Updates

Updates

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.

Science

GAT-3: Study Offers a Biological Explanation of Why Some People Are Prone to Addiction: Could Inform New Options for Treatment

In an effort to approach addiction research from a different angle, scientist Markus Heilig modified his experimental conditions so that rats could choose between alcohol and sugar water, more closely mimicking conditions in the real world, where humans choose from a range of pleasurable substances. This modification meant that the rats studied in the experiment had the same rate of alcohol misuse – around 15% — as that found in the human population. The research led to the discovery of a molecular mechanism that potentially explains why some people are more likely to become addicted to alcohol. The study, published in Science, found the expression of a particular gene, GAT-3, was greatly reduced in the rats who chose alcohol. GAT-3 codes for a protein that controls levels of GABA, a neurotransmitter in our brains known to be involved in alcohol dependence. Heilig and his team believe they have identified a promising addiction treatment based on their work, and have teamed up with a pharmaceutical company in hopes of testing the compound in humans. The drug suppresses the release of GABA and could thus restore levels of the neurotransmitter to normal in people with alcohol addiction.

Medication that Blocks the “Hunger Hormone” May Prove Useful in Reducing Cravings for Alcohol

Ghrelin, a hormone involved in signaling hunger in the brain, is the focus of a new drug study to treat alcohol use disorder (AUD). A team of scientists, including University of Rhode Island professor Fatemeh Akhlaghi and Lorenzo Leggio, Chief of the Clinical Psycho-neuroendocrinology and Neuro-psychopharmacology Section, NIAAA, NIDA, are now testing the safety and efficacy of an oral drug originally developed to treat obesity and diabetes, to stave off alcohol cravings.

Brain Receptor GPR139 Potential New Target for Treating AUD

A new study found that activating a receptor that has no known function in the brain reduced excessive alcohol use and the pain of withdrawal in a preclinical study in rats. This study suggests that the receptor, GPR139, could be a potential new avenue of exploration for treating alcohol use disorder (AUD). “The big takeaway here is that we have a new molecular target linked to alcohol addiction,” said Olivier George, Ph.D., associate professor at Scripps Research Institute. “This is something that will trigger a lot more research and hopefully eventually lead to the discovery of new medicines not only for alcohol addiction but drug addiction in general.”

AUD Patients More Likely To Attend Treatment Appointments When Sent SMS Reminders

An Australian study found that sending short message service (SMS) reminders to patients who were due for alcohol addiction treatment sessions improved attendance rates. “We hope these results will demonstrate that, even in a complex area of healthcare like addiction treatment, simple initiatives can increase engagement with treatment,” said study co-author Dr. Matthew Gullo of the University of Queenland’s Centre for Youth Substance Abuse Research.

Despite Availability and Evidence That They Can Help, Medications for AUD Underused

Despite there being three FDA-approved drugs to treat alcohol use disorder (AUD), less than 10 percent of those with AUD are prescribed these medications. A recent review in JAMA discusses how medications for AUD are underutilized and recommends that simple screening tools be used to identify patients who should be further evaluated for AUD in order to obtain treatment when necessary.

Opioid and Cannabis Use May Compromise Effectiveness for Treatments of Alcohol Use Disorder

New research published in Alcoholism: Clinical and Experimental Research found that people with alcohol dependence who misused opioids and those who used cannabis and other drugs were more likely to drink heavily and frequently during and following treatment.

Long-Term Drinking Can Lead to Problems Communicating That Persist Even After Quitting Drinking

A new study has found that people with AUD have a difficult time communicating and interpreting other people’s feelings because they cannot easily decipher the speaker’s tone of voice in order to recognize the intended emotion of their comments. They also are frequently unable to express different emotions through their own tone of voice. The researchers found that difficulty recognizing and expressing emotion continues long after people stop drinking.

For Those with Anxiety and AUD, Adding Cognitive Behavioral Therapy to Addiction Treatment Improves Success

A study has shown that adding cognitive behavioral treatment for anxiety disorders to usual treatment for AUD in people with anxiety leads to greater control of alcohol use, especially in older women.

Research on Treatments for AUD Should Look at Multiple Brain Networks, Not Just the Reward System

The brain’s reward network has been heavily studied in order to prevent and treat alcohol and drug abuse. More than half of addiction studies look at the effects of drug use on the reward network, but a new review has shown that the reward system does not stand alone in the role it plays in, and how it is altered by, drug use. The review, published in the journal Neuron, found that drug addiction affects six main brain networks: the reward, habit, salience, executive, memory and self-directed networks.

