A Fighting Chance: CBD and Alcoholism
As you know, CBD is quickly becoming a promising new treatment for a variety of conditions. Now, researchers are investigating whether or not CBD can have an affect on alcoholism as well.
But what is alcoholism?
In general, alcoholism refers to an addiction to alcohol or the mental illness and compulsive behavior resulting from alcohol dependency.
The medical diagnosis for this condition is called “alcohol use disorder” or AUD and refers to a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using. However, the condition is considered both a mental and physical illness as in addition to severe physical withdrawal symptoms, alcoholism can also cause irreversible damage to critical organs and body systems including the liver, nervous system, heart, stomach (intestines), and the brain. Alcoholism often reduces a person’s life expectancy by around ten years and the most common cause of death in alcoholics is from heart complications.
Although environmental risk factors including social, behavioral, and cultural influences account for a large portion of the risk for AUD, the condition also seems to run in families, and research has shown that genes are responsible for about half of the risk for AUD. High stress levels, anxiety, as well as inexpensive easily accessible alcohol increases risk as well.
Here are just some of the statistics on AUD’s devastating effects on society:
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), an estimated 16 million people in the United States have AUD. Approximately 6.2% or 15.1 million adults in the United States ages 18 and older had AUD in 2015. This includes 9.8 million men and 5.3 million women. Adolescents can be diagnosed with AUD as well, and in 2015, an estimated 623,000 adolescents ages 12–17 had AUD.
According to the Centers for Disease Control and Prevention (CDC), excessive alcohol use is known to kill about 88,000 people in the United States each year. It is also a drain on the American economy as well.
The cost of excessive alcohol use in the U.S. reached $249 billion in 2010, or about $2.05 per drink. Most (77%) of these costs were due to binge drinking. Binge drinking is defined as drinking four or more alcoholic beverages per occasion for women or five or more drinks per occasion for men. Further, 2 of every 5 dollars were paid by federal, state, and local governments, demonstrating that we are all paying for excessive alcohol use.
Excessive alcohol use cost states and the District of Columbia (D.C.) a median of $3.5 billion in 2010, ranging from $488 million in North Dakota to $35 billion in California. D.C. had the highest cost per person ($1,526, compared to the $807 national average), and New Mexico had the highest cost per drink ($2.77, compared to the $2.05 national average).
Most of the costs resulted from losses in workplace productivity (72% of the total cost), health care expenses for treating problems caused by excessive drinking (11% of total), law enforcement and other criminal justice expenses (10%), and losses from motor vehicle crashes related to excessive alcohol use (5%).
Treatment Options For Alcoholism
Although millions of Americans struggle with some form of alcoholism, many people don’t know about the variety of treatment options that are available to them.
Behavioral treatments include cognitive-behavioral therapy, motivational enhancement therapy, marital and family counseling, and brief interventions. Mutual support groups such as Alcoholics Anonymous (AA) and other 12-step programs provide peer support for people quitting or cutting back on their drinking as well.
Also, the U.S. Food and Drug Administration (FDA) has approved three medications for treating alcohol dependence. These include:
- Naltrexone – which can help people reduce heavy drinking.
- Acamprosate – which makes it easier to maintain abstinence.
- And Disulfiram – which blocks the breakdown (metabolism) of alcohol by the body, causing unpleasant symptoms such as nausea and flushing of the skin. Those unpleasant effects can help some people avoid drinking while taking disulfiram.
According to the NIAAA, scientists are working to develop a larger menu of pharmaceutical treatments that can be tailored to individual needs in the future. By studying the underlying causes of alcoholism in the brain and body, NIAAA is working to identify key cellular or molecular structures — called “targets” — that could lead to the development of new medications.
Other scientists are studying potential targets as well – one of which is the endocannabinoid system (ECS). More specifically, researchers want to know if cannabidiol (CBD) can be a novel therapeutic approach in treating alcoholism.
