CBD in the treatment of addiction: research into its properties

Among the many studies on the potential applications of CBD, or cannabidiol, is the treatment of some addictive disorders. As these problems continue to affect people around the world, a range of research is looking for new ways to tackle them.

This post sets out the current research on the use of CBD in the treatment of addiction from Dr Caudevilla, a GP and specialist in drug dependence with extensive experience in clinical care, research and teaching projects related to drug use.

This article is intended for informational purposes only and is not intended to diagnose, prevent or cure any disease or symptom. Its content can complement, but never replace, the diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines. Consult your doctor before using CBD.

CBD for overcoming addiction: introduction

What are addictions?

An addiction is a pattern of substance use in which control over the substance is lost and its use becomes central to the person's life. A distinction is usually made between physical and psychological dependence, although the line between the two concepts is debatable.

Physical dependence refers to the state in which the body becomes accustomed to the presence of a substance and begins to require it to function properly. It is usually related to withdrawal syndrome, which is the set of symptoms that appear when abruptly stopping the consumption of a substance, which can be very uncomfortable and even dangerous in some cases.

Psychological dependence, on the other hand, refers to the emotional and mental need for the substance. The person may feel an uncontrollable need to use the substance even while aware of the negative consequences it causes them. In any case, addictions are the result of a complex and interrelated set of biological, psychological and social factors. The treatment of addiction begins by addressing these three areas in a professional, specialised medical way, and there are no “miracle pills” in this regard.

Can cannabis cause dependence?

The DSM, the international reference manual for diagnosing mental health problems, includes “cannabis use disorder” in its fifth and latest edition. Some scientists have criticised the validity of this definition, or its use in the same way as alcohol or cocaine dependence is classified (1, 2, 3).

The same DSM-5 manual introduces the diagnosis of “cannabis withdrawal” for the first time. The condition is non-specific and mild, and affects 12-20% of regular cannabis users who stop using abruptly (4).

Is cannabis dependence common?

Most authors agree that, regardless of individual and contextual factors, the potential of cannabis to generate dependence is lower than that of other substances.

It has been estimated that the statistical risk of cannabis dependence is around 8% (compared to 20% for cocaine or 60% for tobacco) (5). Other studies estimate the prevalence of the disorder at 4% - 10% (6, 7, 8). Although they offer slightly different figures, the authors cited above agree on the following ideas:

• At the pharmacological level, cannabis has a lower dependence potential than opiates, alcohol, cocaine and tobacco.
• Sociocultural and socioeconomic factors contribute to greater vulnerability to developing dependence.
• Starting to use cannabis at an early age is, epidemiologically, a clear and relevant risk factor for developing problematic use, dependence or substance use disorder.

CBD for addiction: research into its possible mechanism of action

Differences between THC and CBD in addictive potential

Tetrahydrocannabinol (THC) is the main psychoactive compound in the cannabis plant and has been linked to negative effects in relation to substance dependence. THC can be addictive and can increase vulnerability to dependence on other substances such as alcohol, opioids and tobacco. This is partly because THC can affect the brain's reward circuits, which can lead to greater craving for the substance and more difficulty in stopping its use.

Cannabidiol (CBD), however, appears to have anti-addictive properties. Some theories have been proposed suggesting that CBD may affect reward circuits, anxiety and stress, memory and inflammation, among other things. These basic research studies are complemented by case series and even clinical trials suggesting that CBD has anti-addictive potential.

For more information on these two cannabinoids, see our post on the differences between CBD and THC.

Effectiveness of CBD for addiction: are there studies in humans?

Yes. In almost all types of addictions, there are preliminary studies suggesting that CBD may become, in the near future, another option among the drugs available to treat addictive disorders.

CBD for tobacco addiction

The first pilot clinical study evaluated the effects of CBD in smokers trying to quit smoking. CBD was effective in reducing the number of cigarettes smoked after one week of treatment by up to 40%, an effect that was maintained after 7 days of treatment (28). A few years later, a study administering a single dose of CBD reduced some of the withdrawal symptoms (29).

CBD to quit smoking

CBD and alcohol addiction

The end of 2022 saw the completion of the first two human clinical trials to explore the potential of CBD in the treatment of alcohol use disorder. Both trials enrolled patients with severe dependence and were carried out at New York University. One of the studies followed 40 patients for 8 weeks (30). The other focused on patients with alcohol dependence syndrome who also had post-traumatic stress disorder (31). Neither clinical trial has been published yet and the results have not been made public.

CBD shows therapeutic potential for addiction to tobacco (especially), alcohol and cannabis.

CBD and cannabis addiction

Several clinical trials have demonstrated that Sativex is effective in the treatment of cannabis dependence (38, 39, 40). This is not surprising, as the cannabinoid spray is an extract of the cannabis plant with fixed concentrations of THC and CBD, and in practice involves the administration of the same substance through a different route.

There are published anecdotal cases in which CBD on its own has been effective in treating cannabis dependence (41, 42). These cases have been confirmed in well-designed clinical trials involving 82 patients with cannabis dependence who managed to stop or cut down their use with CBD (43).

Another clinical trial evaluated the effect of giving cannabidiol to regular cannabis users who did not want to stop using (44). The trial showed improvements in attention, verbal learning and memory tests, as well as lower scores on psychotic symptom scales and better sleep.

There are also ongoing clinical trials, with unpublished results, on the efficacy of CBD in cannabis users with psychotic disorders (45).

CBD and opiate addiction

As for CBD for opiate addiction, although there are positive results on its therapeutic potential, there is still little evidence. The first clinical trial to evaluate the efficacy of CBD in acute opiate withdrawal was published in 2019. In a study of 42 patients, CBD proved more effective than placebo at reducing “craving” (the urge to use) and some of the typical symptoms of opiate withdrawal (32). There are also lower-quality studies and anecdotal cases that support the use of CBD for this indication (33). Another study exploring the potential of CBD in methadone detoxification has recently been completed and is currently awaiting publication (34).

CBD and addiction to stimulant drugs

Clinical trials published so far have not been able to demonstrate differences between CBD and placebo in reducing withdrawal symptoms associated with cocaine use disorder. One clinical trial used doses of 300 mg of CBD in crack (smoked cocaine) use (35), and two more clinical trials have used doses of up to 800 mg of CBD for 10 weeks (36) (37), without finding positive results in the use of CBD for addiction to this type of drug.

As for addiction to stimulant drugs, such as cocaine and amphetamines/methamphetamines, clinical trials so far have not shown CBD to be effective in their treatment.

Despite the good results obtained in preclinical models (in vitro and animal research) there are no published studies or ongoing clinical trials evaluating the efficacy of CBD in amphetamine/methamphetamine use disorder.

CBD dosage and how it is used for addiction

The doses used in clinical trials have varied widely. The most common route of administration is oral, in the form of capsules or tablets. Studies on alcohol have used doses of up to 1,200 mg a day (30, 46). For opiates, doses of 400-800 mg have been used (32, 33, 34). Doses of 300-800 mg a day have proved ineffective for cocaine (35, 36, 37), but amounts in that range produced positive results for tobacco (29) and cannabis (41).

Other forms of administration include sublingual CBD spray, used in the treatment of cannabis dependence at a daily dose of 18-24 mg/day (41) and in the methadone detoxification trial awaiting publication (34). Inhaled cannabidiol (at doses of 400 micrograms per inhalation) has also been used for tobacco (28).

In conclusion...

The conclusion is that more research and clinical trials are still needed before CBD can be applied as a therapy for addictions, although there are preliminary studies in humans that support its therapeutic potential. One of the uses that gathers the most evidence is the use of CBD in the treatment of tobacco addiction.

It is important to note that more research and rigorous clinical studies are needed to confirm the efficacy of CBD for addictions and to establish clear dosing and administration guidelines.

Addiction should be treated by specialist professionals. Please remember that this article is for information only and is not intended to prevent, diagnose or treat any disease or symptom. Its content may complement, but never replace, the diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. Talk to your doctor before using CBD.