Medication can help the 1 in 12 people who suffer from an alcohol use disorder. But most of them will never be treated.
Something that claims the lives of more Americans each year than fatal drug overdoses, car accidents, or firearms remains legal, requires no background check to purchase, is heavily advertised, and is available for purchase in stores on every corner. That «monster» is alcohol.
While cold beer, glasses of wine and strong cocktails are often seen as a way to unwind after a long day at work or on the weekend, alcohol is actually an addictive psychoactive substance that has been linked to a host of deadly pathologies, including heart disease, breast, pancreatic and stomach cancer, liver disease, hypertension and stroke.
While cold beer, glasses of wine and strong cocktails are often seen as a way to unwind after a long day at work or on the weekend, alcohol is actually an addictive psychoactive substance that has been linked to a host of deadly pathologies, including heart disease, breast, pancreatic and stomach cancer, liver disease, hypertension and stroke.
According to the latest data from the Centers for Disease Control and Prevention (CDC), 178,000 people in the U.S. will die from excessive drinking in 2020 and 2021, a 29% increase from just five years ago. These deaths reduce average life expectancy by 23 years each year, resulting in a total loss of 4 million potential years of life. Consequently, alcohol is one of the leading causes of selective mortality in the country.
https://www.cdc.gov/chronicdisease/resources/publications/factsheets/alcohol.htm
A growing body of research supports the conclusion that drinking even small amounts of alcohol — less than 15 servings per week for men or eight servings per week for women — can increase the risk of cardiovascular disease and cancer. In various countries, including Canada, medical guidelines are becoming stricter, emphasizing that there is no safe level of alcohol consumption.
https://www.cdc.gov/chronicdisease/resources/publications/factsheets/alcohol.htm
A growing body of research supports the conclusion that drinking even small amounts of alcohol — less than 15 servings per week for men or eight servings per week for women — can increase the risk of cardiovascular disease and cancer. In various countries, including Canada, medical guidelines are becoming stricter, emphasizing that there is no safe level of alcohol consumption.
However, it should be remembered that the dose makes the poison, and the greatest health risks are posed by people who abuse alcohol. This group suffers from alcohol use disorder, a condition in which a person consumes so much alcohol that they lose control of their behavior, ignoring the negative consequences on their health and social life. The number of people with this disorder is much higher than it may seem: more than one in twelve people in the United States have AUD, and perhaps these numbers underestimate the real problem.
In the last century, excessive drinking and its consequences were often referred to as alcohol dependence or alcoholism. However, these terms stigmatize and reduce unhealthy alcohol consumption to simply bad choices without considering possible psychological aspects. In 2013, the American Psychiatric Association began classifying all types of excessive drinking as alcohol use disorder (AUD) to better characterize the condition of people suffering from unhealthy alcohol consumption.
In the last century, excessive drinking and its consequences were often referred to as alcohol dependence or alcoholism. However, these terms stigmatize and reduce unhealthy alcohol consumption to simply bad choices without considering possible psychological aspects. In 2013, the American Psychiatric Association began classifying all types of excessive drinking as alcohol use disorder (AUD) to better characterize the condition of people suffering from unhealthy alcohol consumption.
Decades ago, alcohol use and other substance use disorders were seen as personality flaws or moral problems, says Carrie Mintz, an assistant professor of psychiatry at Washington University in St. Louis. Today, however, a growing body of research and data over the past 50 years has made it clear that it is actually a brain disease. There are neurological changes that occur with pathological alcohol use, and this is supported by accumulating data.
While society in America turns to other dangerous substances such as opioids as a public health issue, alcohol use is not viewed as a legislative, medical, or cultural crisis. On the contrary, access to alcohol continues to increase. The alcoholic beverage industry generated $250 billion in revenue in 2021, and the spirits category has surpassed beer in sales despite an increase in the number of breweries in the U.S. from 3,305 in 2017 to 4,493 in 2020. Taxes on alcohol are typically higher than on other goods, in part to curb its consumption, but since 2000 these taxes have lost their effectiveness due to inflation and rising beverage prices.
