, Baclofen, have lots of side effects."
As cannabis comes into wider use in California and elsewhere, it is important that its interactions with other medications be studied and publicized.
As cannabis comes into wider use in California and elsewhere, it is important that its interactions with other medications be studied and publicized. Cannabis may also have an amplifying effect on alcohol, enabling some patients to achieve a desired level of inhibition-reduction or euphoria while drinking significantly less.
The harm-reduction approach to alcoholism is based on the recognition that for some patients, total abstinence has been an unattainable goal. Success is not defined as the achievement of perpetual sobriety. A treatment may be deemed helpful if it enables a patient to reduce the frequency and quantity of alcohol consumption; if drunken episodes and/or blackouts are reduced; if success in the workplace can be achieved; if specific problems induced by alcohol (suspended driver's license, for example) can be resolved; if ineffective or toxic drugs can be avoided.
As noted, all of the patients in this study were seeking physician's approval to use cannabis medicinally, a built-in bias that explains the very high level of efficacy reported. However, the majority were using cannabis for other conditions as well, and would have qualified for an approval letter whether or not they reported efficacy with respect to alcoholism.
Although medicinal use of cannabis by alcoholics can be dismissed as "just one drug replacing another," lives mediated by cannabis and alcohol tend to run very different courses. Even if use is daily, cannabis replacing alcohol (or other addictive, toxic drugs) reduces harm because of its relatively benign side-effect profile.
Cannabis is not associated with car crashes; it does not damage the liver, the esophagus, the spleen, the digestive tract. The chronic alcohol-inebriation-withdrawal cycle ceases with successful cannabis substitution. Sleep and appetite are restored, ability to focus and concentrate is enhanced, energy and activity levels are improved, pain and muscle spasms are relieved. Family and social relationships can be sustained as pursuit of long-term goals ends the cycle of crisis and apology.
Carl S., a 42 year old journeyman carpenter, is a success story from a harm-reduction perspective. At his initial visit he defined his problem as "intermittent explosive disorder," for which he had been prescribed Lithium. Although drinking eight beers/day, he reported "Cannabis has allowed me to just drink beer when I used to blackout drink vodka and tequila." By the time of a follow-up visit (12 months),
Carl had been sober for four months. He also reported "anger outbreaks less severe, able to complete projects," and, poignantly, "paranoia is now mostly realism." He plans to put his technical skill to use in designing a vaporizer.
The Doctor-Patient Relationship
As a certified addictionologist I have supervised both inpatient and outpatient treatment for thousands of patients since 1969. In the traditional alcoholism medical-treatment model, the physician is an authority figure to a patient whose life has spun out of control.
The patient enters under coercive circumstances, frequently under court order, with physiologies in toxic disarray. Transference dynamics cast the physician into a parental role, producing the usual parent-child conflicts. After detoxification when cognition has returned from the confusional state of withdrawal, the patient leaves, usually with powers of denial intact. Follow-up outpatient treatment is oriented to AA and/or pharmacologic substitutes.
Treating alcoholism by cannabis substitution creates a different doctor-patient relationship. Patients seek out the physician to confer legitimacy on what they are doing or are about to do. My most important service is to end their criminal status, Aeschalapian protection from the criminal justice system which often brings an expression of relief.
An alliance is created that promotes candor and trust. The physician is permitted to act as a coach , an enabler in a positive sense.
As enumerated by patients, the benefits can be profound: self-respect is enhanced; family and community relationships improve; a sense of social alienation diminishes. A recurrent theme at follow-up visits is the developing sense of freedom as cannabis use replaces the intoxication-withdrawal-recovery cycle , freedom to look into the future and plan instead of being mired in a dysfunctional past and present; freedom from crisis and distraction, making possible pursuit of long-term goals that include family and community.
Re: Alcoholics Anonymous
Although nine patients made voluntary reference to attending 12-step meetings (three presently, six in the past), it is likely that many more actually tried the 12-step program, but the question was not posed on the intake form. A future study should examine the relationship between cannabis-only users and Alcoholics Anonymous.
