The Pros and Cons of Substituting Marijuana for Alcohol

Pot or Booze? The Choice for Parents Is Clear

The Pros and Cons of Substituting Marijuana for Alcohol

As anxiety over the pandemic rose, so did alcohol and marijuana sales across the country. That’s not exactly surprising. One piece of this trend that is worth taking a beat with is that parents are increasingly choosing weed over booze, by wide margins. 

Of parents who have tried pot, 52 percent increased their consumption during the pandemic compared to 33 percent of adults without young kids.

And while many parents are also drinking, 57 percent said they stopped or decreased their alcohol consumption in exchange for weed, according to a survey of nearly 2,000 adults by Harris Poll, conducted on behalf of cannabis manufacturer and retailer Curaleaf.

Although abstinence is (unfortunately) the healthiest choice, marijuana is probably the least damaging if you are going to indulge. But making that comparison is tricky. Many studies have investigated all the good and bad alcohol can do to your body and your life.

There’s been much less research on cannabis. The data that does exist suggests marijuana is safer in terms of physical and mental health, addiction, and family life. “Alcohol is a more dangerous substance.

Period,” says Meenakshi Subbaraman, the director of statistical and data services at the Alcohol Research Group. Why? Here’s the breakdown. 

Effects of Marijuana and Alcohol on Physical Health

In terms of physical health, weed is the clear winner. In the very short term, alcohol is more ly than marijuana to leave you reeling the day after. Longer-lasting effects also skew toward cannabis as the lesser of two evils. Alcohol can increase risk of several types of cancer and can weaken the immune system, in addition to these effects, according to Healthline:

  • Liver disease
  • Pancreatitis
  • Heart damage
  • Stomach and digestive issues
  • Central nervous system damage
  • Erectile dysfunction
  • Infertility

The physical effects of marijuana vary depending on how you use it. Smoking has more associated health consequences than, say, eating pot brownies. Smoking pot can cause lung damage and increase the risk of developing a cough or bronchitis.

Several studies have found a link between smoking marijuana and heart issues, but it’s unclear if that’s due to the cannabis itself or the smoking.

And although many people use marijuana for sleep, the evidence is mixed about whether it helps catch z’s.

One clear physical effect of heavy weed use is cannabinoid hyperemesis syndrome, which is characterized by nausea, vomiting, and dehydration. However, the syndrome is uncommon — far more so than alcoholism — and only occurs in people who use weed almost every day over the course of several years.

If you’re worried about your physical health, your best bet the information available is to opt for moderate weed use over moderate alcohol use — with a preference towards edible marijuana. 

Effects of Marijuana and Alcohol on Mental Health

Comparing the risks of alcohol and marijuana gets murkier when it comes to the brain and mental health. The clear worry here is addiction. In 2019, more than 14 million adults in the U.S.

met the criteria for alcohol use disorder, otherwise known as alcoholism. In comparison, about four million had marijuana use disorder in 2015.

However, the language around weed and addiction is fuzzy, and not all of those with marijuana use disorder have an addiction.

More people drink alcohol than smoke weed, so the above numbers don’t give the full picture. Instead, experts look at how ly each substance is to cause addiction.

Many people who smoke pot don’t think it’s addictive, but 10 percent of people who try marijuana develop an addiction, according to the Centers for Disease Control and Prevention. Still, addiction to cannabis is less of an issue.

“The addiction potential is higher for alcohol,” Subbaraman says. “It’s more ly to lead to addiction among people who use it.”

Some experts recommend that people grappling with an alcohol addiction move to marijuana as a substitute. The same is not true the other way around. “I have never heard anyone suggest that alcohol might be a substitute medication for another drug,” Subbaraman says.

Drinking, especially long-term or heavy drinking, can mess with the brain, leading to learning and memory problems and increase the risk of anxiety and depression.

Heavy drinking may cause Wernicke-Korsakoff syndrome, a brain disorder with symptoms such as amnesia, confusion, and hallucinations.

Alcohol can also directly damage brain cells, but most resulting cognitive impairments are reversible after a year of sobriety.

Once again, the data regarding your brain on weed is lacking. There is some evidence that cannabis can trigger the onset of schizophrenia in some people, especially those with a family history of the condition.

