Summary: A randomized, placebo-controlled trial shows that cannabis with active THC reduces immediate alcohol cravings and lowers drinking levels in heavy-drinking young adults. After smoking THC, participants not only drank less, they waited longer before taking the first sip and reported lower urges to drink.

This trial provides the clearest causal evidence to date supporting the “California sober” idea of substituting cannabis for alcohol—at least in the short term. However, researchers stress that cannabis is not a proven treatment for alcohol misuse and may carry its own risks.

Key Facts

• Short-Term Substitution: THC cannabis reduced alcohol intake by up to 27% in a controlled bar-like setting.
• Craving Reduction: Participants reported weaker urges to drink and delayed their first sip after using THC.
• Not a Treatment Yet: Long-term effects are unknown, and cannabis carries its own addiction risks.

Source: Brown University

The “California sober” trend, which involves ditching alcohol in favor of cannabis, is gaining momentum, spreading from Hollywood to health influencers to homes across America.

Among the motivations for many adopters is to reduce alcohol use, and a new study on the causal effect of cannabis on alcohol consumption suggests that smoking marijuana may lead people to drink less — in the short term.

Published in the American Journal of Psychiatry, the study by researchers at Brown University is the first randomized, placebo-controlled trial to test whether cannabis use directly changes alcohol consumption.

Unlike previous research that relied on surveys or self-reported associations, this trial allowed scientists to measure cause and effect under controlled laboratory conditions.

“What we found was consistent with this idea of the substitution effect popularized by the California sober trend,” said Jane Metrik, a professor of behavioral and social sciences and of psychiatry and human behavior at Brown University.

“Instead of seeing cannabis increase craving and drinking, we saw the opposite. Cannabis reduced the urge for alcohol in the moment, lowered how much alcohol people consumed over a two-hour period and even delayed when they started drinking once the alcohol was available.”

The trial included 157 adults, ages 21 to 44, who drink heavily and use cannabis at least twice a week. Over three separate lab visits, each participant smoked cannabis cigarettes containing lower or higher levels of THC, the main psychoactive ingredient in marijuana, or a placebo.

Placebo-controlled trials, in which neither the researchers nor the participants know who receives the placebo or the actual drug, are considered the gold standard for establishing what drives behavior, according to Metrik, who is affiliated with Brown’s School of Public Health and Warren Alpert Medical School.

After smoking, participants took part in what researchers called the Alcohol Choice Task, a well-established laboratory test of drinking behavior that the team conducted in a room designed to resemble a bar. Participants were offered servings of their preferred alcoholic beverage on a tray and could choose either to drink or to earn small cash payments for each drink they declined.

The payments were deliberately small to provide a subtle alternative to drinking without meaningfully swaying participant choices. During each two-hour session, participants were provided with enough alcohol to raise their blood alcohol level to about 0.10%, which is above the legal intoxication limit in many states.

The researchers found that when the participants smoked the cannabis with THC, they drank less alcohol than when they smoked the placebo. For example, when the participants smoked the lower THC dose at 3.1%, they drank about 19% less than when they had the placebo. When they smoked the cannabis with the higher THC dose at 7.2%, they drank about 27% less alcohol.

After smoking the cannabis with active THC doses, participants reported less immediate urges to drink than when they smoked a placebo cigarette. When they smoked the cannabis with the 7.2% THC dose, participants took significantly longer to take the first sip than when they were administered the placebo.

“We saw that cannabis reduces the urge in the moment,” Metrik said. “What we don’t know from this study is what is the long-term effect.”

The researchers caution that the results of the study don’t mean that cannabis should be recommended as a therapeutic substitute for alcohol. They emphasized that cannabis itself can be addictive and that — just as is the case is for alcohol — there is risk for progressing to problematic use of cannabis, as well.

The authors also noted that it remains unclear whether the same reduction in alcohol use would hold up in real-world settings, where people drink socially or use higher-potency cannabis.

Excessive drinking is the third leading cause of preventable death in the United States and, according to the Centers for Disease Control, costs the United States an estimated $249 billion a year (for lost labor and lower worker performance, property damage, crashes and health care services for injuries). Cannabis use often overlaps with alcohol problems, with about 60% of people with cannabis use disorder also meeting criteria for alcohol use disorder.

The researchers said the risk that using cannabis may actually increase drinking is higher for people who tend to combine cannabis and alcohol to enhance the effects of each or if they use the substances together in social settings.

To address these factors, the team is conducting a new clinical trial funded by the National Institutes of Health that explores what happens when cannabis and alcohol are used together, not just sequentially — and how different cannabinoids like THC and CBD may influence alcohol consumption in the laboratory and under real-world conditions.

For now, the study provides preliminary evidence that cannabis may reduce alcohol consumption in the lab, but more study is warranted before cannabis can be considered a tool to help people cut back or stop drinking altogether.

“Our job as researchers is to continue to answer these questions,” Metrik said. “We can’t tell anyone yet, ‘you should use cannabis as a substitute for problematic or heavy drinking.’”

Key Questions Answered:

Editorial Notes:

• This article was edited by a Neuroscience News editor.
• Journal paper reviewed in full.
• Additional context added by our staff.

About this AUD, cannabis, and addiction research news

Author: Juan Siliezar
Source: Brown University
Contact: Juan Siliezar – Brown University
Image: The image is credited to Neuroscience News

Original Research: Open access.
“Acute Effects of Cannabis on Alcohol Craving and Consumption: A Randomized Controlled Crossover Trial” by Jane Metrik et al. American Journal of Psychiatry

Abstract

Acute Effects of Cannabis on Alcohol Craving and Consumption: A Randomized Controlled Crossover Trial

Objective:

Cannabis use is strongly linked with heavy drinking and worse alcohol treatment outcomes; however, it may also contribute to decreased alcohol consumption. To date, no human studies have established a causal effect of cannabis on alcohol motivation.

The aim of this double-blind crossover randomized clinical trial was to examine dose-dependent acute effects of delta-9-tetrahydrocannabinol (THC) on alcohol craving and consumption.

Methods:

Across three experimental days, 157 participants reporting heavy alcohol use and cannabis use two or more times weekly were randomized to smoke cannabis cigarettes containing 7.2% THC, 3.1% THC, or 0.03% THC (placebo), followed by exposures to neutral and personalized alcohol cues and an alcohol choice task for alcohol self-administration.

A total of 138 participants completed two or more experimental sessions (mean age, 25.6 years [SD=5.1]; 35% women; 45% racial/ethnic minorities). Primary outcomes included craving, Alcohol Craving Questionnaire–Short Form, Revised (ACQ-SF-R), and an alcohol urge question; the secondary outcome was percent of total available milliliters of alcohol consumed.

Results:

There were no significant effects of cannabis on ACQ-SF-R ratings after smoking and during alcohol cue exposure, but 7.2% THC reduced alcohol urge immediately after smoking. Participants consumed significantly less alcohol after smoking cannabis with 3.1% THC and 7.2% THC, reducing consumption by 19% and 27%, respectively.

Conclusions:

Following overnight cannabis abstinence, smoking cannabis acutely decreased alcohol consumption compared to placebo. Further controlled research on a variety of cannabinoids is needed to inform clinical alcohol treatment guidelines.