At AA meetings, cannabis use is considered a violation of sobriety. This puts cannabis-only users in a bind. Those who attend meetings can't practice the "rigorous honesty" that AA considers essential to recovery; and those who avoid meetings are denied support and encouragement that might help them to stay off alcohol. Support-group meetings at which cannabis-using alcoholics are welcome would be a positive development.
Frank R., first seen at age 29, was diagnosed as an alcoholic in 1987 and began attending AA meetings, which he found helpful although he could not achieve sustained sobriety. In 1998, after realizing that cannabis reduced his cravings for alcohol, he received approval to use it. At a follow-up in November '99 he reported, "Have stopped drinking for the first time in many years. I have not taken a drink of alcohol in 14 months. I attribute some credit for this to daily use of cannabis. My life has improved with this treatment."
Frank R. was seen again in April '01 and reported, "I continue to maintain sobriety regarding alcohol. Have not had a drink for 2 1/2 years. I drank alcohol heavy for about 10 years, and had difficulty stopping drinking and staying stopped until I began this treatment. Pain symptoms from back spasms/scoliosis also better."
Factors in Drug of Choice
British psychiatrist G. Morris Carstairs spent 1951 in a large village in northern India and reported on the two highest castes, Rajput and Brahmin, and their traditional intoxicants of choice, alcohol and cannabis, respectively. The Rajputs were the warriors and governors; they consumed a potent distilled alcohol called daru. The Brahmins were the religious leaders; they were vegetarians and drank a cannabis infusion called bhang.
"By virtue of their role as warriors, the Rajputs were accorded certain privileged relaxations of the orthodox Hindu rules," writes Carstairs, "in particular, those prohibiting the use of force, the taking of life, the eating of meat and drinking of wine." The Rajputs viewed the daru-inspired release of emotions, notably sexual and aggressive impulses, as admirable. Rajput lore, as shared with Carstairs, glorified sexual and military conquests.
The priestly Brahmins, on the other hand, "were quite unanimous in reviling daru and all those who indulged in it. They described it as foul, polluting, carnal and destructive to that spark of Godhead which every man carries within him." Bhang, a Brahmin told Carstairs, "gives good bhakti." He defined bhakti as "emptying the mind of all worldly distractions and thinking only of God." The Brahmin emphasis on self-denial includes "the avoidance of anger and or any other unseemly expression of personal feelings; abstinence from meat and alcohol is a prime essential." Carstairs's stated goal was to understand how the Brahmins could rationalize intoxicant use. He concluded:
"There are alternative ways of dealing with sexual and aggressive impulses besides repressing them and then 'blowing them off in abreactive drinking bouts in which the superego is temporary dissolved in alcohol. The way which the Brahmins have selected consists in a playing down of all interpersonal relationships in obedience to a common, impersonal set of rules of Right Behavior. Not only feelings but also appetites are played down, as impediments to the one supreme end of union with God... Whereas the Rajput in his drinking bout knows that he is taking a holiday from his sober concerns, the Brahmin thinks of his intoxication with bhang as a flight not from but toward a more profound contact with reality."
Two aspects of Carstair's report resonate strongly with my own observations:
The disinhibition achieved via alcohol is the Rajput kind a flight from reality, becoming "blotto" whereas the disinhibition achieved via cannabis is the result of focused or amplified contemplation.
"Drug of choice" is strongly influenced by social and cultural factors, and, once determined, becomes a defining element of individual self-image, i.e., possible but not easy to change in adulthood.
Prohibition of marijuana, the intense advertising of alcohol, and its widespread availability encourage the adoption of alcohol as a drug of choice among U.S. adolescents.
It is likely that legal access to cannabis would result in fewer young adults adopting alcohol as their drug of choice, with positive consequences for the public health and countless individuals.
