What is the situation with CBD mixed with alcohol?

Question

CBD-infused shots, beers, and other alcoholic drinks have started to be produced and I have seen claims online that mixing CBD and alcohol can intensify each other’s effects, resulting in changes in mood and behaviour, yet it can help with alcohol addictions.

One study of 10 people found that when participants took 200mg of CBD with alcohol, they had significantly lower blood alcohol levels than when they consumed alcohol with a placebo (Consroe et al. 1979), however, combining alcohol with CBD caused significant impairments in motor performance and alterations in the perception of time.

Compared to placebo, alcohol and alcohol plus CBD, but not CBD alone, produced significant impairments of motor and psychomotor performances, overestimations of time production and subjective responses indicating an accurate self-perception of their intoxication and deficits. The combination of alcohol plus CBD resulted in significantly lower blood alcohol levels compared to alcohol given alone, however, there were few differences observed between the pharmacological effects of the two alcohol conditions.

The point I am making is that the study found that although CBD being added to alcohol lowers blood alcohol levels the pharmacological effects of the alcohol remain the same as without CBD. Although CBD does not have psychoactive effects on its own, it appears to me if I am interpreting the results correctly, that CBD speeds up the metabolization of alcohol, hense lower blood alcohol levels, yet the potency of lower blood alcohol levels is elevated too. Which if you think about it could affect driver blood alcohol testing limits?

The last point I made about driver testing is beside the point (in a way), but what I am wondering is What is the scientific stance on addiction therapy with CBD?

References

Consroe, P., Carlini, E. A., Zwicker, A. P., & Lacerda, L. A. (1979). Interaction of cannabidiol and alcohol in humans. Psychopharmacology, 66(1), 45-50. pmid: 120541

Answer 1

The article you linked seems to be the best reference to answer your title question about mixing CBD and alcohol, and as pointed out by @CareyGregory in a comment:

I think you misstated the 1979 study's findings. They found impairment with alcohol, but no difference between impairment with and without CBD. That agrees with the modern understanding that CBD has no psychoactive effects

I'll focus on your last sentence "What is the scientific stance on addiction therapy with CBD?" with respect to alcohol use disorder.

Currently there has not been sufficient clinical study to say anything about treating alcohol addiction with CBD specifically (the only existing studies included THC or studied effects of marijuana decriminalization). I can not find a single published clinical trial with CBD in the context of alcohol use disorder or measuring alcohol use more generally. This is consistent with limited or lacking clinical study for other indications of CBD besides epilepsy.

A recent review (Nona et al 2019) discusses the lack of clinical research in this area, and summarizes existing preclinical research (all in rodents). The results overall are mixed but point to some potential anxiolytic effects that may contribute to reduced ethanol preference in CBD-treated rodents, as well as some results suggesting a reduction in ethanol toxicity. One recent mouse study (Viudez‐Martínez et al 2018) showed reduced ethanol self-administration and reduced relapse with CBD, but of course such models are only of limited predictive value for human outcomes.

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Nona, C. N., Hendershot, C. S., & Le Foll, B. (2019). Effects of cannabidiol on alcohol-related outcomes: A review of preclinical and human research. Experimental and clinical psychopharmacology.

Viudez‐Martínez, A., García‐Gutiérrez, M. S., Navarrón, C. M., Morales‐Calero, M. I., Navarrete, F., Torres‐Suárez, A. I., & Manzanares, J. (2018). Cannabidiol reduces ethanol consumption, motivation and relapse in mice. Addiction biology, 23(1), 154-164.

Answer 2

Jury still being out for an overall picture, it seems at least for a harm reduction perspective things are looking quite good. As an adjunct form of actual treatment it may have value as well. Specifically it seems as if neurologically and regarding the liver some of the worst outcomes of alcohol consumption are mitigated to a degree, but psychologically the state of drunkenness from a certain level of alcohol may not be lowered but motor impairments actually amy increase while the level of actual alcohol in the blood may slightly decrease.

As a modulator for addictive behaviour it may have a tremendous effect on the positive side.

Results: Experimental studies find that CBD reduces the overall level of alcohol drinking in animal models of AUD by reducing ethanol intake, motivation for ethanol, relapse, anxiety, and impulsivity. Moreover, CBD reduces alcohol-related steatosis and fibrosis in the liver by reducing lipid accumulation, stimulating autophagy, modulating inflammation, reducing oxidative stress, and by inducing death of activated hepatic stellate cells. Finally, CBD reduces alcohol-related brain damage, preventing neuronal loss by its antioxidant and immunomodulatory properties.
Conclusions: CBD could directly reduce alcohol drinking in subjects with AUD. Any other applications warrant human trials in this population. By reducing alcohol-related steatosis processes in the liver, and alcohol-related brain damage, CBD could improve both hepatic and neurocognitive outcomes in subjects with AUD, regardless of the individual's drinking trajectory. This might pave the way for testing new harm reduction approaches in AUD, in order to protect the organs of subjects with an ongoing AUD. _{–– De Ternay J et al.: "Therapeutic Prospects of Cannabidiol for Alcohol Use Disorder and Alcohol-Related Damages on the Liver and the Brain.", Front Pharmacol. 2019 May 31;10:627. doi: 10.3389/fphar.2019.00627. eCollection 2019.}

