Alcohol use disorder (AUD) remains one of the most damaging addictions worldwide, driving millions of deaths and enormous health and social costs each year. READ MORE HERE: Greenleaf Medical Clinic

In recent years, some patients and harm-reduction advocates have turned to cannabis as a way to reduce or even replace alcohol use — sometimes called a “substitution” strategy or “California sober.” The idea is not that cannabis is harmless, but that it may be less harmful than heavy drinking and might help some people move away from alcohol.

So what do we actually know from studies and patient reports?

The “Substitution Effect”: Replacing Alcohol With Cannabis

Researchers use the term substitution effect when one substance is used in place of another, leading to lower use of (or abstinence from) the original drug.

A 2020 cross-sectional survey of 973 Canadian medical cannabis patients with a history of regular drinking found that after starting medical cannabis:

• 43.5% reported fewer drinking days per month
• 34.1% reported fewer drinks per week
• 7.8% reported no alcohol use at all in the previous 30 days (i.e., recent abstinence)

The effect was strongest among heavy drinkers: those who had been consuming more than 30 drinks per week before cannabis were much more likely to both reduce and completely stop drinking, with 27.4% of that subgroup reporting alcohol cessation.

Intent also mattered. Among people who deliberately used medical cannabis to cut down alcohol:

• 69.4% reduced drinking days
• 67.4% reduced weekly drinks
• 21.9% reported complete cessation of alcohol, compared with just 5.4% among those who had no explicit intent to use cannabis this way.

These are self-reported data, not a randomized trial, but they strongly suggest that for some patients, starting medical cannabis coincides with meaningful reductions in alcohol use and even abstinence.

Case Series: Early Clinical Experience With AUD Patients

One of the most frequently cited early reports comes from physician Tod Mikuriya, who reviewed 92 patients treated with cannabis as a substitute for alcohol. In that sample:

• 90% said cannabis was “effective” or “very effective” in helping them reduce or stop drinking
• 10% reported one year or more of alcohol abstinence that they directly attributed to cannabis
• 21% said that when they stopped using cannabis, they went back to unsafe drinking levels

While this was not a controlled trial and has clear limitations (retrospective, no control group), it is one of the earliest clinical snapshots of patients explicitly using cannabis to overcome alcoholism.

Larger Reviews: How Common Is Substitution?

A 2020 review of 64 human and animal studies on cannabis and alcohol found a complex picture: READ MORE HERE: Frontiers

• 30 studies supported a substitution effect (more cannabis → less alcohol)
• 17 supported complementarity (cannabis and alcohol used together)
• The rest were mixed or neutral

Importantly, the review noted that all studies conducted specifically in medical cannabis patient populations supported substitution, and one U.S. study found about 40% of medical cannabis users reported using cannabis to decrease their alcohol intake.

Another survey-based paper from New Frontier Data reported that 57% of cannabis consumers said they had replaced some of their drinking with cannabis, and 40% said they would like to stop drinking completely. READ MORE: newfrontierdata.com

These numbers don’t prove causation, but they show that a significant fraction of cannabis users perceive it as a tool for reducing alcohol.

Experimental Evidence: “California Sober” in the Lab

Until recently, most data came from surveys and observational studies. In 2025, researchers at Brown University and colleagues published one of the first randomized controlled trials testing how cannabis affects drinking behavior in a bar-like setting. MORE ABOUT: Brown University

Participants were given joints with:

• High THC (7.2%)
• Moderate THC (3.1%)
• Placebo (0.03% THC)

Then they were allowed to drink in a controlled environment. The results:

• Those who smoked 3.1% THC drank about 19% less alcohol than placebo
• Those who smoked 7.2% THC drank about 27% less alcohol
• Cannabis reduced the urge to drink, lowered total alcohol consumed over a two-hour period, and delayed when people started drinking once alcohol was available

This trial offers strong experimental evidence that, at least in the short term and in a controlled setting, cannabis can reduce alcohol intake for some heavy drinkers — consistent with the “California sober” idea. MORE ABOUT: Brown University

Not All Good News: Risks and Conflicting Findings

The story is not one-sided, and it’s important not to oversell cannabis as a simple cure for alcoholism.

Several treatment studies have found that using cannabis during or after professional alcohol treatment is associated with worse outcomes, such as:

• lower percentage of days abstinent
• higher relapse rates
• more difficulty maintaining long-term sobriety STAY INFORMED: PMC

A clinician brief from CannabisEvidence.org summarized this by noting that while substitution might help some people in the short term, any cannabis use during formal alcohol treatment has often been linked to poorer abstinence outcomes overall. READ MORE HERE: Cannabis Evidence

There are also risks specific to cannabis itself:

• Cannabis use disorder (dependence and withdrawal)
• Mental health problems, including higher risk of paranoia in people who self-medicate heavily with high-THC products. MORE HERE: The Guardian
• In rare, chronic heavy users, cannabinoid hyperemesis syndrome (severe vomiting and abdominal pain) READ ON: People.com

In other words, for some individuals, cannabis could become another addictive substance rather than a bridge to recovery.

Why Might Cannabis Help Some People Drink Less?

Several mechanisms have been proposed:

1. Endocannabinoid system involvement
   Pre-clinical work shows the endocannabinoid system plays a key role in alcohol reward, craving, and relapse, making cannabinoid modulation a plausible target for AUD treatment.
2. Symptom relief
   Many patients use medical cannabis for chronic pain, anxiety, or insomnia — all of which can drive drinking. If cannabis reduces these symptoms, the “need” to drink may drop, leading to de-facto alcohol reduction.
3. Substitution of rituals
   For some, the social or nightly “unwind” ritual may shift from alcohol (beers, shots) to cannabis (vaping, THC beverages), which can reduce alcohol-related harms but doesn’t necessarily address underlying addiction.

What This Means for Patients With Alcohol Use Disorder

Putting it all together:

• There is real evidence that some patients successfully use cannabis — especially medical cannabis — to reduce or even stop alcohol use, and observational data and early trials support a substitution effect for a subset of people.
• At the same time, cannabis is not an approved treatment for alcohol use disorder, and in traditional treatment settings, cannabis use often predicts poorer abstinence outcomes.
• Cannabis itself carries meaningful risks, particularly at high doses and with chronic use.

For someone struggling with alcoholism, the safest evidence-based roadmap still includes:

• professional addiction treatment (counseling, CBT, motivational interviewing)
• FDA-approved medications for AUD (like naltrexone or acamprosate, where appropriate)
• social support (AA, SMART Recovery, or other peer groups)

Cannabis may function as a harm-reduction tool for some, particularly those who have not succeeded with other methods and are moving from very heavy drinking to something less damaging. But it should be approached carefully, ideally with:

• honest discussion with an addiction-informed clinician
• awareness that “California sober” is not risk-free
• clear goals (e.g., reduced harm vs. complete abstinence)

The Verdict

Cannabis has helped some patients reduce or even stop drinking, and early data on substitution are promising — especially in medical cannabis populations and controlled experimental settings. But the evidence is mixed, not definitive, and cannabis can bring its own set of problems.

For now, cannabis is best understood not as a magic cure for alcoholism, but as a potential harm-reduction tool that might support certain people on a carefully managed recovery path, alongside — not instead of — established treatments. While some Hollywood Icons are jumping on the latest tequila making kick, other have made a point to now promote cannabis. READ MORE HERE: New Jersey MMJDispensary