Kava: Addiction, Withdrawal & Tolerance.
The lack of these three seen in kava consumption.
It's a common question that arises with kava use: "Can kava be addictive?" In today’s world, where countless drugs and botanicals are available, it is natural to wonder about the potential consequences of consuming any substance regularly. Withdrawal, tolerance, and addiction are all essential pieces of information to consider when thinking about daily consumption of a substance. For the purposes of this discussion, addiction to a substance can be classified into two non-exclusive types. The first is physical dependence, which is a physical condition caused by the chronic use of a tolerance-forming drug. Abrupt or gradual withdrawal from the drug can result in unpleasant physical symptoms [1]. The second type is psychological dependence, which is a state that involves emotional-motivational withdrawal symptoms, such as anxiety and anhedonia, when drug use is stopped [2]. It should be noted, however, that these two properties are no longer considered separate in their diagnoses. They are, as of the DSM V, considered to be all wrapped into the wider term “drug use disorder”.
A study was conducted on 48 people who took kava tablets containing 60–280 mg kavalactones per day for several weeks. During the withdrawal period, which lasted a week and all participants were administered a single-blinded placebo, there were no significant increases in symptoms or adverse effects in either the kava or placebo groups. After completion of the study, there was no significant difference in the number of participants in the kava group (6/25, or 24%) compared with the placebo group (6/25, or 24%) who wanted to increase their medication dose, based on the addiction scale. Those in the kava group who noted a desire to increase their dosage had an average intensity of cravings of 5/10, versus 5.3/10 for the placebo group. Only 1/25 (4%) of the kava group took more tablets than instructed, compared with 2/25 (8%) for the placebo group [3]. The tablets used were pressed dried aqueous extract (non-solvent) standardized to 60 mg of kavalactones per tablet.
Tolerance, which is the need for an increasing dose corresponding to the duration of consumption, is another aspect of addiction that is commonly but not exclusively found. However, a study on mice using aqueous and lipophilic kava extracts did not show any development of tolerance over a 3-week period. In addition, a study on rats that received a kavapyrone complex for 3 months at dosages of 7.3 and 73 mg/kg body weight found no change in body weight or spontaneous behavior after discontinuation. Neither tolerance nor dependence was observed in this study [4].
The typical kava drinkers will consume anywhere from 400 mg to 8000 mg 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/.../13111065_Kava-kava...