Using marijuana near-daily and in high doses occasionally leads to anxiety and paranoia, according to the CDC. People who use weed long-term are also more ly to develop social anxiety than those who abstain.

Whether weed changes the brain itself — and whether that has any effect on day-to-day life — is understudied, and results are conflicting for adults.

Effects of Marijuana and Alcohol on Mortality

If you’re hitting the bottle hard, overdosing is a real concern. Hitting the vape pen hard? Not so much. Alcohol kills 88,000 people each year, and marijuana kills near zero, according to the American Addiction Centers. To get a lethal dose of THC, the main psychoactive compound in marijuana, you would need to smoke between 238 and 1,113 joints in one day.

But overdosing is not the only way that drugs increase the risk of death. In 2010, 1.5 million people died worldwide from alcohol-attributable cancer, liver cirrhosis, and injury, according to a 2014 study. Nearly 1.2 million of those deaths were among men. That said, how much you drink matters.

Light and moderate drinking have a reduced risk of death from all causes, whereas heavy drinking increases risk of all-cause mortality, according to a study of more than 330,000 people.

(Although this is a large and rigorous study, long-term mortality for moderate use of alcohol is difficult to pin down and there are a number of quality studies that flip this finding). The jury is out on whether cannabis increases the risk of death.

Effects of Marijuana and Alcohol on Child Development

The presence of both alcohol and weed in a household isn’t great for child development. In every two three published associations, parents’ drinking is linked to a negative outcome in their children, according to a review study. One of the main negative outcomes is that kids with parents who consume alcohol are more ly to drink as an adolescent.

Kids of parents who smoke weed are similarly more ly to use weed and alcohol themselves. But when comparing the two, alcohol again comes out as worse. “The prevalence of harms to others with alcohol use is a lot higher,” Subbaraman says.

Alcohol use is about three times more ly to result in harassment, vandalism, or family problems compared to marijuana use, according to recent surveys.

In one important way, parents’ marijuana use may be worse on kids’ health. The main reason why is that pot use can affect kids in a way alcohol can’t: secondhand smoke. The cannabinoids that cause weed’s high can get into kids’ bodies through secondhand smoke, and evidence suggests this could have permanent effects on IQ, memory, and executive function.

Some doctors say there’s no reason to think that marijuana secondhand smoke is safer for kids than tobacco secondhand smoke, but there’s not enough evidence to be certain either way. This is yet another reason to stick to edible marijuana if you are partaking.

And, of course, direct ingestion of marijuana is exceedingly dangerous for kids, so always store marijuana safely and away from kids.

Although both alcohol and cannabis can negatively impact children, anecdotal evidence suggests weed may be better for engaging parents in play with their kids. Alcohol tends to disconnect parents, but dads who use weed during playtime often report more relaxation and engagement.

But, as parents who smoke weed and play with their kids told Fatherly, never try anything new with marijuana while playing with your kids, and only take a small hit.

Make sure you’re in a safe environment, and it’s probably best to have a sober adult around in case anything goes sideways.

alcohol Cannabis Guide to Weed marijuana smoking pot smoking weed weed


Marijuana Maintenance — Cannabis Substitution for Alcohol Dependence

The Pros and Cons of Substituting Marijuana for Alcohol
Marijuana Maintenance: Cannabis for Alcohol Dependence —


Many people who have been long term alcohol abusers eventually find that quitting drinking is their best choice. Decades of daily heavy drinking can lead to physical dependence on alcohol and life-threatening withdrawal symptoms if one stops drinking without tapering off or entering a medical detox.

Some people who decide to quit drinking alcohol will do so successfully with an abstinence based support group such as AA or SMART Recovery or SOS or WFS. Others will enter some sort of formal addiction treatment program. However, abstinence only support groups are not successful for all people who enter them.

And a study by Walsh et al showed that more than 60% of patients given formal alcohol treatment relapsed into drinking alcohol. Other studies have shown similar outcomes.

Fortunately, there are other options for people who have been failed by AA or by formal alcoholism treatment programs. One of these options—which has proven highly successful for many individuals—is Marijuana Maintenance, which involves the substitution of cannabis for alcohol.

The Research of Tod Mikuriya, MD

To date there have been no placebo-controlled double-blind studies of the success of cannabis as a substitute for alcohol for people with alcohol dependence. However, the late Dr Tod Mikuriya, MD (1933 — 2007) has long been an advocate of medical marijuana for a wide variety of uses included the treatment of alcohol dependence.