Rise in Drinking in Younger Women

While men are still twice as likely as women to binge drink, women under 30 are now drinking as much as their male counterparts and the numbers continue to rise. A recent research study found that in long-term drinkers, despite women’s vulnerability to develop addiction to alcohol and other medical issues more quickly than men, women actually sustained less brain damage than men, though scientists do not understand why. Because of the differences in how alcohol affects men and women, including which treatments are most likely to be successful, experts say it is important to look at sex differences when conducting research.

Brain Protein Active in Developing Tolerance to Alcohol Could Be Used in Formulating New Treatments for AUD

A protein in the brain, called MUNC-13, that is involved in people developing tolerance to alcohol could be a future target in the development of new drugs to treat alcohol use disorder (AUD), according to a study published in eNeuro.

Teens Living on Native American Reservations More Likely to Use Alcohol and Other Drugs Earlier and at a Higher Rate than Other U.S. Peers

Native American youth who live on or near reservations are more likely to report higher use of alcohol, marijuana, cigarettes, and other illicit drugs, and to start using at younger ages, than their peers living elsewhere in the U.S., according to a survey published in JAMA Network Open.

Alcohol-Related Liver Disease Deaths Have Increased Sharply

Fatal liver disease rates are rising, and young people’s mortality is rising the fastest, with the number of 25- to 34-year-olds who died annually from alcohol-related liver disease nearly tripling between 1999 and 2016. While liver disease can be caused by several things, including obesity and hepatitis C infection, the increase among young Americans was primarily caused by alcohol consumption, according to a study published in the British Medical Journal. The study suggests that a new generation of Americans is being afflicted “by alcohol misuse and its complications,” said lead author Elliot Tapper, a liver specialist at the University of Michigan. Tapper notes that if people with alcohol-related liver disease stop drinking, there is a good chance the liver can repair itself.

Low Endorphin Levels in Those with AUD Lead to Decreased Feelings of Happiness, Even Long After They Stop Drinking

A research study published in Molecular Psychiatry is the first to have found that participants with AUD released significantly fewer endorphins than those in the study’s control group. Endorphins in the brain are associated with feelings of pleasure, pain, and reward. This study contributes to the growing evidence that an endorphin imbalance may be part of the basis for addiction, although further research will be needed to determine whether endorphins are lowered due to alcohol abuse, or if this dysregulation is a pre-existing risk factor that is present before the development of AUD.

Receiving Brief Therapy May Help Patients Accept Pharmacotherapy for Treatment of AUD

A recent study found that discussing alcohol use with a primary care medical professional led to higher rates of treatment, and that those patients who received brief therapy were more likely to use medication to treat AUD, and to stay on it for longer periods of time.

Brief Interventions Can Decrease Drinking and Increase Safe Sex in People with HIV and AUD

Almost 20 percent of the 1 million people in the U.S. living with HIV meet criteria for alcohol use disorder but little research has focused on how to effectively reduce drinking in this population. A new study published in the Journal of Consulting and Clinical Psychology found that using motivational interviewing, a non-confrontational counseling technique, during routine HIV care can lead to decreased drinking. “Individuals with HIV who actively manage their illness by taking antiretroviral therapy are now expected to have comparable lifespans as those without the virus,” said lead author Christopher Kahler, scientific director at the Brown University Alcohol Research Center on HIV and professor of behavioral and social sciences at the University’s School of Public Health. “Yet they are much more vulnerable if they drink heavily. If a patient can even cut drinking in half, this can greatly reduce the risk of mortality.”

Clinical Pharmacists Can Play Vital Role in Managing AUD

An article in U.S. Pharmacist discusses the important role of pharmacists in the screening, identification, and management of patients with AUD. The article also outlines current recommendations for the use of naltrexone in treating AUD, stating that the opioid antagonist has the best available evidence for the treatment of AUD.

Identifying New Neural Connections May Lead to Better Understanding of AUD

Researchers have mapped new connections between neurons in brain systems associated with reward, stress, and emotion. The new study, conducted in mice, may help untangle multiple psychiatric conditions, including alcohol use disorder, anxiety disorders, insomnia, and depression in humans. “These circuits, also implicated in binge drinking, are likely to be elements in understanding the detailed mechanisms driving stress-related alcohol or drug-seeking and consummatory behaviors,” said first author William Giardino of Stanford University.