Kate Humphries, a professor of psychiatry and behavioral sciences at Stanford University, notes that alcohol is often not seen as a drug, even though the problem of its use is serious. This creates a blind spot in drug policy, where many don't recognize alcohol as a drug worth tackling seriously. As a result, after decades of having an Alcoholics Anonymous program that is proven to be effective in helping people overcome addiction, the problem of alcohol use is only getting worse.
While society in America turns to other dangerous substances such as opioids as a public health issue, alcohol use is not viewed as a legislative, medical, or cultural crisis. On the contrary, access to alcohol continues to increase. The alcoholic beverage industry generated $250 billion in revenue in 2021, and the spirits category has surpassed beer in sales despite an increase in the number of breweries in the U.S. from 3,305 in 2017 to 4,493 in 2020. Taxes on alcohol are typically higher than on other goods, in part to curb its consumption, but since 2000 these taxes have lost their effectiveness due to inflation and rising beverage prices.
Kate Humphries, a professor of psychiatry and behavioral sciences at Stanford University, notes that alcohol is often not seen as a drug, even though the problem of its use is serious. This creates a blind spot in drug policy, where many don't recognize alcohol as a drug worth tackling seriously. As a result, after decades of having an Alcoholics Anonymous program that is proven to be effective in helping people overcome addiction, the problem of alcohol use is only getting worse.
Researchers are now learning more and more about the effects of alcohol use on overall health and the potential for addiction. This is prompting more and more people to seek solutions, especially those who suffer from alcohol abuse and need help. In addition to therapeutic and social groups such as AA, there are three FDA-approved drugs that help combat this problem. Recent evidence of Ozempic's ability to curb alcohol consumption and overeating has brought attention to its potential use in medical practice. Similar to medications used to treat depression, such as Prozac, these drugs could be an important part of treatment plans for alcohol abuse.
However, their use is still underutilized: in 2019, only 223,000 of the 14.1 million adults with alcohol dependence were prescribed these medications. The reasons for this are varied: some patients are unwilling to take medication to treat addiction, health care providers lack knowledge and experience in treating alcohol dependence, and the stigma that accompanies the condition prevents patients from seeking help.
However, their use is still underutilized: in 2019, only 223,000 of the 14.1 million adults with alcohol dependence were prescribed these medications. The reasons for this are varied: some patients are unwilling to take medication to treat addiction, health care providers lack knowledge and experience in treating alcohol dependence, and the stigma that accompanies the condition prevents patients from seeking help.
Obviously, failure to effectively treat alcohol dependence has serious consequences and results in many deaths each year. Alcohol addiction destroys families and social relationships, causing huge economic losses. Despite the advent of new treatments and laws, it is important for health care providers and patients with alcohol addiction to remember that there are effective treatment options available.
These medications can be used much more widely than they are now. Although they are not as common as antibiotics, they have their own importance and it is a shame that we do not utilize them to their full potential.
Australian dollar
In the United States, alcohol is available for purchase in a variety of places such as restaurants, bars, liquor and grocery stores, and gas stations. In some states, it can even be purchased in drive-throughs. Mark Disselkoen, senior project manager for the Center for Application of Substance Abuse Technology (CASAT) at the University of Nevada, Reno, notes that alcohol use has become a common phenomenon in society, leading to problems for some people, while for others it is uncomplicated.
These medications can be used much more widely than they are now. Although they are not as common as antibiotics, they have their own importance and it is a shame that we do not utilize them to their full potential.
Australian dollar
In the United States, alcohol is available for purchase in a variety of places such as restaurants, bars, liquor and grocery stores, and gas stations. In some states, it can even be purchased in drive-throughs. Mark Disselkoen, senior project manager for the Center for Application of Substance Abuse Technology (CASAT) at the University of Nevada, Reno, notes that alcohol use has become a common phenomenon in society, leading to problems for some people, while for others it is uncomplicated.
While alcohol abuse and its consequences are widespread, the most serious problems occur among the most active users. Data from the late 2000s shows that the 10% of Americans who consume the most alcohol (approximately 24 million people) consume an average of 74 drinks per week. This means that people with the most severe form of alcohol dependence purchase more than half of all alcohol sold in the country.
Subsequent studies only confirm the impact of alcohol on U.S. society. Americans spend huge sums on alcohol each year, with approximately 65% of adults of drinking age admitting to drinking alcohol (on average, each American consumes 2.51 gallons of alcohol per year).
