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Cannabis Substitution: Marijuana Maintenance as a Treatment for Alcohol Dependence


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Many people who have been long term alcohol abusers eventually find that quitting drinking is their best choice. Decades of daily heavy drinking can lead to physical dependence on alcohol and life-threatening withdrawal symptoms if one stops drinking without tapering off or entering a medical detox.

Some people who decide to quit drinking alcohol will do so successfully with an abstinence based support group such as AA or SMART Recovery or SOS or WFS. Others will enter some sort of formal addiction treatment program. However, abstinence only support groups are not successful for all people who enter them. And a study by Walsh et al showed that more than 60% of patients given formal alcohol treatment relapsed into drinking alcohol. Other studies have shown similar outcomes.

Fortunately, there are other options for people who have been failed by AA or by formal alcoholism treatment programs. One of these options--which has proven highly successful for many individuals--is Marijuana Maintenance, which involves the substitution of cannabis for alcohol.

The Research of Tod Mikuriya, MD

To date there have been no placebo-controlled double-blind studies of the success of cannabis as a substitute for alcohol for people with alcohol dependence. However, the late Dr Tod Mikuriya, MD (1933 - 2007) has long been an advocate of medical marijuana for a wide variety of uses included the treatment of alcohol dependence. In 2004 Dr Mikuriya published a study of 92 patients for whom he had prescribed cannabis as a treatment for their alcohol dependence.

The following quote from Dr Mikuriya's paper tells us about the efficacy of marijuana for these patients:

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. Two patients did not make follow-up visits but had reported efficacy at the initial interview.

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.

Patients who reported a return of symptoms when cannabis was discontinued (19), ranged from succinct to dramatic:

  • "I started drinking a lot more."
  • "More anxiety, less happiness."
  • "Use alcohol when cannabis isn't available."
  • "If I don't have anything to smoke, I usually drink a lot more."
  • "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.
  • "My caretaker got arrested and I lived too far from the city to purchase at a club, and I started doing heroin again and almost killed myself and some of my friends."
  • "Stress level becomes higher, become more uptight. Went back to drinking in the 1970s."-A female patient with 19 years of sobriety. Several patients specifically noted that cannabis use reduced the craving for alcohol:
  • "I crave alcohol when I can't smoke marijuana."
  • "Had to quit drinking at 48 yrs. old. Found cannabis helped stop the urge to drink."-A 69-year-old commercial fisherman.

Three patients reported a sad irony: they had "fallen off the wagon" when they had to stop using cannabis in anticipation of drug tests. Patient S., a 27-year-old cable installer, had six alcohol-related arrests by age 21, ". . . after not smoking herb (for probation drug test) and blacking out on alcohol, I found my drinking getting out of hand and I began getting into more trouble." He later relapsed when denied use of cannabis at a residential treatment facility.

Twenty nine of Mikuriya's patients reported that they had formerly used alcohol for pain relief and were now using cannabis in its stead.

Fourty four reported that they had previously used alcohol to medicate some sort of mood disorder such as depression, anxiety, stress, or PTSD. All forty four reported that they had successfully substituted cannabis for alcohol for the relief of thes psychological issues.

Mikuriya makes the case that cannabis not only has fewer side effects than alcohol, but also fewer side effects than prescription drugs as well. Not to mention that marijuana is much cheaper to purchase than most prescription drugs for the uninsured poor.

Dr Mikuriya's full article can be read here:
Cannabis as a Substitute for Alcohol: A Harm-Reduction Approach

Mr. W.'s Story

We also have testimonial evidence for the effectiveness of pot as a substitute for alcohol in the story of a man who only identifies himself as "Mr. W." Mr. W tells us how marijuana did what AA alone could not do--it helped to relieve his symptoms of anxiety and make life without alcohol livable. The following is a short quote from his story which you may read in its entirety here:


"Marijuana is not for everyone, and certainly may be used irresponsibly. But prohibition, which forces people like me to the black market, is a constant reminder of how Neanderthal our drug policy is. This is reflected in the laws but also in the minds of most people -- who wouldn't understand how marijuana saved my life that February day."

Dr Charlton's Essay

Dr B G Charlton in the UK makes that case that drugs such as cannabis show far fewer harmful effects than alcohol--and advocates drug substitution as the only rational solution to the extremely rapid increases in binge drinking which are taking place in the United Kingdom today. Dr Charlton points out that benzodiazepines are a far less harmful way of treating anxiety disorder than is the use of alcohol. He also points out that there is a social need for recreational intoxication and champions cannabis as a less dangerous drug than alcohol when used for this purpose, as we can see from the following quote:

"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.7 There seems to be a broad consensus that marijuana intoxication is less medically harmful than high-dose alcohol bingeing, and (if hippies are any guide) intermittent marijuana usage largely avoids the social problems of aggression and violence typical of drunkenness. It would make sense for governments of Northern European countries to promote marijuana intoxication as a socially-preferable alternative to binge drinking."

Dr Charlton's full essay is available online here:


My Experience

I can no longer smoke marijuana myself--I used to suffer from depression and I find that for me marijuana brings on a recurrence of my depression. This is why alcohol is my drug of choice.

However, a good friend of mine--my former roommate from the Saint Anthony House of Drunks--always told me that he would prefer to quit alcohol entirely and only smoke marijuana if he could afford it and if it were legal. Sometimes he had alcohol withdrawal seizures if he drank too much--and sometimes he had blackouts and would injure himself when drinking. None of these things ever happened to him if he stuck to the happy weed. The US policy of keeping weed illegal is simply inhumane. That is all.


Charlton BG. (2005). Diazepam with your dinner, Sir? The lifestyle drug-substitution strategy: a radical alcohol policy. QJM. Jun;98(6)


Mikuriya TH. (2004) Cannabis as a Substitute for Alcohol: A Harm-Reduction Approach. Journal of Cannabis Therapeutics, Vol. 4(1) 2004

Free Full Text

Mr. W. (2009). The Alcoholic Fights for His Herb


Walsh, D.C., Hingson, R.W., Merrigan, D.M., Levenson, S.M., Cupples, L.A., Heeren, T., Coffman, G.A., Becker, C.A., Barker, T.A., Hamilton, S.K., McGuire, T.G., & Kelly, C.A. (1991). A randomized trial of treatment options for alcohol-abusing workers. New England Journal of Medicine, 325, 775 781.


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