We at PGDF are always scouring the news for the latest on science, policy, opinion, and culture related to alcohol use disorder and its treatment. In this quarterly series, we present a digest of notable news from the field.
A study out of Yale has identified gene variants that help explain why it is harder for some people to detox from alcohol than others. The researchers linked variants in the SORCS2 gene to the severity of alcohol withdrawal in some people of European ancestry. No similar connection was found in African Americans. “Alcohol takes more lives in the United States every year than opioids, but there are few effective treatments to help people who have an alcohol use disorder,” said Andrew Smith, lead author of the study and professor of genetics and neuroscience at Yale. “For people who experience intense withdrawal symptoms, that’s one more barrier they have to face while trying to reduce unhealthy alcohol use.” The researchers stated that better understanding of the genes involved in withdrawal symptoms may lead to new medications to help treat alcohol use disorder.
The author of a research paper published in Alcohol and Alcoholism concluded that it is a societal responsibility to reduce the harm caused by alcohol use disorders, and that one way of doing so is to reduce overall alcohol consumption. “We already knew that for young people, peer group norms influence drinking. If people in my peer group drink then I am more likely to drink, but it was interesting that the broad social context of general alcohol consumption – alcohol consumption by people I don’t even know – was associated with an increased likelihood of the subsequent onset of a disorder,” said study author Charlene Rapsey, of the Dunedin School of Medicine’s Department of Psychological Medicine. “Relatively small inconveniences, such as limiting availability of alcohol and higher alcohol prices, can have significant influences on reducing alcohol related harms,” she said.
Repeated binge drinking activates different areas of the brain linked to addiction in males and females. “These findings are important as they increase our understanding of male and female differences in molecular pathways and networks that can be influenced by repeated binge drinking. This knowledge can help us identify and develop new targeted treatments for alcohol use disorder in males and female patients,” said study author Deborah Finn, Professor of Behavioral Neuroscience at Oregon Health & Science University and a Research Pharmacologist at the VA Portland Health Care System, USA.
The number of people aged 55 or older in the U.S. has risen over the past decade, and so have the drinking rates among this population. Alcohol use has increased in both men and women over 60, and there has been an increase in binge drinking in women of this age. A study published in JAMA Psychiatry found reduced brain volume in adults with alcohol use disorder (AUD) that were even more pronounced in people age 65 and older. Of note, even people who developed severe AUD later in life showed the accelerated loss. National Institute on Alcohol Abuse and Alcoholism (NIAAA) Director George Koob explains how alcohol misuse and aging can affect each other: “Particularly with alcohol, the negative emotional states associated with aging may converge with the negative emotional states of alcohol withdrawal, which drives many individuals with AUD to self-medicate to avoid experiencing negative effects,” said Koob. “This convergence, in turn, could also drive the need to self-medicate. In short, alcohol misuse in the elderly population may tap into misdirected attempts at emotional self-regulation, in which an individual consumes alcohol to fix the problem that alcohol helped cause.”
A study out of Johns Hopkins has found that off-premise alcohol outlets in Baltimore (such as beer and wine stores), had a greater association with violent crimes, including homicides, aggravated assaults and robbery, than outlets that only allow on-site drinking (such as bars and restaurants). Findings also showed that higher numbers of liquor stores are found in low-income neighborhoods. “A comprehensive approach to reducing violent crime in Baltimore must include policies that restrict or regulate alcohol outlets, particularly those that sell alcohol for off-site consumption,” said Daniel Webster, Professor at Johns Hopkins Bloomberg School of Public Health. “Reducing the number of off-site alcohol outlets in Baltimore has the potential to lead to fewer homicides and aggravated assaults.”
A new study has found extended-release gabapentin, an anti-epileptic drug that is used off-label to treat alcohol use disorder, to be no more effective than placebo in reducing alcohol consumption or cravings. Previous studies that had shown it to have some efficacy in treating alcohol use disorder used immediate-release versions of the medication.