The impact of the Covid-19 pandemic on alcohol consumption in the U.S. has also been shown to be significant. Research shows that in 2020, the first year of the pandemic, a quarter of Americans drank alcohol more frequently due to the stress of the situation.
Subsequent studies only confirm the impact of alcohol on U.S. society. Americans spend huge sums on alcohol each year, with approximately 65% of adults of drinking age admitting to drinking alcohol (on average, each American consumes 2.51 gallons of alcohol per year).
The impact of the Covid-19 pandemic on alcohol consumption in the U.S. has also been shown to be significant. Research shows that in 2020, the first year of the pandemic, a quarter of Americans drank alcohol more frequently due to the stress of the situation.
While alcohol abuse remains prevalent among men, alcohol-related death rates are rising faster among women. This is partly due to increased alcohol consumption in this group and women's higher susceptibility to alcohol-related liver, heart and cancer diseases.
Episodes of binge drinking, historically defined as times when men have five or more alcoholic drinks in two hours and women four or more, have been considered alcohol abuse or alcohol dependence. According to the DSM-IV, a widely used manual for diagnosing mental disorders, alcohol use is classified as abuse, which is the prolonged use of alcohol despite negative consequences, or dependence, characterized by an increasing need for alcohol to intoxicate oneself and prevent withdrawal. This information was provided by George Koob, director of the National Institute on Alcohol Abuse and Alcoholism.
However, experts argue that these outdated terms have given negative connotations and stereotypes to people who use alcohol.
https://www.buffalo.edu/cria/about-us/contact.html
As Kenneth Leonard, director of the Clinical and Research Institute on Addictions at the University at Buffalo and past president of the American Psychological Association's Division of Addictions, noted, the terms «alcohol abuse» or «substance abuse» tend to be avoided because of their stigmatizing effect on people with alcoholism or other substance use disorders.
Episodes of binge drinking, historically defined as times when men have five or more alcoholic drinks in two hours and women four or more, have been considered alcohol abuse or alcohol dependence. According to the DSM-IV, a widely used manual for diagnosing mental disorders, alcohol use is classified as abuse, which is the prolonged use of alcohol despite negative consequences, or dependence, characterized by an increasing need for alcohol to intoxicate oneself and prevent withdrawal. This information was provided by George Koob, director of the National Institute on Alcohol Abuse and Alcoholism.
However, experts argue that these outdated terms have given negative connotations and stereotypes to people who use alcohol.
https://www.buffalo.edu/cria/about-us/contact.html
As Kenneth Leonard, director of the Clinical and Research Institute on Addictions at the University at Buffalo and past president of the American Psychological Association's Division of Addictions, noted, the terms «alcohol abuse» or «substance abuse» tend to be avoided because of their stigmatizing effect on people with alcoholism or other substance use disorders.
In addition, the word «abuse» is associated with violence, leading people to seek to punish people with AUD rather than help them, according to Humphries.
In 2013, the APA replaced the DSM-IV with the DSM-5, which reclassified all forms of abuse as AUD, including mild, moderate, and severe. The DSM-5 criteria include a series of questions with yes or no answers about the patient's drinking habits and the consequences of those habits over the past year.
According to the 2021 National Survey on Drug Use and Health, about 18.7 million white people aged 12 and older have AUD, the largest number of people with AUD.
However, those who identify as two or more races; American Indian or Alaska Native adults; and Native Hawaiian or other Pacific Islander adults report higher rates of AUD relative to their population size.
How is alcoholism treated?
Over the past decade, the medical community has recognized AUD as a disease requiring medical intervention. As with other diseases, AUD is treatable using a variety of methods. With new treatments becoming available every day, there is hope that more and more people will get the help they need in the coming years.
For people with severe AUD, the main goal of treatment is to stop drinking alcohol altogether. It is important to realize that alcohol use or abstinence disorder is not a failure, but part of the recovery process.
As with any other mental illness, successful treatment for AUD often involves a combination of psychotherapy and drug therapy. Just as depression is treated with medications that restore chemical balance in the brain and therapy that helps patients change harmful behaviors, AUD also often requires a comprehensive treatment approach.
