CBD for alcohol use disorder: strong preclinical, mixed human evidence

Alcohol use disorder (AUD) is highly prevalent, yet current pharmacotherapies remain underutilized and demonstrate only modest efficacy. Cannabidiol (CBD) has emerged as a potential therapeutic option for numerous psychiatric conditions, including AUD. Three reviews published in 2019 examined the effects of CBD on alcohol-related outcomes, but conclusions were limited by the scarcity of clinical trials at that time. The clinical research and published literature have since expanded substantially, warranting an updated synthesis of the evidence. In this narrative review, we evaluate the current state of research on CBD as a pharmacotherapy for AUD. Despite strong preclinical evidence for CBD isolate reducing alcohol consumption, clinical trials have yielded largely null findings. Effects on alcohol craving and reward are inconsistent across human and preclinical studies. Initial evidence from observational studies suggests plant-derived CBD formulations including small amounts of THC and other cannabinoids may reduce alcohol consumption and craving, which warrants further investigation in a randomized, controlled trial. There is also growing preclinical evidence that CBD reduces symptoms of alcohol withdrawal and attenuates alcohol-induced liver disease and neurodegeneration; however, clinical evidence is limited in these domains. Several methodological considerations may account for these mixed findings. CBD has poor oral bioavailability, suggesting that alternative formulations and routes of administration may improve ecological validity and therapeutic potential. Future clinical trials should prioritize transparent reporting of cannabinoid content, including THC, as well as measurement of plasma CBD levels. Additionally, incorporating biobehavioral phenotyping approaches may help identify subgroups most likely to benefit from CBD. Overall, preclinical evidence supporting CBD as a treatment for AUD remains strong, while emerging human data are mixed. More rigorous and methodologically refined clinical trials are needed to clarify the potential therapeutic applications of CBD for AUD.