Could cannabis replace some alcohol in programs for people with severe alcohol use disorder? | Research

The takeaway

A mixed-methods study across six Canadian managed alcohol programs found that 63% of participants were already substituting cannabis for alcohol, and 84% were willing to participate in a formal cannabis substitution program, with partial substitution preferred.

Harm reduction practitioners, addiction researchers, and anyone interested in alternative approaches to managing severe alcohol use disorder.

63% already substituting; 84% willing

What the researchers found

63% of MAP participants reported already substituting cannabis for alcohol, most often weekly (42%), primarily for alcohol cravings (79%) and withdrawal (53%). 84% expressed willingness to join a formal cannabis substitution program. Participants preferred staff-administered dry smoked cannabis with partial (not complete) replacement of alcohol doses.

Why it matters

Managed alcohol programs serve people with severe alcohol use disorder who are often experiencing homelessness. Finding that most participants already use cannabis as an informal substitute, and want formal programs, suggests cannabis substitution could be integrated into existing harm reduction infrastructure.

The numbers in context

6 MAPs studied; 19 participants, 17 staff, 7 leaders; 63% already substituting cannabis for alcohol; 42% doing so weekly; 79% for cravings; 53% for withdrawal; 84% willing to join formal program

How the study worked

Pre-implementation mixed-methods study using structured surveys and open-ended interviews with MAP organizational leaders (n=7), program participants (n=19), and staff/managers (n=17) across six MAPs in Canada. Organized using the Consolidated Framework for Implementation Research.

What this study cannot tell us

Very small sample (19 participants). Pre-implementation study without outcome data. Self-selected participants in a specific harm reduction setting. Cannot generalize to broader alcohol use disorder populations.

How to read the evidence

Pre-implementation feasibility study providing important descriptive data but no outcome evidence. Very small sample from a specialized setting.

When this study was published

Published in 2021; cannabis substitution programs remain in early development stages.

The bigger picture

Cannabis substitution for alcohol is controversial, but this study reveals it is already happening informally. Formalizing the practice within supervised programs could improve safety and consistency. The preference for partial rather than complete substitution suggests a pragmatic, incremental approach.

Questions still open

Does formal cannabis substitution reduce alcohol consumption and related harms? What are the optimal cannabis formulations and dosing schedules for alcohol substitution? How would cannabis substitution interact with other treatments like medications for alcohol use disorder?

Common questions

Can cannabis help people drink less?

This study found that most managed alcohol program participants were already informally using cannabis to manage cravings (79%) and withdrawal (53%). However, this is feasibility research, not an effectiveness study.

Why partial substitution instead of full replacement?

Participants preferred replacing some alcohol doses with cannabis rather than stopping alcohol entirely. This pragmatic approach aligns with harm reduction principles of meeting people where they are.

Read the original research

"If I knew I could get that every hour instead of alcohol, I would take the cannabis": need and feasibility of cannabis substitution implementation in Canadian managed alcohol programs.

Harm reduction journal, 18(1), 65

View on PubMed ↗Publisher’s paper ↗

Citation

Pauly, Bernie; Brown, Meaghan; Chow, Clifton; Wettlaufer, Ashley; Graham, Brittany; Urbanoski, Karen; Callaghan, Russell; Rose, Cindy; Jordan, Michelle; Stockwell, Tim; Thomas, Gerald; Sutherland, Christy. (2021). "If I knew I could get that every hour instead of alcohol, I would take the cannabis": need and feasibility of cannabis substitution implementation in Canadian managed alcohol programs.. Harm reduction journal, 18(1), 65. https://doi.org/10.1186/s12954-021-00512-5