How is alcoholism treated?
Over the past decade, the medical community has recognized AUD as a disease requiring medical intervention. As with other diseases, AUD is treatable using a variety of methods. With new treatments becoming available every day, there is hope that more and more people will get the help they need in the coming years.
For people with severe AUD, the main goal of treatment is to stop drinking alcohol altogether. It is important to realize that alcohol use or abstinence disorder is not a failure, but part of the recovery process.
As with any other mental illness, successful treatment for AUD often involves a combination of psychotherapy and drug therapy. Just as depression is treated with medications that restore chemical balance in the brain and therapy that helps patients change harmful behaviors, AUD also often requires a comprehensive treatment approach.
In 1951, the FDA approved disulfiram, known by the brand name Antabuse, as the first drug to treat AUD. It is a pill that causes unpleasant symptoms when drinking alcohol, such as facial redness, headache, and nausea. However, the unwanted side effects that make it effective also make it unpopular among patients.
Today, disulfiram is used as a second-line treatment, while naltrexone and acamprosate, approved by the FDA in the 1990s and 2000s, respectively, are first-line drugs. Naltrexone blocks the effects of opioids or alcohol, preventing intoxication, while acamprosate restores the chemical balance of the brain.
Instead of causing discomfort, acamprosate helps the brain wean off cravings for alcohol. This effectively reduces dependence on alcohol.
While disulfiram, naltrexone, and acamprosate are the only drugs approved by the FDA to treat AUD, there are also other drugs not listed in the guidelines that can be effective. For example, topiramate, an epilepsy medication, and Ozempic, a diabetes medication, have shown the ability to reduce alcohol consumption in animals in experiments. However, despite the availability of effective treatments, less than 5% of people with AUD receive treatment, and only 2% take medication.
Today, disulfiram is used as a second-line treatment, while naltrexone and acamprosate, approved by the FDA in the 1990s and 2000s, respectively, are first-line drugs. Naltrexone blocks the effects of opioids or alcohol, preventing intoxication, while acamprosate restores the chemical balance of the brain.
Instead of causing discomfort, acamprosate helps the brain wean off cravings for alcohol. This effectively reduces dependence on alcohol.
While disulfiram, naltrexone, and acamprosate are the only drugs approved by the FDA to treat AUD, there are also other drugs not listed in the guidelines that can be effective. For example, topiramate, an epilepsy medication, and Ozempic, a diabetes medication, have shown the ability to reduce alcohol consumption in animals in experiments. However, despite the availability of effective treatments, less than 5% of people with AUD receive treatment, and only 2% take medication.
That makes sense when you consider that of the roughly 940,000 physicians in the U.S., about 38,000 specialize in psychiatry and about 3,000 specialize in addiction medicine. And patients today don't have the long-standing relationships with primary care physicians that they once had: nearly half of adults under age 30 said in 2018 that they don't have a primary care physician. Instead, patients are going to emergency departments and urgent care clinics, which are designed not to treat underlying conditions but to treat the symptoms or effects of those conditions.
People with AUD and other mental disorders often need therapy for both conditions. Mild AUD can be treated with medical evaluation and intervention in the primary care office. For severe cases of AUD, cognitive-behavioral therapy or motivational enhancement therapy may be helpful.
People with AUD and other mental disorders often need therapy for both conditions. Mild AUD can be treated with medical evaluation and intervention in the primary care office. For severe cases of AUD, cognitive-behavioral therapy or motivational enhancement therapy may be helpful.
Practical support and a non-judgmental AA society have proven effective in helping people with AUD.
Until recently, it was thought that a person with AUD would have the disorder forever. It was sort of a mantra, and the only way to get better was to not use drugs at all.
People who did use drugs relapsed. Well, that changed over time. And now we realize that a person can drink, that may be a caveat, but it can't mean that they're going to drink at the same levels that they used to.
Until recently, it was thought that a person with AUD would have the disorder forever. It was sort of a mantra, and the only way to get better was to not use drugs at all.
People who did use drugs relapsed. Well, that changed over time. And now we realize that a person can drink, that may be a caveat, but it can't mean that they're going to drink at the same levels that they used to.