Ring Lardner, Jr., on Cannabis as a Substitute for Alcohol
Screenwriter Ring Lardner, Jr. won an Oscar in 1938 for "Woman of the Year" and another in 1970 for "M*A*S*H." His memoir "I'd Hate Myself in the Morning" (which takes its title from his line to the House Un-American Activities Committee) includes this description of his colleagues Ian Hunter and Waldo Salt.
"Ian, too, had an alcohol problem, one that, unlike mine, increased in severity to the point of debilitation. During the period when we had to come up with an episode for a half-hour television program every week, there were times when I had to perform the task by myself. On occasion, he would pull himself together and make a big effort to match what I had done single-handed. Eventually, though, he came to the conclusion that he would have to give up drinking for good. And he proceeded to do just that, first by enlisting in Alcoholics Anonymous, as he went cold turkey, then, to fortify his abstinence, by substituting marijuana for alcohol."
It happened that a friend of ours, the blacklisted writer Waldo Salt, had made the same medicinal switchover. Since Ian and Waldo also shared a love of drawing, they could pool the cost of a model and spend an evening indulging in pot and art. Neither of them drank again, as far as I know.
"Some years earlier, when the film community was still disproportionately Jewish, my good friend Paul Jarrico announced a discovery. He had been wondering why a small grup of his fellow screenwriters Ian, Dalton, Trumbo, Hugo Butler, Michael Wilson, and I were such a close, cozy group. What bound us together, Paul reported, was the fact that we were all gentiles. 'Nonsense,' Ian declared, 'It's that we're all drunks.' Instantly, I knew he was right. It was by far the stronger bond."
The endocannabinoid signaling system: a potential target for next-generation therapeutics for alcoholism
White Matter Integrity in Adolescents with Histories of Marijuana Use and Binge Drinking.
Jacobus J, McQueeny T, Bava S, Schweinsburg BC, Frank LR, Yang TT, Tapert SF
White matter integrity in adolescents with histories of marijuana use and binge drinking. [Journal Article, Research Support, N.I.H., Extramural]
Neurotoxicol Teratol 2009 Nov-Dec; 31(6):349-55.
Structural brain abnormalities have been observed in adolescents with alcohol use disorders but less is known about neuropathological brain characteristics of teens with sub-diagnostic binge drinking or the common pattern of binge drinking combined with marijuana us
The goal of this study was to examine white matter integrity in adolescents with histories of binge drinking and marijuana use. Diffusion tensor imaging (DTI) was conducted with 42 adolescents (ages 16-19) classified as controls, binge drinkers, or binge drinkers who are also heavy marijuana users. Tract based spatial analysis identified shared fiber structure across individuals and facilitated voxelwise comparisons of fractional anisotropy (FA) and mean diffusivity (MD) between groups.
Significant between group differences were found in FA in eight white matter regions (ps < or = .016) between the binge drink-only group and controls, including superior corona radiata, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and superior longitudinal fasciculus. Interestingly, in 4 of these same regions, binge drinkers who are also heavy marijuana users had higher FA than binge drinkers who did not use marijuana (ps<.05). MD did not differ between groups. Findings are largely consistent with research suggesting less neuropathology in adolescents without histories of substance use.
However, binge drinkers who also use marijuana did not show as consistent a divergence from non-users as did the binge drink-only group. Detection of white matter alterations may have implications in identifying early cognitive dysfunction in substance using adolescents.
Pot Might Blunt Damage of Binge Drinking
FRIDAY, Aug. 21 (HealthDay News) -- Marijuana may buffer the brain against the damages of binge drinking, a new study suggests.
Researchers from the University of California, San Diego, used high-tech scans to compare microscopic changes in brain white matter in teens aged 16 to 19 who were divided into three groups: binge drinkers (boys who consume five or more drinks at one sitting, and girls who have four or more drinks); binge drinkers who also smoked marijuana; and a control group with little or no experience with either alcohol or drugs.
As expected, the binge drinkers showed signs of white matter damage in all eight brain regions examined by the researchers. But the binge drinkers/marijuana users had less damage in seven out of the eight brain regions than the binge drinkers did. And compared to the control group, the binge drinkers/marijuana users had more white matter damage in only three regions.
The researchers wrote that brain white matter tracts were "more coherent in adolescents who binge drink and use marijuana than in adolescents who report only binge drinking." They said it's "possible that marijuana may have some neuroprotective properties in mitigating alcohol-related oxidative stress or excitotoxic cell death."
The study appears in the current issue of the journal Neurotoxicology and Teratology.
"This study suggests that not only is marijuana safer than alcohol, it may actually protect against some of the damage that booze causes," Steve Fox, director of state campaigns for the Marijuana Policy Project, said in a news release from the project.
"It's far better for teens not to drink or smoke marijuana, but our nation's leaders send a dangerous message by defending laws that encourage the use of alcohol over marijuana," he added.
Cannabis as a substitute for alcohol and other drugs.
|Title||Cannabis as a substitute for alcohol and other drugs.|
|Institution||School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, Berkeley, CA 94720, USA. [email protected]|
|Source||Harm Reduct J 2009.:35.|
This practice of substitution has been observed among individuals using cannabis for medical purposes. This study examined drug and alcohol use, and the occurrence of substitution among medical cannabis patients.
|Pub Type(s)||Journal Article|
Daily marijuana users with past alcohol problems increase alcohol consumption during marijuana abstinence.
|Title||Daily marijuana users with past alcohol problems increase alcohol consumption during marijuana abstinence.|
|Author(s)||Peters EN, Hughes JR|
|Institution||Yale University School of Medicine, The APT Foundation, One Long Wharf, New Haven, CT 06511, USA. [email protected]|
|Source||Drug Alcohol Depend 2010 Jan 15; 106(2-3):111-8.|
Drug abuse treatment programs typically recommend complete abstinence because of a fear that clients who stop use of one drug will substitute another. A within-subjects study investigated whether consumption of alcohol and other substances changes during marijuana abstinence.
Twenty-eight daily marijuana users who were not trying to stop or reduce their marijuana consumption completed an 8-day baseline period in which they used marijuana and other drugs as usual, a 13-day marijuana abstinence period, and a 7-day return-to-baseline period.
Participants provided self-report of substance use daily and submitted urine samples twice weekly to verify marijuana abstinence. A diagnosis of past alcohol abuse or dependence significantly moderated the alcohol increase from baseline to marijuana abstinence (p<0.01), such that individuals with this diagnosis significantly increased alcohol use (52% increase) but those without this history did not (3% increase). Increases in marijuana withdrawal discomfort scores and alcohol craving scores from baseline to marijuana abstinence significantly and positively correlated with increases in alcohol use.
Increases in cigarettes, caffeine, and non-marijuana illicit drugs did not occur. This study provides empirical validation of drug substitution in a subgroup of daily marijuana users, but results need to be replicated in individuals who seek treatment for marijuana problems.
|Pub Type(s)||Journal Article|
Maternal Marijuana use not Associated with Psychotic Symptoms , but Alcohol is
Maternal Tobacco and Alcohol Use, But Not Marijuana, Associated With Psychotic Symptoms In Offspring, Study Says
Wales, United Kingdom: The maternal use of tobacco and alcohol during pregnancy is linked with increased incidences of psychotic symptoms in adolescents, according to the results of a longitudinal study published in the October issue of The British Journal of Psychiatry.
Investigators at the University of Bristol in Great Britain assessed whether maternal use of tobacco, alcohol, or cannabis during pregnancy increased the risk of psychotic symptoms in their offspring. Researchers examined the drug use habits of the mothers of over 6,300 adolescents – approximately 12 percent of which exhibited some symptoms of psychosis.
Authors concluded: "Frequency of maternal tobacco use during pregnancy was associated with increased risk of suspect or definite psychotic symptoms (in offspring.) Maternal alcohol use shows a non-linear association with psychotic symptoms, with this effect almost exclusively in the offspring of women drinking >21 units (approximately a half-pint of beer or a glass of wine) weekly. Maternal cannabis was not associated with psychotic symptoms."