Exploring cannabis as a harm reduction strategy for reducing alcohol consumption - Jennifer Attonito

Dr. Jennifer Attonito presents "Exploring Cannabis as a Harm Reduction Strategy for Reducing Alcohol Consumption" at CannMed 2026, covering cannabis harm reduction, alcohol use disorder, and CBD. Cannabis may serve as a safer substitute for alcohol among adults seeking to reduce consumption or mitigate alcohol-related harms. THC-dominant cannabis and CBD represent distinct cannabinoid profiles that may differentially influence mood, craving, and risk behaviors. THC-dominant products may reduce stress or craving acutely, while CBD is non-intoxicating and has shown anxiolytic, antidepressant, and anti-craving properties in emerging research. Substituting cannabis for alcohol, whether intentional or incidental, has been proposed as a harm-reduction pathway that may reduce alcohol intake and lower risk for alcohol use disorder (AUD). However, little is known about who uses cannabis or CBD for this purpose, or the psychological and health factors associated with that choice. This study investigated demographic, psychological, and behavioral predictors of using marijuana, CBD, or both to reduce alcohol consumption among Florida adults at elevated risk for AUD. Online surveys were distributed to 451 Florida adults who consumed five or more alcoholic drinks per week and reported lifetime cannabis use. Measures included alcohol use severity (AUDIT), depressive symptoms (PHQ-8), anxiety (GAD-7), PTSD symptoms, childhood trauma, and readiness to change. Regression models identified independent predictors of cannabis- and CBD-based alcohol-reduction behavior. High AUD risk was found in 61.4% of men and 40.9% of women, and was associated with younger age, more depressive and anxiety symptoms, higher trauma scores, PTSD positivity, and greater readiness to change (p less than 0.001). Marijuana (37.9%) and CBD (32.2%) were the most common alcohol-reduction strategies, with higher AUD severity linked to greater perceived effectiveness. Those who had tried CBD, marijuana, or both were notably younger (mean age 39.6-41.5) than those who tried neither (mean age 48.1). Among Hispanic participants, 26.6% reported using both CBD and marijuana for alcohol reduction. Moderate to severe depressive or anxiety symptoms, and being in an action stage of readiness to change, were both associated with trying both products (p less than 0.001 for most). Predictors of marijuana use included PTSD positivity, more comorbidities, action-stage readiness, and high AUD risk. Predictors of CBD use included higher trauma scores, more comorbidities, action-stage readiness, and high AUD risk. Adults with greater AUD severity, trauma exposure, and mental health symptoms were more likely to try cannabis-based strategies, particularly those already motivated to change their drinking. Younger and Hispanic respondents, and those with more anxiety or depressive symptoms, were more likely to have tried both CBD and THC products. These findings point to psychological vulnerability and readiness for change as key drivers of interest in cannabinoid substitution. Since THC and CBD may work through different mechanisms, such as reducing craving, regulating mood, or replacing the reward of alcohol, distinguishing between them matters for public health. This study offers a foundation for developing precision harm-reduction strategies that combine cannabinoid pharmacology with behavioral change models for people at elevated risk for AUD. Dr. Jennifer Attonito earned her PhD in Public Health from Florida International University after years of public health work with the American Foundation for AIDS Research, the NYC Department of Health and Mental Hygiene, and the University of Miami. Since 2014 she has served as an Instructor in the Health Administration programs at Florida Atlantic University. This presentation was given at the CannMed 2026 Innovation & Collaboration Summit, held June 15-18 at the Hyatt Regency Lake Tahoe Resort. Visit cannmedevents.com to learn more.