In 2004 Dr Mikuriya published a study of 92 patients for whom he had prescribed cannabis as a treatment for their alcohol dependence.

The following quote from Dr Mikuriya's paper tells us about the efficacy of marijuana for these patients: As could be expected among patients seeking physician approval totreat alcoholism with cannabis, all reported that they'd found it «veryeffective» (45) or «effective» (38). Efficacy was inferred from other responseson seven questionnaires.

Two patients did not make follow-upvisits but had reported efficacy at the initial interview.

Nine patients reported that they had practiced total abstinence fromalcohol for more than a year and attributed their success to cannabis.Their years in sobriety: 19, 18, 16, 10, 7, 6, 4 (2), and 2.

Patients who reported a return of symptoms when cannabis was discontinued(19), ranged from succinct to dramatic:

  • «I started drinking a lot more.»
  • «More anxiety, less happiness.»
  • «Use alcohol when cannabis isn't available.»
  • «If I don't have anything to smoke, I usually drink a lot more.»
  • «I quit using cannabis while I was in the army and my drinkingdoubled. I was also involved in several violent incidents due to alcohol.
  • «My caretaker got arrested and I lived too far from the city to purchaseat a club, and I started doing heroin again and almost killedmyself and some of my friends.»
  • «Stress level becomes higher, become more uptight. Went back todrinking in the 1970s.»-A female patient with 19 years of sobriety.Several patients specifically noted that cannabis use reduced thecraving for alcohol:
  • «I crave alcohol when I can't smoke marijuana.»
  • «Had to quit drinking at 48 yrs. old. Found cannabis helped stopthe urge to drink.»-A 69-year-old commercial fisherman.

Three patients reported a sad irony: they had «fallen off the wagon»when they had to stop using cannabis in anticipation of drug tests. PatientS., a 27-year-old cable installer, had six alcohol-related arrests byage 21, «. . .

after not smoking herb (for probation drug test) and blackingout on alcohol, I found my drinking getting hand and I begangetting into more trouble.» He later relapsed when denied use of cannabisat a residential treatment facility.

Twenty nine of Mikuriya's patients reported that they had formerly used alcohol for pain relief and were now using cannabis in its stead.

Fourty four reported that they had previously used alcohol to medicate some sort of mood disorder such as depression, anxiety, stress, or PTSD. All forty four reported that they had successfully substituted cannabis for alcohol for the relief of thes psychological issues.

Mikuriya makes the case that cannabis not only has fewer side effects than alcohol, but also fewer side effects than prescription drugs as well. Not to mention that marijuana is much cheaper to purchase than most prescription drugs for the uninsured poor.

Dr Mikuriya's full article can be read here:
Cannabis as a Substitute for Alcohol:A Harm-Reduction Approach

Mr. W.'s Story

We also have testimonial evidence for the effectiveness of pot as a substitute for alcohol in the story of a man who only identifies himself as «Mr. W.» Mr. W tells us how marijuana did what AA alone could not do—it helped to relieve his symptoms of anxiety and make life without alcohol livable. The following is a short quote from his story which you may read in its entirety here:

«Marijuana is not for everyone, and certainly may be used irresponsibly. But prohibition, which forces people me to the black market, is a constant reminder of how Neanderthal our drug policy is. This is reflected in the laws but also in the minds of most people — who wouldn't understand how marijuana saved my life that February day.»

Dr Charlton's Essay

Dr B G Charlton in the UK makes that case that drugs such as cannabis show far fewer harmful effects than alcohol—and advocates drug substitution as the only rational solution to the extremely rapid increases in binge drinking which are taking place in the United Kingdom today.

Dr Charlton points out that benzodiazepines are a far less harmful way of treating anxiety disorder than is the use of alcohol.

He also points out that there is a social need for recreational intoxication and champions cannabis as a less dangerous drug than alcohol when used for this purpose, as we can see from the following quote:

«Since hundreds of thousands of people in the UK and Ireland regularly get drunk during their leisure hours, it is clear that a lifestyle drug that induces a state of euphoric release is needed, and alcohol is currently the only legal and available intoxicating agent. Marijuana is probably a safer and less antisocial alternative to high-dose alcohol.7 There seems to be a broad consensus that marijuana intoxication is less medically harmful than high-dose alcohol bingeing, and (if hippies are any guide) intermittent marijuana usage largely avoids the social problems of aggression and violence typical of drunkenness. It would make sense for governments of Northern European countries to promote marijuana intoxication as a socially-preferable alternative to binge drinking.»