CBD and Alcoholism: The latest research
Alcohol addiction is undoubtedly linked to the ECS. Cannabinoids and alcohol activate similar reward pathways, and CB1 receptors also seem to regulate the reinforcing properties of alcohol. These mechanisms of action generally involve the CB1 receptor agonist THC – which has been shown to promote the relapse of alcohol use in abstinent rats.
However, CBD does not exhibit psychotropic effects as it is not an agonist at CB1 receptors. In fact, CBD is very well tolerated in humans and has a plethora of actions, including anticonvulsive, anxiolytic, anti-relapse, anti-inflammatory and neuroprotective properties. Not only do these properties make it promising for the treatment of a variety of conditions, they also make it an ideal candidate for treating multiple pathologies associated with AUDs.
For example, since binge alcohol consumption causes substantial neurodegeneration (probably through the induction of neuroinflammatory mediators and/or oxidative stress), researchers from the American Society for Pharmacology and Experimental Therapeutics wanted to see if CBD could have an effect on binge drinking. In 2005, they published a study in the Journal of Pharmacology and Experimental Therapeutics.
Using rat models with substantial neurodegeneration in the hippocampus and entorhinal cortex induced by binge alcohol (ethanol) consumption, the researchers evaluated CBD as a neuroprotectant. Damage to these brain areas is particularly important because of their involvement in memory formation and recall.
They found that CBD substantially limited neuronal damage to hippocampal and entorhinal cortical brain regions when administered with alcohol at the same time.
Building on this research, a more recent study was published in 2013 in the journal Pharmacology Biochemistry & Behavior. Using the same rodent model of AUD, researchers tested the effectiveness of transdermal delivery (application through the skin) of CBD for the treatment of alcohol-induced neurodegeneration. Transdermal delivery is advantageous versus other method of administration because it promotes patient compliance as it is non-invasive and pain free compared to injectable formulations, which is especially important in the alcohol dependent population. Their results showed that transdermal CBD (in gel form) prevented alcohol-induced neurodegeneration similar to intraperitoneal injection or IP injection. Transdermal systems for treating alcoholism may improve patient compliance.
In another study published in 2014 in the journal Free Radical Biology & Medicine, researchers from China and the U.S. evaluated whether CBD protected the liver from alcohol-generated oxidative stress-induced steatosis.
Steatosis, also known as fatty-liver, is a term that describes the buildup of fat in the liver. It often has no symptoms and typically does not cause permanent damage however the excess fat is stored in liver cells where it accumulates to form fatty liver disease. The most common cause of fatty liver is alcoholism and heavy drinking. Although reversible, its progression can develop into more severe liver problems such as hepatitis and cirrhosis. Recent research has shown that oxidative stress is an important factor contributing to mechanisms that induce steatosis.
Given the antioxidant properties of CBD, the researchers hypothesized that it could exhibit therapeutic properties in the context of alcohol-induced liver injury, by alleviating oxidative stress-induced hepatocellular injury and fat accumulation. They also wanted to determine if CBD protected against alcohol-induced liver steatosis through induction of autophagy. Autophagy, especially macroautophagy, is a mechanism by which hepatocytes break down lipids (a mechanism called lipophagy). In some studies, acute alcohol was shown to decrease autophagy in the liver, leading to steatosis.
Not only did the study show that CBD increased autophagy, it also found that CBD prevented acute alcohol-induced liver steatosis in mice, possibly by preventing the increase in oxidative stress and the activation of the JNK MAPK pathway. c-Jun N-terminal kinases (JNK), also known as stress-activated protein kinases, and are a subfamily of mitogen-activated protein (MAP) kinases.
Kinases are enzymes that catalyze the transfer of a high energy phosphate group (ATP) to a specified molecule and JNK. The JNK MAPK pathway plays a role in apoptosis (cell death), insulin resistance, inflammatory response and neural polarity.
The researchers concluded that CBD protects mouse liver from acute alcohol-induced steatosis through multiple mechanisms including attenuation (lowering) of alcohol-mediated oxidative stress, prevention of JNK MAPK activation, and increasing autophagy.
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