The use of Cannnabidiol (CBD) to Reduce Insomnia and the Urge To Use Alcohol in a Geriatric person in on going Behavior Therapy.
300.02 (Generalized Anxiety Disorder), 296.32 (Major Depressive Disorder Recurrent Moderate), 303.90 (Alcohol-Related Disorder Moderate), 301.89 (Other Specified Personality Disorder Mixed Personality Features, Dependent, Schizoid).
This case highlights a trail of CBD in an ongoing behavior therapy. CBD was used to: break a cycle of insomnia, secondary to a major depressive episode and reduce alcohol consumption as per an addiction.
65 or Above
Brief history and target symptomatology
Patient sought treatment (cognitive behavioral therapy) after the sudden loss of partner after 30 years of co-habituating / marriage. This was a traumatic event and came not to long after the trauma of 911 in New York City. She presented as anxious and depressed and as treatment progressed disclosed a moderate alcohol addiction. The patient was willing to attend sessions and willful as per reduction of substance abuse. The patient has had difficulty with medical doctors as per trust based on the medical treatment of her significant other. An increase in symptoms of anxiety and depression occurred after a diagnosis of a urinary tract issue warranted a surgical consultation. Target symptoms for CBD: insomnia and alcohol.
Previous and current conventional therapies
Cognitive behavioral therapy, functional analysis of drinking, relaxation techniques, cognitive restructuring, and schema focused therapy. The patient started Escitalopram Oxalate on 3/25/13 and discontinued the anti depressant secondary to the side effect of dizziness on 4/1/13.
Clinical response to Cannabis
To assess tolerability and using the concept of ‘start low and go slow’ for geriatrics, the patient was recommend on 5/2/13, CBD drops, once in the morning, then after one week, morning and evening doses. The CBD was tolerated without side effects. The patient however reported no change in insomnia or drinking. To break the cycle of insomnia Diphenydramine was recommended on 5/13/13. The patient stopped the evening dose of CBD and tried Diphenydramine, reporting that 25mg of Diphenydramine was helpful but not enough to break the cycle of insomnia. The next recommendation 5/20/13 was to keep the morning dose of CBD and in the evening 45 minutes prior to going to bed to add CBD drops with 1 25mg of Diphenydramine. By 6/10/13 the combined treatment broke the cycle of insomnia. The patient reported an increase in better quality of sleep, feeling more restoration post waking and a decrease in depression. Based on the efficacy of this intervention the patient was willing to try 1 CBD pill in the A.M. instead of CBD drops to reduce alcohol use. Morning doses did not produce a therapeutic response and like the drops, the pill form was well tolerated by the patient. Based on a reduction in depression secondary to better sleep the patient was willing to try 1 CBD pill 45 minutes before she started to drink, which started at 5pm and continue till 11pm. She was very ambivalent about giving up alcohol, refused Alcoholics Anonymous and was still willing to try CBD. By 6/24/13 the patient reported a reduction in the urge to have the first drink. On 7/1/13, the patient was encouraged to try to push back the first drink. The patient reported on 7/15/13 that she was able to cut her drinking by one drink.
The treatment is ongoing. The patient still is very ambivalent about stopping drinking all together. This is exacerbated by the anxiety secondary to the prospect of surgery. However based on the CBD treatment she is surprised that she is able to reduce the urge at all and is contemplating the concept of controlled drinking. The successful cessation of insomnia was a major gain for the patient, improving her mood and her ability to think more clearly about her decision making as per surgical intervention. Standing dose of CBD is: drops in the morning, 45 minutes before her usual drinking time 1 CBD pill and before bed CBD drops and 1 tab 25 mg of Diphenydramine 45 minutes before bed. The biggest challenge to continuing CBD treatment is the expense of the treatment.
CBD was first used in the form of drops and then combined with a pill. Trying to control the use of CBD in the form of a dropper without milligram markings and as the drops were used less would come up in the dropper receptacle from the bottle rendered drops under the tongue difficult to quantify. The patient was encouraged to use 2-3 drops. Due to the current lack availability of CBD, as per state regulations, CDB products were bought online via Dixie Botanicals.
Due to age of the patient and to assess tolerability, drops were introduced first in the morning then morning and night. Sleep was dramatically improved by the combination of CBD drops and Diphenydramine 1 tab 25mg. Alcohol use was reduced by the use of 1 CBD pill 45 minutes prior to drinking pattern started which resulted in a reduction in the urge to drink.
Usual method of Cannabis administration
Cannabis strain (if known)
Mono therapy with CBD
Frequency of Usage: Time Per Day
Frequency of Usage: Days per Week