A large study that included data on over 50,000 people identified a gene that affects the risk of alcohol dependence. The gene, called ADH1B, regulates how the body breaks down alcohol into a chemical called acetaldehyde. Variations in genes affect how quickly alcohol is metabolized, which can in turn make people more or less likely to drink heavily. The drug Disulfuram (Antabuse) works on the same metabolic processes as the gene variants identified in this study. The researchers also found that that the genetic risk factors related to alcohol dependence also were linked to risk for other psychiatric disorders, such as depression, schizophrenia, ADHD and the use of cigarettes and marijuana.
Recent research out of the Virginia Tech Carilion Research Institute has shown that specific brain training may improve working memory in people with alcohol use disorder (AUD). Using games and tasks to enhance short-term memory and attention can help people with AUD to increase everyday skills and decision-making. The study also used training to help participants value delayed gratification, with the practical application of participants being able to more readily consider long-term consequences: for example, instead of accepting a drink offered to them, looking ahead to future rewards, like improved health, and declining the drink.
Two pilot studies have found that Prazosin, a medication used to treat high blood pressure and post-traumatic stress disorder (PTSD), may help people with alcohol use disorder to drink less over time.
People with liver disease should be assessed by their doctor for alcohol use, according to a recent review. The authors state that “…there is no known safe threshold of alcohol consumption for patients with chronic liver disease, especially those with HCV infection, obesity, or the metabolic syndrome.” The authors discuss treatment options for AUD as well as non-pharmacologic strategies for preventing relapse that can be used in primary care. “These include establishing a supportive patient–physician relationship; scheduling regular follow-up visits; mobilizing family support; suggesting involvement in 12-step programs; developing a plan to recognize, cope with, and manage early relapse; facilitating positive lifestyle changes; and treating coexisting conditions that can trigger relapse,” state the authors.
When alcohol hits the brain, it releases dopamine, which produces feel-good sensations, and sends out messages to get more in order to keep the good feelings going. Researchers at the Center for Alcohol Research in Epigenetics at the University of Illinois at Chicago have now identified a new target for AUD treatment: the KCNK13 channel, that, when blocked, leads to increased production of dopamine in the brain. “The KCNK13 channel is absolutely required for alcohol to stimulate the release of dopamine by these neurons,” said study lead author Mark Brodie, professor of physiology and biophysics in the UIC College of Medicine. “Without the channel, alcohol can’t stimulate the release of dopamine, and so drinking is likely less rewarding…If someone has naturally lower levels of this channel, then in order to produce the pleasurable effects of alcohol, that person would have to drink much more, and may be at higher risk for binge drinking disorder,” said Brodie. “Currently available drugs reduce the impact of alcohol on the brain that is akin to turning down the volume on a stereo,” he said. “A drug that would target KCNK13 would be different in that it would be like an on/off switch. If it’s turned off, alcohol just wouldn’t trigger increased dopamine release.”
Using data from the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study, the largest known controlled pharmacotherapy trial for treating AUDs, scientists looked at how reductions in drinking levels affected the health of people with alcohol dependence. Instead of studying abstinence only, the researchers analyzed health outcomes looking at reductions in drinking levels as defined by the World Health Organization (WHO)—very high, high, moderate, and low—which are defined in terms of average alcohol consumption in grams per day. They found that reducing drinking by one or two WHO levels during treatment in the COMBINE study was associated with health improvements such as lowered blood pressure and liver enzyme levels, as well as improved quality of life.
People who get a common type of gastric bypass surgery are at increased risk for alcohol-related problems, yet current screening tools used to identify people who may have alcohol use disorder do not work well in this population, according to a study in the Annals of Surgery. The study also found a steady increase in alcohol consumption in people who had Roux-en-Y gastric bypass surgery during the seven years following their surgery.
Patients with alcohol-related liver (ALD) disease fare worse than people who are admitted to intensive care (ICU) for other conditions. A Scottish study found that only one out of three ICU patients admitted with ALD survived for more than a year afterwards. Patients with ALD were 31 per cent more likely to die in the five years following a stay in intensive care, compared with those with severe heart, lung or kidney disease and other patients of similar age and background. Nazir Lone, Senior Clinical Lecturer in Critical Care at the University of Edinburgh, who led the study, said: “Alcohol-related liver disease is often associated with stigma in society. Our findings underline the need for better community services for alcohol addiction and management of long-term conditions.”
