Kava Addiction And Overview Of Piper Methysticum Use

Last Updated: July 30, 2021

Reviewed by Michael Espelin APRN

Kava or Kava Kava is a plant of the species Piper methysticum. The term “Kava” can be used to refer to both the plant as well as its derivative drink. The Kava plant is native to the Pacific Islands and from its roots, various cultures of Polynesia, Micronesia, and Melanesia produce a water-based drink with sedative, anesthetic, and euphoric properties. This drink has a long history of use associated with traditional ritualistic ceremonies in these cultures and due to its psychoactive and intoxicating effects, it has also been used as a tea, recreational drink. More recently, organic solvent extracts have been sold in the western world as medicinal substances that can be used for the treatment of anxiety. This article reviews Kava Kava usage, various Kava benefits, its basic pharmacology/mechanism of action, and the possibility of Kava abuse and Kava addition resulting from its intoxicating and euphoric effects.

What Is Kava?

Kava or Kava-Kava is a plant of the species Piper methysticum, which is native to the South Pacific islands. The components of this plant have been used to produce an anxiolytic and sedative ceremonial drink that has been for centuries. Recently, many people have started using it for anxiety and other health conditions because of its stress-reducing and relaxing properties.

The Western interest in kava kava usage started in 1778 when Captain Cook voyaged to the Pacific islands. The plant goes by many different names, as there are numerous languages throughout the Pacific Islands. Kava-kava is the most commonly used. Others include awa, ava, yaqona, and sakau. Hawaiian and other strains are known to produce a sedative effect and are considered central nervous system depressants. Historically, Pacific Island cultures have used the root of this plant as a sedative and anesthetic, as well as utilizing its euphoriant properties in spiritual ceremonies and social settings. Now, those in other cultures who have become familiar with this plant’s properties use it to relieve conditions such as anxiety and insomnia.

What Does Kava Plant Look Like and Where Does It Grow?

Kava plant is a member of the pepper family, Piperaceae. Piper methysticum, specifically, is a hardy, slow-growing perennial, meaning that it lives for more than two years. The shrub of this plant looks like a bouquet of woody stems growing from a cluster at the base. It does not have many leaves, but the ones it does have are thin, single, whole, heart-shaped, alternate, petiolate, and quite long (8-25).

The Kava plant grows across the tropical Pacific. Specifically Hawaii, Federated States of Micronesia, Vanuatu, Fiji, the Samoas and Tonga. The plant grows best when temperatures are between 75-95°F and in loose, well-drained soil where plenty of air reaches the roots.

There are many different cultivars of this plant, but the “Noble” variants are ones that are traditionally used by the indiginous peoples as they are purported to have  more pleasant effects and have lower potential for causing negative side-effect when compared to “non-noble” cultivars.

Kava plant.

The consumption of this plant is legal in most of the world, and is treated as a dietary additive or a Kava supplement. Although specific regulations regarding its use, export, or sale do exist in certain parts of the world.

In North America, including the United States of America and Canada, Kava Kava usage is legal. It is often sold as a dietary supplement, and the FDA has issued guidelines for safe usage of the plant.

In the Republic of Vanuatu, which is a large exporter of the noble cultivar of this plant, only the noble cultivars of the plant are allowed to be taken out of the country.

In Australia, due to concerns over Kava abuse and addiction in the indigenous populations, since 2007 only 4kg of the plant substance (ie. root, leaf) can be brought into the country by users who must be 18 years or older.

In New Zealand, the plant root and its derived water-extracts are treated as a Dietary Kava Supplement, and is regulated as such.

In Europe, the sale of the plant as a medicinal substance is regulated in certain EU states. In the United Kingdom, the salel, supply or importation of medicinal substance containing awa for human consumption is illegal, but it is legal to possess the plant for personal, non-human purpose. A similar regulation exists in Poland.

How Does It work?

The plant contains several active substances. The chief of these are Kavalactones, which there are 18 of, however out of the 18 six seem to predominate and include Kavain, Methysticin, 7,8-Dihydromethysticin, Yangonin, Desmethoxyyangonin and 5,6-Dihydrokawain. Other than the Kavalactones there are also several Alkaloids(Pipermethystine, 3α,4α-epoxy-5β-pipermethystine, Avaine) and Flavokavins.