Dr Charlton's full essay is available online here:

My Experience

I can no longer smoke marijuana myself—I used to suffer from depression and I find that for me marijuana brings on a recurrence of my depression. This is why alcohol is my drug of choice.

However, a good friend of mine—my former roommate from the Saint Anthony House of Drunks—always told me that he would prefer to quit alcohol entirely and only smoke marijuana if he could afford it and if it were legal.

Sometimes he had alcohol withdrawal seizures if he drank too much—and sometimes he had blackouts and would injure himself when drinking. None of these things ever happened to him if he stuck to the happy weed. The US policy of keeping weed illegal is simply inhumane. That is all.


Charlton BG. (2005). Diazepam with your dinner, Sir? The lifestyle drug-substitution strategy: a radical alcohol policy. QJM. Jun;98(6)

Mikuriya TH. (2004) Cannabis as a Substitute for Alcohol: A Harm-Reduction Approach. Journal of Cannabis Therapeutics, Vol. 4(1) 2004

Free Full Text

Mr. W. (2009). The Alcoholic Fights for His Herb

Walsh, D.C., Hingson, R.W., Merrigan, D.M., Levenson, S.M., Cupples, L.A., Heeren, T., Coffman, G.A., Becker, C.A., Barker, T.A., Hamilton, S.K., McGuire, T.G., & Kelly, C.A. (1991). A randomized trial of treatment options for alcohol-abusing workers. New England Journal of Medicine, 325, 775 781.


Is It Safe to Mix Alcohol & Marijuana?

The Pros and Cons of Substituting Marijuana for Alcohol

It is common for people to mix alcohol and marijuana. In fact, marijuana is the most frequently used substance among drinkers. People may use a combination of these substances to get more of an effect for both or combat the side effects of one or the other, but it can be risky and unsafe.

Article at a Glance:

  • Using alcohol and marijuana in combination increases your risk of experiencing uncomfortable side effects due to increased absorption of THC.
  • Using a combination of alcohol and marijuana can lead to a greater degree of impairment than either on its own.
  • When you combine alcohol and marijuana, you’re more ly to experience “greening out,” which is a sick feeling following the use of marijuana.
  • Using marijuana and alcohol in combination can make alcohol poisoning more ly, which can be life-threatening.

The Effects of Mixing Alcohol & Marijuana

When someone uses alcohol and marijuana together, they might start to notice they feel the effects of one (or both) much more quickly and more pronounced than otherwise.

Marijuana and alcohol both impact the central nervous system. Marijuana impacts areas of the brain responsible for memory, thinking, pleasure and perceiving time and senses. Alcohol is a depressant that affects the entire central nervous system, heavily impacting motor skills, judgment, cognition and memory.

One of the main active ingredients in marijuana is tetrahydrocannabinol (THC). THC and alcohol are both psychoactive. THC acts on cannabinoid receptors in the brain, which can lead to cognitive effects and impairments.

When people drink and smoke marijuana together, alcohol increases the amount of THC that is absorbed into the body. While this means that people who use an alcohol and marijuana combination may report a “higher high,” the lows can also become amplified. For example, impaired judgment symptoms are more obvious.

What Are the Risks?

While people might use a combination of alcohol and marijuana to experience a more intense high, this can be dangerous. The effects of marijuana and alcohol on their own are unpredictable, and combining them makes this worse. You can absorb THC more quickly when there’s alcohol in your blood, which can increase the risk of experiencing uncomfortable side effects.

Combining the two substances also leads to a greater degree of impairment than taking either one on its own. This can increase your risk for accidents and injury. You may put yourself in risky or dangerous situations if you’re drinking or using marijuana, and an alcohol and marijuana combination makes this even more ly.

It’s also important to note that if you regularly use an alcohol and marijuana combination, you’re at a higher risk of developing a dependence on one or both of the substances. Further, if you try to cut back on either alcohol or cannabis, your reliance on the other substance is ly to increase.

What Is Greening Out?

