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.
Even though the Veterans’ Health Administration (VHA) mandates FDA-approved pharmacological and psychosocial treatment to veterans with AUD, medications for AUD are only prescribed for 3 percent of VHA patients with AUD. To better understand potential barriers to treatment, Sean J. Haley, Assistant Professor of Health Policy and Management at CUNY SPH, led a study, published in the journal Substance Abuse, looking at patients’ experiences and attitudes towards AUD treatment. One study finding was that few of the patients who spoke to their providers about AUD treatment options followed up with actual treatment. “Results from this study suggest that most—although not all—patients who experience problems with alcohol use welcome a conversation with their primary care provider about alcohol use and information about how medication may help,” Haley said. “However, many providers appear reluctant to initiate conversations about alcohol or treatment options, including pharmacotherapies.”
A study comparing two types of treatment for PTSD patients who also have alcohol use disorder found that prolonged exposure therapy is more effective than coping skills training in treating their PTSD. The goal of exposure therapy is for patients to eventually be able to think about their trauma without anxiety and stress. This is accomplished by slowly approaching feelings and memories related to their trauma. The study, published in JAMA Psychiatry, was led by Dr. Sonya Norman, a researcher at the San Diego VA, director of the PTSD Consultation Program for the National Center for PTSD, and a professor of psychiatry at the University of California San Diego. “The next stage of this research,” stated Norman, “is to learn how to make prolonged exposure even more effective for patients with PTSD and alcohol use disorder. We are now conducting a study where we are combining medication to help reduce drinking with prolonged exposure to see if the combination helps patients complete prolonged exposure and benefit even more from the treatment.”
Disputing previous research, a new study examining structural brain changes in people with alcohol use disorder found that white matter damage in the brain continues throughout the first weeks of sobriety. Unlike previous studies that found when people stopped drinking, brain damage caused by alcohol also ended, the new study, published in JAMA Psychiatry, found that the brain damage from repeated bouts of excessive drinking can have a continued negative effect for those who drink excessive amounts of alcohol over extended time periods, including depression, anxiety and Wernicke-Korsakoff syndrome.
While gabapentin seems to be better than placebo in treating AUD, the only measure on which a recent meta-analysis found gabapentin efficacious was in its potential to reduce the frequency of heavy drinking days. It was not shown to help with reducing the number of drinks a person has per day when they drink, or helping them to stay abstinent.
A genomic study of nearly 275,000 people found that there are genetic differences between heavy drinkers and people who have alcohol use disorder (AUD). Researchers from Penn Medicine found 18 genetic variants of significance associated with either heavy alcohol consumption, AUD, or both. The study findings suggest that while heavy drinking is a prerequisite for AUD, variants in several genes may need to be present for people to develop AUD. The results are “evidence of something I think many people have thought or wondered about, that is, is heavy drinking the same thing as alcohol use disorder, and what we found is that it both is and it isn’t,” said study co-author Henry Kranzler, a psychiatrist who is director of Penn’s Center for Studies of Addiction. “It’s overlapping, but it’s not the same thing.”
The bulk of scientific studies looking at brain abnormalities associated with AUD have been conducted with men or combined gender groups. Researchers from Boston University School of Medicine (BUSM), in conjunction with the VA Boston Healthcare System and Massachusetts General Hospital, set out to distinguish features of AUD that differ in men and women in hopes that these findings will lead to more specific and effective treatments for the disease. They found that men with AUD, compared to women with AUD, have more diminished brain activity in areas responsible for emotional processing (limbic regions including the amygdala and hippocampus), as well as memory and social processing (cortical regions including the superior frontal and supramarginal regions), among other functions. “Our findings indicate that the experiences and mechanisms of AUD and addiction differ for men and women,” explained corresponding author Kayle S. Sawyer, PhD, from the department of anatomy and neurobiology at Boston University School of Medicine (BUSM).
Preliminary findings from a survey conducted by researchers at Johns Hopkins University and the Erowid Center found that a moderate dose of a psychedelic drug (psilocybin or LSD) significantly reduced alcohol use and cravings in patients with alcohol use disorder. The survey respondents, who were largely male, reported using alcohol in a problematic way for an average of seven years prior to the psychedelic experience that led to a reduction in their alcohol consumption. Participants attributed the changes in drinking patterns to the insight they gained from their psychedelic use. The researchers state that while these results do not demonstrate causality, they do support further investigation of psychedelic-assisted treatment for AUD.
A study conducted by researchers from the Boston University School of Medicine (BUSM) has found that specific molecules found in saliva may serve as potential biomarkers that could predict alcohol dependence. “The identification of disease-specific biomarkers in easily accessible body fluids such as saliva can result in the early diagnosis and treatment of diseases. This study provides initial evidence that salivary miRNAs are potential biomarkers for this illness,” said corresponding author Huiping Zhang, Ph.D., associate professor of psychiatry at BUSM.