Researchers in New Zealand were surprised to find that heavy drinkers do not “mature” out of drinking, as had been previously speculated. The longitudinal study, which followed more than 800 people and examined their lifetime drinking habits, found that drinking patterns remain surprisingly stable across a person’s lifespan.
Following criticism that it underplayed the cancer risk associated with drinking alcohol, the National Institute on Alcohol Abuse and Alcoholism changed the wording on its website to align with that of the National Cancer Institute’s. The wording on the NIAAA site, which previously implied that only heavy drinking could increase the risk of developing certain cancers, has been changed and now states that “there is a strong scientific consensus of an association between alcohol drinking and several types of cancer” and that the Department of Health and Human Services lists alcohol as a known human carcinogen.
Your genes play a role in whether or not you will develop an addiction at some point in your life. Genes are partially responsible for determining your risk as well how difficult it may be for you to stop drinking once you start. A U.S. News and World Report article lists five strategies to help keep you healthy.
The 2017 National Survey on Drug Use and Health (NSDUH), released by SAMHSA in September 2018, contains annual data that is used to shape mental health and substance abuse policy. Among this year’s findings: The number of people starting to use heroin decreased more than 50 percent from 2016 to 2017, and significantly more people received treatment for their substance use disorder in 2017 than had the year before. The report found that young adults, age 18-25, have higher rates of alcohol use disorder and other SUDs than people both older and younger than them, and also have increasing rates of serious mental illness and major depressive episodes. The report also noted that over 8 percent of individuals are living with both a mental health and substance use disorder, and that these co-occurring issues must be addressed.
An editorial in JAMA underlines the need for primary care providers to screen for unhealthy alcohol use in all adults, and to follow-up with brief behavioral counseling interventions for patients with at-risk alcohol use. The editorial was written in the wake of the recently updated recommendations by the US Preventive Services Task Force (USPSTF). The authors state that patients who are seen for issues related to unhealthy alcohol use, such as high blood pressure, are often not assessed properly, and therefore not treated properly. Screening and discussing a plan to cut back or abstain from alcohol when necessary should be part of routine care, state the authors.
A survey of almost 750 U.S. employers found a large majority (90%) would give employees time off to deal with addiction-related problems. Despite this, stigma may stop employees from asking. “There are no established guidelines on how to talk to your boss about taking time off for such a personal matter,” Tom Doub, chief clinical officer for American Addiction Centers (AAC), told Forbes online. “Although there are protections in place for employees, our data shows that 81% of employers fear that work-related stress would send an employee into relapse. Getting back to work from recovery is hard enough but gaining the trust back from an employer and co-workers could also be a factor in wanting to keep their reason for taking time off under wraps.”
This article outlines current options for the treatment of alcohol use disorder, from the first step of acknowledging that there is a problem with alcohol use to outlining different types of therapy and medication that can be used to treat AUD.
Regarding sexual assault, researchers for the National Institute of Alcohol Abuse and Alcoholism (NIAAA) have noted, “Conservative estimates of sexual assault prevalence suggest that 25 percent of American women have experienced sexual assault, including rape. Approximately one-half of those cases involve alcohol consumption by the perpetrator, victim, or both.” Vox writer German Lopez discusses why we need to talk about the role of alcohol in violent behavior, including sexual assault, and what can be done about it.
Alcohol Death Rates are Rising, Especially in Women: Why Are We Not Talking About It?
An editorial in USA Today makes the case for reducing drinking as a means to decrease the public health costs attributable to alcohol. Suggestions for doing so include raising taxes on alcohol, limiting the number of liquor stores per region and reducing their hours of operation, expanding access to treatment, and teaching coping skills to children to help them deal with stress in order to prevent them from turning to drugs and alcohol in difficult times.
Is measuring sobriety an outdated measure of recovery success? Psychology Today contributor Adi Jaffe thinks so. Jaffe states that lifelong abstinence is an unrealistic goal and the wrong yardstick to use for measuring addiction recovery. Instead, says Jaffe, it makes more sense to look at outcomes that measure successes rather than failures such as: percentages of abstinence over a period of time; overall quality of life; and (lack of) criminal justice involvement. Jaffe is an advocate for individualized treatment for people with an addiction in a shame-free, abstinence-agnostic package that is accessible to all.