The Exact Pharmacologic Mechanism of These Active Compounds Is Not Fully Known However Several Actions Have Been Studied.

  • The activation of GABA-A receptors
  • Inhibition of Norepinephrine and Dopamine reuptake
  • Inhibition of  Monoamine Oxidase, preventing degradation of Serotonin, Norepinephrine, Dopamine.
  • Reduces the activity of the beta adrenaline receptors, relaxing muscles.
  • Blocking of calcium ion and sodium channels

The effects of the active compounds on GABA are thought to produce anxiolytic effects, its effects of Dopamine are thought to account for the mild/moderate psychotropic effects as well as for the possibility of Kava addiction, and the elevated levels of serotonin are thought to contribute to sedation.

What Is Kava Used For?

Kavalactones, the active ingredients, have anxiolytic, calming and euphoric effects. Kavalactones affect neurotransmitters in the brain, such as gamma-aminobutyric acid (GABA), decreasing the activity of the nerves.

Kava For Anxiety Relief The first study on kawa’s effects on people with anxiety was made public in 1997, and it showed that the plant significantly decreased the anxiety symptoms. The majority of research done in this area has shown that Piper methysticum extract with 70% kavalactones (WS 1490) does not only lower anxiety but can also substitute several prescription anti-anxiety drugs.
Depression The Piper methysticum root also has benefits in depression. The kavalactones regulate the neurotransmitter levels and relieve depressive symptoms, just like some antidepressant drugs do but with less risk of dangerous side effects. The Kava Anxiety And Depression Spectrum Study analyzed 60 individuals who enrolled in the study with generalized depression. The results showed that with 250mg  per day over three weeks, the depressive symptoms were significantly reduced with no adverse effects. Piper methysticum increases GABA, serotonin, and dopamine and decreases glutamate.
Stress Kava is an adaptogen plant, which means it is a powerful stress-fighter and promoter of overall well-being. Many studies have shown that stress relief could be successfully used to make someone calmer and more relaxed. One of these studies was made on 101 patients with stress-induced anxiety, and it showed a significant drop in stress levels after eight weeks of kawa treatment.
Insomnia Sleep disturbance is one of the leading symptoms of depression and anxiety. Piper methysticum can also be successfully used as an alternative substance to replace sleeping pills. One study, which used kava-kava for sleep, showed the plant-reduced insomnia and stress and had calming effects on the patients. The study results showed a shortened time to fall asleep, an increased length of deep sleep and the decrease in wakeful phases. Awa for sleep might also be efficient thanks to its effects on anxiety. Stress-induced insomnia is a common symptom in people with anxiety. So when kawa addresses anxiety effects, it also implicitly helps with insomnia and sleeping problems.
Pain Relief The active compounds kavalactones, found in the root and other parts of the Piper methysticum plant, also have neuroprotective, anti-convulsant, anti-inflammatory and pain-killing properties. It showed results in chronic nociceptive pain, which is felt when nerve cells affected by harm in the body and not by direct injury or infection. Kawa therapy is also useful in orofacial pain, the chronic pain localized in front of the ears, above the neck, inside the mouth or below the centerline of the eyes. Kava-kava for pain is also recommended in back pain, joint pain, migraine headaches, muscle spasms and neuralgia caused by cystic fibrosis.
Urinary Tract Infections Kawa taken by mouth also relieves the symptoms of urinary tract infections, such as burning sensation when urinating, pain in the lower abdomen and the intense urge to urinate. The plant relaxes the urinary tract thanks to its anti-inflammatory properties, thus reducing the stinging feeling. This antispasmodic plant also helps in bladder contractions, being traditionally used by the Native Hawaiians as treatment for urinary difficulties.
Menopause Menopause and perimenopause symptoms include night sweats, hot flashes, and increased irritability and anxiety. A study made on 40 women showed that Piper methysticum therapy could be used as treatment of irritability, depression, insomnia, and anxiety related to menopause by increasing dopamine levels, inhibiting monoamine oxidase-B and activating the GABA-A receptors. The plant manages to successfully suppress the mood swings and hormonal switches associated with menopause.
Asthma Kawa acts as a natural tranquilizer, calming asthma attacks without the foggy side effects of the calming prescription drugs. It eases and soothes the nervous system, improves adrenal health and reduces anxiety. Two or three cups of Piper methysticum tea per day have a strong relaxant, anti-inflammatory, numbing effect on the respiratory tract, helping with treatment and relief of asthma symptoms.
Improved Brain Function Another study showed that 300 mg of kava-kava extract could improve performance and accuracy in attention, working memory tasks, and visual processing. Kawa pyrones improve parts of the brain, such as the hippocampus, caudate nucleus, and amygdala, which deal with brain processes and emotions. However, higher dosage and chronic usage can lead to motor function impairment.

Despite the multiple potential Kava benefits in medical therapy, this plant is not currently used as a component of complementary pharmacotherapy, and is still labeled as an alternative option to pharmacotherapy.

Does Kava Have Health Benefits?

Many users believe that kava benefits their health. This claim is quite common, with many kava supplements stating it as fact. But do the studies back this up? Yes and no. Studies have shown that there are kava benefits. For example, it has been shown to treat anxiety and stress, and provide help in the several conditions listed above.

But many argue that the benefits do not outweigh the risks. Despite this, kava-kava is becoming more and more widely used. In many cases, people start using it because of the supposed tea benefits without knowing the risks. It is important that people fully research these teas before they use them.

Is Kava Safe?

Because Kava has been proven to have health benefits and is legal to use, it is easy to assume it is relatively safe. However, the medical community considers this to be up for debate.

Kawa side effects range from the desired relaxation to liver damage. It is this link to liver damage that has resulted in the most significant concern, with many countries opting to restrict or even ban awa because of it. Even in the U.S. where it is legal, it is suggested that people carefully limit their use to reduce risk.

One reason use can be problematic is that Ava interactions, such as with alcohol,  can increase the risk of damage to the liver and other organs. Because it is a legal supplement, people often do not consider how it can interact with other substances and since it is frequently used to get high, many combine it with alcohol containing drinks. This combination, and many others, can result in long-term health consequences.

Is Kava Addictive?

Given that its use is becoming more and more common and some are using it to treat addiction, it begs the question: is it addictive?

Kava addiction has to be looked at from two perspectives: physical addiction and psychological addiction. Physical Kava addiction can occur because the active components of this plant act on Dopaminergic reward pathways which can lead to Kava abuse and subsequent addiction, leading one to physically crave the drug. While psychological Kava addiction may make an user feel that they may need to use the substance in order to avoid perceived negative effects associated with discontinuing its use. Addicts tend to experience psychological addiction more so than physical dependence.

Kava Addiction: Data And Statistics

As this plant-based medicinal supplement is not a regulated medication nor is its use so widespread, information about its abuse and addiction statistics is lacking. However, addiction may be an issue as in 2007 Australia introduced strict restrictions on the use of Kava due to concerns about its abuse in its indigenous communities.

A woman with a glass of water and a pill in her hand.

Signs of Kava Abuse and Addiction

Because the effects of Kawa are mild when compared to other drugs in its class, such as kratom and marijuana, it can be hard for loved ones to spot the signs of addiction, and equally difficult for users to see them in themselves. Signs of kava abuse and addiction can be broken down into three categories: physical, psychological, and social.

Physical Signs

When someone is physically addicted to a substance, their body adapts to its presence and experiences withdrawals in its absence, craving the drug almost as if it were a means of survival. Overall, awa is not considered to be physically addictive, but studies on the matter are limited, and this consensus could change.

Some users report symptoms when stopping heavy and consistent use that line up with withdrawal from drugs, including sweating, abdominal pain, and muscle pain. Ultimately, kava effects differ from user to user, and physical addiction is within the realm of possibility.

Physical Signs Include:

  • Slowed speech
  • Slurred speech
  • Impaired motor control
  • Dizziness
  • Impulsivity and risk-taking
  • Struggles concentrating
  • Slowed or shallow breathing
  • Memory impairment

The physical signs of kava abuse and addiction are mostly just the side effects of the drug. However, if they are noticed frequently or the symptoms seem to be severe, it can indicate that an addiction is present.

Psychological Signs

Users can experience psychological addiction, as users can feel attached to the drug and the way it makes them feel. Awa addicts may want to stop using the drug but fear what life will be like without it or find themselves preoccupied with thoughts of using or obtaining the drug. This is especially risky in those using it to treat other addictions, as it sets them up for relapse.

Psychological Symptoms Of Addiction Include:

  • Thinking about the supplement throughout the day
  • Planning around when the drug will be taken
  • Feeling an overwhelming need to take the medication, especially when stressed
  • Desiring to stop using the drug but being unable to
  • Opting to continue use despite negative consequences
  • No longer being interested in activities they used to enjoy
  • Trying to encourage use in others
  • Spending excessive time in places like awa bars
  • Ending friendships that do not involve the substance
  • Withdrawing from social life to stay at home and use instead

Psychological symptoms can be difficult for others to pick up on unless they manifest in the behaviors of the user. As such, users need to fully understand these signs and be willing to look for them in themselves.

Dangers Of Kava Misuse

While there has been very low documented evidence of adverse health effects associated with moderate use of this plant-derived drink. However, misuse and heavy use has been associated with multiple reversible signs and symptoms, most prevalent among them is Hepatotoxicity/Liver damage. The exact cause of Hepatotoxicity is not quite known, but association with its use in conjunction with other substances such as drugs or alcohol is thought to play a role. Furthermore, the active components of this drink have been known to inhibit those enzymes that take part in the hepatic metabolism of many drugs. This can lead to accumulation of unmetabolized drugs and/or their metabolites within the body leading to further toxicity. Other dangers of heavy consumption and misuse include scaly skin rash, weight loss, nausea, loss of appetite, sore red eyes, laziness, loss of sex drive and general poor health.

Treating Kava Addiction

The treatment of and recovery from addiction is pretty straightforward, and since physical addiction is rare, often easier than correcting dependence on other drugs. Recovery focuses on providing help to users through the development of skills they need to say no to Awa use going forward and getting them to identify what drove their use in the first place.

If the addiction began because the user was relying on it to manage another addiction (opioids, benzodiazepines, alcohol, etc..), the recovery process would be more complicated. However, it is possible to end the addiction to both substances and get the user into rehab. There are thousands of rehab centers across the United States who can help addicts get and stay clean.

While it is marketed as a safe and natural high, it has the potential for abuse and addiction. Given its negative health effects, anyone who is craving the drug should seek help. The sooner treatment is sought, the less likely it is that there will be long-term consequences.

Hope Without Commitment

Find the best treatment options. Call our free and confidential helpline

Most private insurances accepted

Marketing fee may apply

Page Sources

  1. Baker J. D. (2011). Tradition and toxicity: evidential cultures in the kava safety debate. Social studies of science, 41(3), 361–384. https://doi.org/10.1177/0306312710395341
  2. Lebot, V., Merlin, M., & Lindstrom, L. (1997). Kava: The Pacific Elixir: The Definitive Guide to Its Ethnobotany, History, and Chemistry (First Printing ed.). Healing Arts Press.
  3. Sarris J, Kavanagh DJ, Byrne G, Bone KM, Adams J and Deed G (2009). The Kava Anxiety Depression Spectrum Study (KADSS): a randomized, placebo-controlled crossover trial using an aqueous extract of Piper methysticum. Psychopharmacology (Berl) 205(3):399–407.
  4. Singh, Y.N., Singh, N.N. Therapeutic Potential of Kava in the Treatment of Anxiety Disorders. Mol Diag Ther 16, 731–743 (2002). https://doi.org/10.2165/00023210-200216110-00002
  5. Teschke R, Qiu SX and Lebot V (2011a). Herbal hepatotoxicity by kava: update on pipermethystine, flavokavain B, and mould hepatotoxins as primarily assumed culprits. Dig Liver Dis 43(9):676–681.
  6. World Health Organization. (2006). Kava: A review of the safety of traditional and recreational beverage consumption. http://www.Fao.org http://www.fao.org/3/i5770e/i5770e.pdf

Published on: April 15th, 2019

Updated on: July 30th, 2021

About Author

Peter J. Grinspoon, MD

Dr. Peter Grinspoon is an experienced physician with long-term clinical practice experience. As a former analgesic addict, Dr. Grinspoon knows precisely how important it is to provide patients with effective treatment and support. Medical writing for him is the way to communicate with people and inform them about their health.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.