A study assessing the campus alcohol policies of 15 Maryland colleges found that less than half of current policies should be rated as “most effective,” highlighting the need for improved policies that will better deter students from problematic drinking. The review, led by Johns Hopkins Bloomberg School of Public Health researchers and alcohol policy experts, found that some of the most effective strategies include: banning alcohol delivery to campus, prohibiting drinking games, and conducting mandatory ID checks at all campus events serving alcohol.
BACtrack, a smartphone-connected breathalyzer, has launched a new remote monitoring device that will allow friends, family, or sponsors to remotely check a BACtrack user’s sobriety level via blood alcohol content. “Alcohol is a drug, and when people have addiction issues with drugs, when they’re at their worst, there can be a lot of lies and a lot of deception,” BACtrack President and Founder Keith Nothacker told MobiHealthNews. “And we heard that from many people. So when you can get to a fundamental truth, you can see the result here, someone is highly intoxicated, or you know they don’t have alcohol, it’s really a big step forward for being able to … take control of their own lives.”
A two-question screening tool developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) can help health care providers to identify youth at risk for alcohol-related problems. One question is about personal drinking and the other is about friends’ drinking. The NIAAA researchers who developed the tool looked at many other questions and found these to be the most effective in predicting current risk from alcohol use, as well as future drinking levels, in adolescents aged 9-18. View the Alcohol Screening and Brief Intervention for Youth: A Guide for Practitioners here.
In an effort to reduce stigma and boost employment, New York lawmakers are earmarking $2 million this year to give tax credits to employers who hire people in recovery from drug or alcohol addiction. Beginning in 2020, eligible employers can receive up to $2,000 in tax credits for every eligible person they hire who has worked a minimum of 500 hours. Credits are available for both part- and full-time employees. “Steady employment can be vital to successful recovery,” said Office of Alcoholism and Substance Abuse Services (OASAS) Commissioner Arlene González-Sánchez. “With this program, people in recovery will have another avenue to rebuild their lives, while employers have the chance to contribute to the recovery and well-being of their employees and community.”
These are figures worth repeating: Less than 10 percent of the nearly 15 million people in the U.S. with alcohol use disorder (AUD) receive treatment, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Research shows that about 1/3 of people who do get treatment are no longer drinking a year later. So why do so many people forego treatment? “Finding quality AUD care can often be complicated,” says George F. Koob, Ph.D., Director of the NIAAA, “and many people aren’t aware of the full range of available treatment options. It can also be difficult to tell if a provider is offering evidence-based care that is grounded in clinical and health services research and has been demonstrated to produce positive treatment outcomes.” This NIAAA article discusses ways to help people search for the most effective treatment, treatment options (such as treatment settings and FDA-approved medications for AUD), and what successful treatment looks like.
Alcohol misuse is more common in the armed forces than post-traumatic stress disorder, yet it receives far less attention. To help combat the issue, a collaborative group from King’s Centre for Military Health Research and University of Liverpool developed an app to help people in the military monitor and manage their alcohol consumption. The app allows users to set goals, and compare their drinking to civilians and others in the armed forces community, with the goal of reducing their drinking.
The opioid crisis persists and is discussed on a daily basis in the news, while discussion of alcohol use disorder often falls by the wayside, despite its higher prevalence. According to current statistics, 1 in 12 Americans have AUD, and 88,000 Americans die each year from alcohol-related causes, compared with 72,000 who die from opioid overdoses, yet the scope of the problem seems to be lost on the nation. A Pew Charitable Trusts quiz, designed to raise awareness about alcohol addiction, states that 6 people die every day in the United States, due to extreme binge drinking that leads to alcohol overdose, also known as alcohol poisoning. Psychologist Benjamin Miller said that because alcohol is legal and socially accepted, people aren’t as wary of its dangers. “Culturally, we’ve made it acceptable to drink but not to go out and shoot up heroin,” Miller said. “A lot of people will read this and say ‘What’s the problem?’”
Psychology Today contributor Adi Jaffe discusses how social isolation and loneliness increase the odds that a person will use drugs and alcohol to self-medicate. He notes that a recent NIAAA-funded report found that living in a collaborative housing setting leads to more effective treatment for those with substance use problems. Jaffe makes note of some recovery programs that include a social element and discusses why they might make a difference.
Author Jodie Prouse, who has not had an alcoholic drink in 25 years, discusses what to say to someone who does not drink. Her bottom line: So what should you say when someone says they do not drink alcohol? The same thing you should say to anyone. Nothing. Absolutely nothing.
Harvard Health Blog Contributing Editor Dr. Peter Grinspoon discusses the reasons he decided to go public with his own personal story of addiction and recovery. At the base of his reasoning was the premise that “secrets make you sick” and honesty will set you free.
Sober events have gained momentum recently as more people choose to socialize without alcohol. Victoria Kim, who writes for The Fix, notes that sober living is attracting not just people grappling with a drinking problem, but the full spectrum of drinkers and non-drinkers. Kim views this trend as a chance to step back and reflect on current drinking choices and discusses the movement.
Writer Kristin Harlow disputes what she says is the widespread idea that 12-step programs are the only effective treatment for AUD. In this article, she discusses whether 12-step programs are evidence-based and the importance of a holistic approach to AUD treatment.