If you’re researching the safety of mixing marijuana and alcohol, you may come across the term “greening out.” It refers to a person feeling sick after smoking marijuana. This can happen with marijuana use on its own, but with an alcohol and marijuana combination, it’s more ly to happen due to the higher THC levels when you drink.

How To Handle a Bad Reaction

If a person has been drinking and smoking weed, higher THC levels in their blood from drinking may increase the risk of a bad reaction. Because physical and mental impairment can be more pronounced when you combine cannabis and alcohol, it can be hard to know if someone’s symptoms are due to a marijuana green-out or excessive alcohol intake.

Because alcohol poisoning can be deadly, it is best to seek medical attention to make sure that your symptoms are not due to a dangerous blood alcohol level.

While awaiting medical attention, it is important to keep the person safe from harm. This includes preventing injury and providing reassurance and emotional support.

Can You Overdose On Alcohol & Marijuana?

Another risk of an alcohol and marijuana combination is that you may take too much of either substance. Although using too much marijuana isn’t usually life-threatening, inhalation burns and asthma attacks from smoking cannabis can be deadly.

Drinking too much alcohol can be lethal. If you’re using an alcohol and marijuana combination, you can be more ly to get alcohol poisoning, which can be fatal.

When To Get Help

It is important to seek emergency medical help if you suspect a person is experiencing alcohol poisoning. Because a person becomes more impaired when they mix alcohol and marijuana, it can be hard to tell if a person is reacting to too much drink or too much cannabis. The signs of alcohol poisoning include:

  • Confusion
  • Problems staying conscious
  • Vomiting
  • Seizures
  • Slow or irregular breathing
  • Slow heartbeat
  • Clammy skin
  • Dulled reflexes
  • Bluish or pale skin color

Alcohol poisoning can be fatal. If you suspect someone is experiencing alcohol poisoning, call 911 immediately. Do NOT be afraid to seek help. If you do not have access to a phone contact Web Poison Control Services for online assistance.

You shouldn’t mix marijuana and alcohol. If you think you’re abusing these or other substances, help is available. Contact us to speak with an intake coordinator who can answer your questions and help you understand what options may be available to you.

  • Sources
    • American Association for Clinical Chemistry. “Any dose of alcohol combined with cannabis significantly increases levels of THC in blood.” May 27, 2015. Accessed October 2, 2021.
    • Chait, LD; Perry, JL. “Acute and residual effects of alcohol and marijuana, alone and in combination, on mood and performance.

      ” Psychopharmacology (Berlin), July 1994. Accessed October 2, 2021.

    • Karoly, Hollis C.; Ross, J. Megan; Prince, Mark A.; et al. “Effects of cannabis use on alcohol consumption in a sample of treatment-engaged heavy drinkers in Colorado.” Addiction, September 2021. Accessed October 2, 2021.
    • National Institute on Alcohol Abuse and Alcoholism.

      “Understanding the Dangers of Alcohol Overdose.” May 2021. Accessed October 2, 2021.

    • U.S. National Library of Medicine. “Marijuana Intoxication.” January 1, 2021. Accessed October 2, 2021.
    • Subbaraman, Meenakshi S.; Kerr, William C. “Simultaneous vs. concurrent use of alcohol and cannabis in the National Alcohol Survey.

      ” Alcoholism: Clinical and Experimental Research, May 2015. Accessed October 2, 2021.

    • Sheikh, Nafiz K.; Dua, Anterpreet. “Cannabinoids.” StatPearls, July 25, 2021. Accessed October 2, 2021.
    • U.S. Department of Justice, Drug Enforcement Administration. “Drugs of Abuse.” April 2020. Accessed October 2, 2021.

    • Brumback, Ty; Cao, Dingcai; King, Andrea. “Effects of Alcohol on Psychomotor Performance and Perceived Impairment in Heavy Binge Social Drinkers.” Drug and Alcohol Dependence, June 8, 2007. Accessed October 2, 2021.
    • Gunn, Rachel L.; Sokolovsky, Alexander; Stevens, Angela K.; et al.

      “Ordering in alcohol and cannabis co-use: Impact on daily consumption and consequences.” Drug and Alcohol Dependence, January 1, 2021. Accessed October 2, 2021.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes.

We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment.

It should not be used in place of the advice of your physician or other qualified healthcare provider.

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