Do you know how to treat alcohol addiction? Chances are you don’t

Did you know that you can buy America’s deadliest drug at your local supermarket every day of the week?

April is Alcohol Awareness Month and according to the National Institute on Drug Abuse, alcohol addiction is trending most common Substance use disorder (SUD) in the United States and the second most common addiction worldwide (tobacco ranks first). From celebrities like Billie Holiday and Amy Winehouse to people in your workplace, alcohol is responsible for more than 178,000 deaths in the US every year. More Americans die from alcohol in one year than the total number of American alcohol victims. First World War and the Vietnamese war combined. Careers, marriages and friendships have been destroyed by this simple but powerful liquid chemical.

Despite its heavy toll on individuals and society, alcohol use disorder (AUD) remains poorly understood, and people with AUD rarely receive evidence-based treatment and care. Less than 10% of people with AUD have undergone treatment in the past year. Stigma and lack of education remain major barriers to people getting the therapeutic attention they need and deserve.

As an addiction medicine physician, I have cared for dozens of patients dealing with addictions, including addictions to alcohol, opioids, tobacco, and stimulants (cocaine, amphetamines), as well as behavioral addictions such as gambling and food. As with most chronic conditions such as heart failure and kidney disease, most people with addiction – including alcohol – get better once they encounter treatment and care.

“One of the reasons people are still struggling is that alcohol is legal and socially acceptable, so it can be difficult to avoid at social gatherings, sporting events, corporate parties and fancy dinners,” explains Michael Weaver, MD, DFASAM, professor in the Department of PsychiatryUniversity of Texas Health Sciences Center.

It’s a disease, not a moral failing

The prevailing myth in society is that ‘problem drinkers’ have a moral weakness. ‘They’re not strong enough‘ or ‘they don’t want to get better.’ are common misconceptions among family members, police and doctors – including myself, until I learned about the effects of alcohol. effects on the brain. For example, in low to moderate amounts, wine or beer can help people feel happier, relaxed and sociable. This is because alcohol activates the brain’s reward system by increasing the release of the ‘pleasure neurotransmitter dopamine’.

However, over time the effect of dopamine wears off, causing a person to drink more to achieve the same initial level of euphoria. Chronic alcohol use can lead to several complaints changes in the brain including cognitive impairment (e.g. poor memory and judgment), dysregulated emotions and behavioral changes. Alcohol is also associated with brain atrophy and neuronal loss. In other words, too much whiskey or rum can kill brain cells and shrink gray and white matter.

Women And Alcohol

In a case of unwanted gender equality, women have closed the gender gap in alcohol consumption in recent decades. Alcohol use and abuse are increases among women. Although men are still 2.88 times more likely to die from alcohol-related causes than women, studies show an increase in alcohol use, alcohol use disorders and alcohol-related deaths among women. Moreover, for the first time in history, women are binge drinking more than men. Caused by alcohol complications such as liver disease and stomach bleeding increased by 33 to 56% among women aged 40 to 64 during Covid-19 compared to life before the pandemic.

So why do more women drink? The reasons are not exactly clear, but experts believe that women use alcohol to cope with increased stress. The pandemic disproportionately affected women who were forced to quit their jobs, care for children and elderly relatives, and faced an increase in domestic violence.

“Isolation and depression due to the Covid-19 pandemic resulted in an increase in alcohol consumption and alcohol-related harm requiring medical treatment,” says Dr Weaver.

Beverage companies are also specifically targeting women. Branding strategies including making alcohol pink; promoting ‘low-calorie’, ‘organic’ and ‘clean’ options; and using messages of empowerment such as “Believe in yourself” in advertisements or earning your “mommy juice” after a hard day’s work. Holly Whitaker, bestselling author Quitting Like a Woman: The Radical Choice Not to Drink in an Alcohol-Obsessed Culture, debunked the idea of ​​healthy alcohol and calls these ads predatory.

First-line treatment consists of medications

Most people mistakenly believe that alcohol addiction can be treated through detox or Alcoholics Anonymous (AA). Although detoxification using medications such as benzodiazepines and phenobarbital reduces the risk of potentially fatal attacks (i.e. delirium tremens), it is considered an acute treatment. not chronic treatment for what is clearly a chronic condition. While mutual support groups like AA can provide a valuable layer support as additional therapy, first-line treatment for AUD, three FDA-approved medications remain: naltrexone, disulfiram, and acamprosate; as well as behavioral therapies led by health professionals. Several other drugs are currently off-label but can be very effective.

But too few individuals receive scientifically substantiated treatment. Of the nearly 30 million Americans with an AUD, only 8% received treatment and of those, only 2% received medication.

“AUD is treatable with both medications and behavioral therapies, and they are generally covered by health insurance,” describes addiction medicine expert Dr. Weaver. “The biggest barrier to treatment is that a person may not recognize that he or she has AUD, and so may not seek treatment until they are in a difficult situation with their family or are dealing with work or legal problems.”

We also need to reframe “failure” and “success.” Returning to drinking (also called ‘relapse’) is not considered a failure. In fact, the return-to-use rates for addiction are the same similar to relapse rates in other chronic conditions. A shift in the addiction community has made us realize that successful recovery does not necessarily mean abstinence. There is no ‘one-size-fits-all’ treatment model. The four dimensions of SAMHSA of their updated definition of recovery include health, home, purpose and community. Many of my patients view recovery as having a goal: returning to school, caring for their children, going to work, or spending time with supportive friends and family. Recovery is 100% possible. Just look at the long list of sober celebrities, including Samuel L. Jackson, Bradley Cooper, Drew Barrymore, Brad Pitt, Sir Anthony Hopkins and many more, who live healthy, productive lives.

Harm reduction strategies

“Just say no.” is an ineffective approach for people who use addictive substances. What if we instead adopted methods that kept people safe and alive? That’s the premise of damage control This is a set of practical strategies and ideas aimed at reducing the negative consequences associated with substance use. It is a spectrum of methods including safer use, managed use and abstinence. The goal is to meet people where they are, not where you wants them to be. Examples of harm reduction include clean syringes, naloxone, fentanyl test strips, condoms, overdose prevention sites, job centers, and clothing.

Similar strategies can and should be applied reduce damage among people with AUD. Examples include setting goals or boundaries, such as eating and hydrating before drinking alcohol on days you plan to drink; set timers to evenly distribute consumption; socializing with non-drinking friends; and increasing stress-relieving activities such as exercise, meditation and music. Medications, as mentioned earlier, can reduce alcohol cravings. Vitamin supplements (e.g., thiamin, vitamin B12, and folic acid) may be helpful for people who are at high risk of developing alcohol-induced vitamin deficiencies.

Get help

“Treatment for AUD works and can improve quality of life,” Dr. Weaver emphasizes. “Help is available. Talk to a school counselor or nurse, a doctor or minister/priest/rabbi to get in touch with treatment resources for AUD.â€

If you or someone you know is struggling with alcohol, seek help from a healthcare provider. Think of it this way: If you had lupus, strep throat, or lung cancer, you would see a doctor, right? AUD should be viewed the same way. Remember the good news: most people with addiction – once connected to the right treatment and recovery services – get BETTER!