Substance use disorder is characterized by repeated use of a substance, leading to clinically significant distress, making it a serious public health concern. The endocannabinoid system plays an important role in common neurobiological processes underlying substance use disorder, in particular by mediating the rewarding and motivational effects of substances and substance-related cues. In turn, a number of cannabinoid drugs (e.g., rimonabant, nabiximols) have been suggested for potential pharmacological treatment for substance dependence. Recently, cannabidiol (CBD), a non-psychoactive phytocannabinoid found in the cannabis plant, has also been proposed as a potentially effective treatment for the management of substance use disorder. Animal and human studies suggest that these cannabinoids have the potential to reduce craving and relapse in abstinent substance users, by impairing reconsolidation of drug-reward memory, salience of drug cues, and inhibiting the reward-facilitating effect of drugs. Such functions likely arise through the targeting of the endocannabinoid and serotonergic systems, although the exact mechanism is yet to be elucidated. This article seeks to review the role of the endocannabinoid system in substance use disorder and the proposed pharmacological action supporting cannabinoid drugs' therapeutic potential in addictions, with a focus on CBD. Subsequently, this article will evaluate the underlying evidence for CBD as a potential treatment for substance use disorder, across a range of substances including nicotine, alcohol, psychostimulants, opioids, and cannabis. While early research supports CBD's promise, further investigation and validation of CBD's efficacy, across preclinical and clinical trials will be necessary.
_{–– Chye Y et al.: "The Endocannabinoid System and Cannabidiol's Promise for the Treatment of Substance Use Disorder", Front Psychiatry. 2019 Feb 19;10:63. doi: 10.3389/fpsyt.2019.00063.}

Increased access to medicinal and recreational cannabis will be accompanied by greater exposure to its chemical constituents, including Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD), the primary nonpsychoactive compound. Increasing attention has focused on CBD, in part, due to its potential therapeutic properties. Relatively little is known about how CBD might interact with other commonly used drugs. While a number of studies have explored the influence of cannabis or Δ9-THC on alcohol consumption and treatment outcomes, few have examined the effects of CBD on alcohol-related outcomes. This article reviews preclinical and human studies examining the effects of CBD administration on alcohol responses. Preliminary preclinical results suggest that CBD can attenuate alcohol consumption and potentially protect against certain harmful effects of alcohol, such as liver and brain damage. Also reviewed herein are the few existing studies involving CBD and alcohol coadministration in humans. The paucity of such studies precludes any definitive conclusions relating to CBD-alcohol interactions. Effects of CBD on alcohol use and potential therapeutic implications for alcohol use disorder are discussed.
_{–– Nona CN et al.: "Effects of cannabidiol on alcohol-related outcomes: A review of preclinical and human research", Exp Clin Psychopharmacol. 2019 May 23. doi: 10.1037/pha0000272.}

There is substantial interest in the therapeutic potential of cannabidiol (CBD), a non-psychoactive cannabinoid found in plants of the genus Cannabis. The goal of the current systematic review was to characterize the existing literature on this topic and to evaluate the credibility of CBD as a candidate pharmacotherapy for alcohol use disorder (AUD). Using a comprehensive search strategy, 303 unique potential articles were identified and 12 ultimately met criteria for inclusion (8 using rodent models, 3 using healthy adult volunteers, and 1 using cell culture). In both rodent and cell culture models, CBD was found to exert a neuroprotective effect against adverse alcohol consequences on the hippocampus. In rodent models, CBD was found to attenuate alcohol-induced hepatotoxicity, specifically, alcohol-induced steatosis. Finally, findings from preclinical rodent models also indicate that CBD attenuates cue-elicited and stress-elicited alcohol-seeking, alcohol self-administration, withdrawal-induced convulsions, and impulsive discounting of delayed rewards. In human studies, CBD was well tolerated and did not interact with the subjective effects of alcohol. Collectively, given its favorable effects on alcohol-related harms and addiction phenotypes in preclinical models, CBD appears to have promise as a candidate AUD pharmacotherapy. This is further bolstered by the absence of abuse liability and its general tolerability. A clear limitation to the literature is the paucity of human investigations. Human preclinical and clinical studies are needed to determine whether these positive effects in model systems substantively translate into clinically-relevant outcomes.
_{–– Turna J et al.: "Cannabidiol as a Novel Candidate Alcohol Use Disorder Pharmacotherapy: A Systematic Review", Alcohol Clin Exp Res. 2019 Apr;43(4):550-563. doi: 10.1111/acer.13964.}

Cannabidiol protects liver from binge alcohol-induced steatosis by mechanisms including inhibition of oxidative stress and increase in autophagy.

Transdermal delivery of cannabidiol attenuates binge alcohol-induced neurodegeneration in a rodent model of an alcohol use disorder.

Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence