Medical Marijuana and Alcoholism
- 12-step program
The consideration of medical cannabis as a treatment therapy for those suffering from alcohol addiction, including abuse and dependence, is rarely discussed. Understandably, diseases like muscular dystrophy, cancer, arthritis, and Crohn’s get most of the attention during debates over the efficacy of cannabis and safe access for patients.
Nevertheless, million of Americans suffer from alcoholism and alcohol-related disorders, including Alcohol Use Disorder (AUD) and Alcohol Dependence Syndrome (ADS). Is medical cannabis, which has shown such amazing efficacy for dozens of serious conditions and diseases, up to the task of recovery treatment? Can it help those who have a demonstrated and serious disease like alcoholism to kick the habit?
Addiction: Key to Embracing Cannabis
Much of the controversy over the effectiveness of treating alcoholics with cannabis hinges on whether one perceives the herb to be addictive. Those who are critical of cannabis and its use as a treatment therapy for alcoholism claim that sufferers are merely swapping one addiction for another.
Because science has proven that cannabis is merely habit forming, but not physically addictive in any way, there is a complete lack of withdrawal symptoms. Heroin, prescription opiates, tobacco, and alcohol all are highly addictive at the physical level and offer a slew of undesirable and painful withdrawal symptoms.
It is commonly understood that severe alcoholism is accompanied by significant physical withdrawal symptoms, including seizures, irregular heartbeat, hallucinations, spikes in blood pressure, and tremors (the “shakes”). If untreated, severe alcohol withdrawal syndrome kills one out of three sufferers. Clearly, alcoholism is a public health issue that affects millions of Americans, many of them drinkers, but countless others who are innocent domestic partners, family members, or co-workers.
Cannabis, on the contrary, carries no physical addiction and offers no opportunity for overdose. Smokers and vapers also suffer none of the violent rages that often accompany severe drinking disorders. A nation of tokers will experience dramatically lower rates of domestic violence and child neglect than one populated by chronic use of ethanol in the form of whiskey, vodka, and tequila.
Overdose: Impossible vs. Easy
It must be assumed that some patients will not only leverage cannabis as a therapy to overcome alcoholism, but will also adopt it as part of a new lifestyle. While not all who use marijuana to overcome an opiate or alcohol addiction will continue use of the herb following their successful recovery, the issue of adults “swapping” one chronic behavior for another cannot be avoided.
Fortunately, it is impossible to overdose on cannabis, something that can’t be said of alcohol, opiates, and nearly anything else one might put into their body. In fact, when one considers that a hangover is the body’s response to low-level alcohol poisoning, society’s acceptance of alcohol and drunkenness does nothing to mitigate the fact that heavy drinking is a risky and often deadly activity.
One of the most common methods by which the “danger” inherent in a particular drug is objectively measured within the medical community is the rate at which it kills those who consume it. This is expressed by something called the LD-50 rating, which indicates the dosage necessary to kill 50 percent of test animals “as a result of drug induced toxicity.” In other words, LD-50 indicates a substance’s median lethal dose.
For alcohol, the LD-50 is about 0.40 percent blood alcohol level (BAL). Rutgers University’s Center for Alcohol Studies reports the lethal dose for alcohol to be between 0.40 and 0.50 percent. It should be noted, however, that body weight, metabolism, and several other factors influence how much one can drink before overdose becomes a serious threat.
But what does this mean in practical terms? A 100-pound person who consumed nine to 10 standard drinks in less than an hour would be in the LD-50 range. A more common example is a 200-pound person, who would have to consume only five to six drinks per hour for four hours to reach the LD-50.
In a 1988 ruling, DEA Administrative Law Judge Francis Young detailed the amount of cannabis necessary to achieve a level of toxicity that might cause death in humans:
“At present it is estimated that marijuana’s LD-50 is around 1:20,000 or 1:40,000. In layman terms this means that in order to induce death a marijuana smoker would have to consume 20,000 to 40,000 times as much marijuana as is contained in one marijuana cigarette. A smoker would theoretically have to consume nearly 1,500 pounds of marijuana within about 15 minutes to induce a lethal response.”
Not convinced? According to the National Cancer Institute, part of the National Institutes of Health,
“Because cannabinoid receptors, unlike opioid receptors, are not located in the brainstem areas controlling respiration, lethal overdoses from cannabis and cannabinoids do not occur.”
Some estimates peg the number of people who die from alcoholism and alcohol-related accidents at two million per year globally. Cannabis, fortunately, has never been responsible for a single death. Despite sensationalistic (and poorly researched) media reports to the contrary, cannabis simply has never taken a life. Instead of a toxin, like alcohol, cannabis is a medicine.
12-Step Programs Not Effective
Unfortunately, 12-step programs like Alcoholics Anonymous, or AA (a form of therapy categorized as Twelve Step Facilitation, or TSF) fail to help the majority of alcoholics. It is estimated that more than two-thirds of those enrolled in such programs drop out prior to completion. In the United States, AA estimated that, as of 2013, about one million people regularly attended meetings at one of roughly 60,000 groups across the nation.
According to Dr. Lance Dodes, a retired professor of psychiatry at Harvard Medical School and author of The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry:
“Peer reviewed studies peg the success rate of AA somewhere between five and 10 percent. About one of every 15 people who enter these programs is able to become and stay sober.”
In 2000, Alcoholism Treatment Quarterly published a report that analyzed AA membership surveys collected between 1968 and 1996. The hard data is striking: 81 percent of newcomers stopped attending AA meetings within the first month. After 90 days, only 10 percent remained. After a year, participation had dwindled to only five percent.
(If you doubt society’s acceptance of unscientific 12-step programs, consider that the approach is applied to more than 300 addiction and psychological disorders, but remember that only five to 10 percent of those who participate in such programs are successful at kicking their addiction and actually staying sober.)
Clearly, a different approach is necessary to help the majority of those afflicted with alcoholism in the form of AUD or ADS who are not served by 12-step programs.
While a stoner stigma continues to plague heavy, daily cannabis users, it can easily be argued that marijuana consumers are not only preventing the damage to their bodies that would result from heavy alcohol consumption — including liver damage, ulcers and gastrointestinal issues, blackouts, heart disease, memory loss, and depression — but that they also are fighting off disease and using the herb in a preventative manner.
From a public health perspective, a nation of stoners is considerably less taxing and expensive than one in which the primary recreational euphoric activity involves the consumption of fermented vegetables and fruits. Mothers Against Drunk Driving should be embracing and endorsing cannabis legalization efforts because they result in markedly lower traffic fatalities and lower teen pregnancy. While preliminary, initial statistics from Colorado are proving that full legalization actually results in lower rates of teen use, less crime, and fewer traffic accidents.
The late Dr. Tod Mikuriya was a strong advocate of medical cannabis for a variety of therapeutic applications, including the treatment of alcohol dependence. Mikuriya published a study in 2004 that involved 92 patients, all of whom had been prescribed cannabis as a treatment for alcohol dependence.
“As could be expected among patients seeking physician approval to treat alcoholism with cannabis, all reported that they’d found it ‘very effective’ (45) or ‘effective’ (38). Efficacy was inferred from other responses on seven questionnaires.”
The report continued:
“Nine patients reported that they had practiced total abstinence from alcohol for more than a year and attributed their success to cannabis. Their years in sobriety: 19, 18, 16, 10, 7, 6, 4 (2), and 2.”
Many patients involved in the study reported that their symptoms of alcohol dependence returned after they discontinued use of cannabis. A whopping 29 of the patients who participated in Mikuriya’s study formerly used alcohol for pain relief, but all had instead converted to using cannabis for this task.
A significant portion of the study participants, 44, reported that they had used alcohol to treat a mood disorder such as stress, anxiety, or depression. Some also reported using booze to squelch the pain of PTSD. All forty four reported that they had successfully substituted cannabis for alcohol for the relief of their psychological ailments. Mikuriya stressed that cannabis has fewer side effects than both alcohol and prescription drugs.
A study published in the Harm Reduction Journal in 2009 and conducted at the University of California at Berkeley concluded with the recommendation that cannabis be used as a substitute for alcohol in the treatment of alcohol abuse. The study polled 350 cannabis users, finding that 40 percent used the herb to control their alcohol cravings and that 66 percent leveraged it as a replacement for prescription drugs. Even 26 percent of those polled used cannabis as a substitute for more potent illegal drugs, like cocaine and heroin.
The study was conducted by Amanda Reiman at the UC-Berkeley Patient’s Group medical cannabis dispensary. Said Reinman:
“Substituting cannabis for alcohol has been described as a radical alcohol treatment protocol. This approach could be used to address heavy alcohol use in the British Isles — people might substitute cannabis, a potentially safer drug than alcohol with [fewer] negative side effects, if it were socially acceptable and available.”
The study reported that 65 percent of participants used cannabis as a substitute because it delivers fewer negative side effects than alcohol, prescription drugs, or harder illegal drugs. Of those polled, 34 percent said they used cannabis because it has no physical addiction and, thus, less withdrawal potential. Nearly 58 percent of participants said they used cannabis because it is more capable of dealing with their symptoms.
In states where cannabis remains prohibited, it’s understandable that citizens would opt for a legal, albeit dramatically more dangerous, drug that is vastly easier to obtain. In states like Colorado and Oregon, where recreational use for those 21 and older has been legalized, those suffering from alcohol dependence now have the option of legally and conveniently visiting a dispensary or retail shop to purchase an alternative to a 12-pack of Bud Light or too many whiskey sours.
According to Dr. B.G. Charlton in the United Kingdom:
“Since hundreds of thousands of people in the UK and Ireland regularly get drunk during their leisure hours, it is clear that a lifestyle drug that induces a state of euphoric release is needed, and alcohol is currently the only legal and available intoxicating agent. Marijuana is probably a safer and less antisocial alternative to high-dose alcohol.”
There will always be a sizeable portion of the population that refuses to engage in illegal activities or deal with the black market for uncertain product. For these people, alcohol and tobacco are among the only sanctioned, legal, and encouraged euphoric activities in the majority of the United States. As cannabis becomes legal in more areas of the nation, especially at a recreational level, more sufferers of alcoholism and opiate addiction will be given the option of “switching” to cannabis.
Photo credit: Drug Policy Alliance.
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