 

Law, Policy & Best Practice

USPSTF Recommends Primary Care Doctors Screen for Unhealthy Alcohol Use in Adults

The U.S. Preventive Services Task Force (USPSTF) has issued a recommendation that clinicians in primary care settings screen for unhealthy alcohol use in adults age 18 years or older, including pregnant women, and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. Screening entails physicians asking patients a series of questions about drinking patterns, including how often they drink. If patients are found to be engaging in risky or hazardous drinking, the USPSTF recommends that physicians provide brief behavioral counseling interventions to reduce unhealthy alcohol use. These brief interventions typically include discussing how the patients’ drinking compares to recommended limits and ways to reduce drinking. Patients who appear to have a more severe alcohol use disorder (AUD), may be referred for more extensive treatment.

What Every General Practitioner Should Know About Screening and Managing AUD in Their Patients

Primary care providers can play an important role in helping to assess and refer patients with issues related to AUD, especially if they are equipped with the right tools to do so. This article outlines current best practices for screening, diagnosing, intervening and treating AUD.

How to Talk to Older People When You Are Worried About Their Alcohol Use

Approximately 15 percent of older Americans (age 65 and over) drink more than the recommended limit. Writer Anna Ciulla discusses the Do’s and Don’ts of addressing an older person’s alcohol use when you suspect there may be a problem.

Canadian Company Finds Success in Harm Reduction Program; Abstinence Not Necessary for Recovery

A Canadian company is offering an at-home treatment recovery program that does not require abstinence. Costing $6,500, the program allows clients to continue drinking during treatment and beyond, with the aim of controlled drinking. The program combines the endorphin-blocking drug naltrexone with video-conference therapy with doctors and therapists. “Abstinence is simply not everyone’s goal, partly because people have tried at it and failed many times. They come to us because they want something else. They want safer drinking, not no drinking,” said Alavida co-founder and medical director Dr. Diane Rothon.

Addiction Service Providers Must Now Be Vetted Before Advertising on Facebook

Facebook is now requiring advertisements for drug and alcohol treatment providers to be certified by LegitScript, a company that verifies and vets healthcare merchants. LegitScript’s Addiction Treatment Certification launched in July. The Partnership for Drug-Free Kids, Center on Addiction, the National Association of Addiction Treatment Providers, and Facing Addiction with NCADD and other organizations have formed an advisory committee to LegitScript for this certification program, aimed at improving the accountability and integrity of addiction treatment advertisers.

CHESS Health Adding Evidence-based Digital Therapy to its Addiction Management Platform

CHESS Health, a provider of addiction management technology, will add CBT4CBT, a digital delivery of cognitive behavioral therapy (CBT) specific for substance use disorder, to its comprehensive A-CHESS platform for patients and families, their care teams, providers and payers.

Boticelli: Congress Needs a Broader Approach to Address Opioid Epidemic and Alcohol Misuse

Michael Botticelli, former Director of National Drug Control Policy, writes about the potential shortfalls of a House bill that aims to ease the opioid crisis, but, Boticelli states, could do more harm than good. Boticelli says one of the limitations of the bill is that it does not cover the full continuum of services needed for treatment that range from institutional care, to pharmacotherapies, to psychosocial and rehabilitation services. He says the House bill is also troubling in other ways: While it focuses exclusively on opioid treatment, an estimated 64 percent of people seeking care for an SUD use multiple substances, including alcohol. Boticelli says the focus of the bill should include this broader population.

 

Opinion & Culture

5 Things That Differentiate Binge Drinking from High-Functioning Alcoholism

Where is the line between heavy recreational drinking and alcohol use disorder? While they look similar and often carry the same consequences, there are differences, including physical dependence, frequency of drinking, the ability to stop, and the way they treatment is approached.

More People Die from Alcohol than Opioids – Why Do We Still Embrace the Drinking Culture?

Writer Christina Mair notes that alcohol is at the root of the cause of a greater number of deaths and social and physical problems than opioids and other drugs. She discusses America’s acceptance of alcohol use and how the dangers of alcohol may be underplayed while its benefits are exaggerated, and how public policy changes could reduce the burden of alcohol.

Posts You Share on Social Media Could Influence Your – and Others – Drinking Behaviors

A recent review of 19 studies found that greater alcohol-related social media engagement was correlated with higher levels of drinking and having more problems related to alcohol use. While the study shows only correlation, not causation, it is possible that repeatedly seeing, or posting, images, GIFs and other social media content related to alcohol conditions us to normalize drinking behaviors that may be unhealthy.

Drinking Too Much? Tips on When – and How – to Reduce Your Drinking

A Boston Globe article offers tips on identifying when it’s time to cut back on your drinking, and how to do so.

The Role of Alcohol in Country Music

Country music fans are probably no strangers to the “tear in your beer” format so popular in this music genre. Washington Post write Emily Yahr discusses the link between country music and alcohol.