Kava: Addiction, withdrawal and tolerance.
We see the question often, and with good reason. “Is kava addictive?” With the multitude of drugs and chemicals available today, one of the questions we tend to gravitate towards is “What will happen when I stop taking this?”. Withdrawal, tolerance and addiction are extremely important pieces of information to understand when considering daily consumption of a substance. Addiction to a substance can be broken down into two non-exclusive types for the sake of this discussion. Physical dependence, or a physical condition caused by chronic use of a tolerance-forming drug, in which abrupt or gradual drug withdrawal causes unpleasant physical symptoms [1], or psychological dependence: a state that involves emotional–motivational withdrawal symptoms, e.g. anxiety and anhedonia, upon cessation of drug use [2].
Kava’s physical and psychological addiction have been studied in a controlled, double-blind trial over several weeks on 48 individuals with doses ranging from 60mg to 280mg kavalactones per day. Tablets that were used were pressed dried aqueous extract (non-solvent) standardized to 60mg of kavalactones per tablet. In the withdrawal observation period (week 8), during which all participants were given single-blinded placebo, no significant increase in symptoms or AEs (adverse effects) occurred in either the kava or placebo arms (assessed on the purpose-designed adverse reactions checklist). Assessment of potential addictive effects in completers found no significant difference in the number of participants in the kava group [6/25 (24%)] compared to the placebo group [6/25 (24%)] who said they wanted to increase the dose of medication (assessed on the purpose-designed addiction scale). Of the participants who noted a desire to increase their dosage, the kava group had an average of 5/10 for intensity of cravings versus 5.3/10 for the placebo group. A total of 1/25 (4%) in the kava group took more tablets than instructed, compared to 2/25 (8%) for placebo [3].
Another aspect of addiction commonly but not exclusively found is tolerance, or the need for an increasing dose corresponding to the duration of consumption. Development of tolerance was studied in mice, and none could be observed during this 3-week study that used aqueous and lipophilic kava extracts. Sorrentino examined the potential for dependence. Rats showed no change in body weight or spontaneous behavior after discontinuing 3 months of treatment with a kavapyrone complex at dosages of 7.3 and 73 mg/kg body weight. Neither tolerance nor dependence was observed [4].
The typical kava drinkers will consume anywhere from 400mg-8000mg over the course of a session which is vastly larger than the amounts given in the study. Even with this large discrepancy in dose, kava drinkers have yet to report addiction issues even when consumed for years daily in this manner.
[1] “Physical dependence.” Wikipedia, Wikimedia Foundation, 15 October 2020, https://en.wikipedia.org/wiki/Physical_dependence
[2] “Psychological dependence.” Wikipedia, Wikimedia Foundation, 11 September 2020, https://en.wikipedia.org/wiki/Psychological_dependence
[3] Sarris, J., Stough, C., Teschke, R., Wahid, Z. T., Bousman, C. A., Murray, G., . . . Schweitzer, I. (2013). Kava for the Treatment of Generalized Anxiety Disorder RCT: Analysis of Adverse Reactions, Liver Function, Addiction, and Sexual Effects. Phytotherapy Research, 27(11), 1723-1728. doi:10.1002/ptr.4916
[4] Josef Scherer. “Kava-kava extract in anxiety disorders: An outpatient observational study” researchgate.net, https://www.researchgate.net/public...y_disorders_An_outpatient_observational_study
We see the question often, and with good reason. “Is kava addictive?” With the multitude of drugs and chemicals available today, one of the questions we tend to gravitate towards is “What will happen when I stop taking this?”. Withdrawal, tolerance and addiction are extremely important pieces of information to understand when considering daily consumption of a substance. Addiction to a substance can be broken down into two non-exclusive types for the sake of this discussion. Physical dependence, or a physical condition caused by chronic use of a tolerance-forming drug, in which abrupt or gradual drug withdrawal causes unpleasant physical symptoms [1], or psychological dependence: a state that involves emotional–motivational withdrawal symptoms, e.g. anxiety and anhedonia, upon cessation of drug use [2].
Kava’s physical and psychological addiction have been studied in a controlled, double-blind trial over several weeks on 48 individuals with doses ranging from 60mg to 280mg kavalactones per day. Tablets that were used were pressed dried aqueous extract (non-solvent) standardized to 60mg of kavalactones per tablet. In the withdrawal observation period (week 8), during which all participants were given single-blinded placebo, no significant increase in symptoms or AEs (adverse effects) occurred in either the kava or placebo arms (assessed on the purpose-designed adverse reactions checklist). Assessment of potential addictive effects in completers found no significant difference in the number of participants in the kava group [6/25 (24%)] compared to the placebo group [6/25 (24%)] who said they wanted to increase the dose of medication (assessed on the purpose-designed addiction scale). Of the participants who noted a desire to increase their dosage, the kava group had an average of 5/10 for intensity of cravings versus 5.3/10 for the placebo group. A total of 1/25 (4%) in the kava group took more tablets than instructed, compared to 2/25 (8%) for placebo [3].
Another aspect of addiction commonly but not exclusively found is tolerance, or the need for an increasing dose corresponding to the duration of consumption. Development of tolerance was studied in mice, and none could be observed during this 3-week study that used aqueous and lipophilic kava extracts. Sorrentino examined the potential for dependence. Rats showed no change in body weight or spontaneous behavior after discontinuing 3 months of treatment with a kavapyrone complex at dosages of 7.3 and 73 mg/kg body weight. Neither tolerance nor dependence was observed [4].
The typical kava drinkers will consume anywhere from 400mg-8000mg over the course of a session which is vastly larger than the amounts given in the study. Even with this large discrepancy in dose, kava drinkers have yet to report addiction issues even when consumed for years daily in this manner.
[1] “Physical dependence.” Wikipedia, Wikimedia Foundation, 15 October 2020, https://en.wikipedia.org/wiki/Physical_dependence
[2] “Psychological dependence.” Wikipedia, Wikimedia Foundation, 11 September 2020, https://en.wikipedia.org/wiki/Psychological_dependence
[3] Sarris, J., Stough, C., Teschke, R., Wahid, Z. T., Bousman, C. A., Murray, G., . . . Schweitzer, I. (2013). Kava for the Treatment of Generalized Anxiety Disorder RCT: Analysis of Adverse Reactions, Liver Function, Addiction, and Sexual Effects. Phytotherapy Research, 27(11), 1723-1728. doi:10.1002/ptr.4916
[4] Josef Scherer. “Kava-kava extract in anxiety disorders: An outpatient observational study” researchgate.net, https://www.researchgate.net/public...y_disorders_An_outpatient_observational_study