CBD in the treatment of addictions: Research on its properties

Smoking cessation with CBD

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, research is looking for new ways to address the problem.

This post presents the current research on the use of CBD in the treatment of addictions by Dr. Caudevilla, Family Physician and Expert in Drug Addictions with extensive experience in 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 to stop addictions: 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 limits of both concepts are 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 though he or she is aware of the negative consequences. In any case, addictions are the result of a complex and interrelated set of biological, psychological and social factors. The treatment of addictions begins by addressing these three areas in a professional and specialized medical manner, and there are no “miracle pills” in this regard.

Can cannabis produce dependence?

The DSM Manual, the international reference in the diagnosis of Mental Health problems, considers “Cannabis Use Disorder” in its fifth and latest edition. Some scientists have criticized the validity of this definition or its use in the same sense that alcohol or cocaine dependencies are classified (1, 2, 3).

The same DSM-5 manual introduces for the first time the diagnosis “Cannabis withdrawal”. The picture is nonspecific, mild, and affects 12-20% of regular cannabis users who stop using cannabis 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.
  • Socio-cultural and socioeconomic factors influence a greater vulnerability in the onset of dependence.
  • The age of early onset of cannabis use is, at the epidemiological level, a clear risk factor relevant to the development of abusive use, dependence or substance use disorder.

CBD for addictions: Research on its possible mechanism of action

Differences between THC and CBD in addictive potential

The tetrahydrocannabinol (THC) is the main psychoactive compound present in the cannabis plant and has been associated with 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 increased craving for the substance and greater 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 other case series and even clinical trials suggesting an anti-addictive potential of CBD.

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

How does CBD work for addictions?

The neurobiological mechanisms by which CBD acts in addictive disorders are as follows:

First, it has been suggested that CBD may affect the brain’s reward circuits, reducing the pleasurable effect of the substance and thus reducing the motivation to consume it (9).

In addition, it has been shown that CBD can modulate cannabinoid receptor activity in the brain, which may help reduce anxiety and stress associated with substance withdrawal (10).

Another potential mechanism is that cannabidiol could affect memory and learning ability, which may help reduce the formation of associations between the substance and the stimuli that trigger its consumption (11).

In addition, some studies have found that CBD may have anti-inflammatory and antioxidant properties, which may help reduce neuroinflammation and neuronal damage associated with substance dependence (12).

In which models have the properties of CBD been demonstrated for the treatment of dependencies?

In animal models, cannabidiol has shown evidence of anti-dependence properties for alcohol (13, 14), nicotine (15, 16), opiates: morphine (17, 18) and heroin (19, 20); stimulants: cocaine (21, 22, 23), amphetamine (24), methamphetamine (25, 26) and cannabis (27).

Effectiveness of CBD for addictions: Are there human studies?

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 in 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).

We dealt with this topic in depth in the post on CBD for smoking cessation .

CBD and alcohol addiction

The end of 2022 saw the completion of the first two human clinical trials that have explored the potential of CBD in the treatment of Alcohol Use Disorder. The two trials enrolled patients with severe dependence and were conducted at New York University. One of the studies followed 40 patients for 8 weeks (30). Another focused on patients with Alcohol Dependence Syndrome who also suffered from Post Traumatic Stress Disorder (31). Neither clinical trial has yet been published 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, in isolation, has been effective in treating cases of cannabis dependence (41, 42). These cases have been confirmed in well-designed clinical trials on 82 patients with cannabis dependence who have successfully suppressed or reduced their use using CBD (43).

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

On CBD for opiate addiction, although there are positive results on the therapeutic potential, there is little evidence yet. The first clinical trial that has evaluated the efficacy of CBD in acute opioid withdrawal was published in 2019. In a study of 42 patients, CBD was shown to be more effective than placebo in reducing craving and some of the typical opioid withdrawal symptoms (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 pending publication at this time (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 in addictions

The doses used in clinical trials have been highly variable. The most common route of administration is oral in the form of capsules or tablets. Studies on alcohol have used doses up to 1200 mg per day (30, 46). In the case of opiates, doses of 400-800 mg have been used (32, 33, 34). Doses of 300-800 mg per day have proven 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 clinical trial for methadone detoxification pending publication (34). Inhaled cannabidiol (in doses of 400 micrograms per inhalation) has also been used in the case of 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.

Addictions should be treated by specialized professionals. We remind you that this article is informative and is not intended to prevent, diagnose or treat 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 and are intended for external use. Consult your doctor before using CBD.

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Dr. Fernando Caudevilla
Family Physician | Expert in Drug Addictions. He works in different assistance, research and training projects related to drugs, including therapeutic cannabis.

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