Name: What We Get Wrong About “Alcoholism”
Uploaded: 2020-03-30T05:25:28.000Z
Duration: 11 min 11 s
Description: Thousands of YouTube videos with English-Chinese subtitles! Now you can learn to understand native speakers, expand your vocabulary, and improve your pronunciation...

Excessive drinking can have a wide range of consequences,

and it can lead to other diseases, like liver disease, heart disease, and cancer.

It's also incredibly common and seriously undertreated, affecting millions of people worldwide.

And to make matters more complicated, there are a lot of stereotypes and stigma

surrounding alcohol that prevent both understanding and adequate care.

For one thing, though we usually refer to “alcohol abuse” or “alcoholism,”

psychiatrists and other medical professionals now formally use the term alcohol use disorder, or AUD.

That's because previous definitions didn't totally capture the spectrum of symptoms that AUD can include.

But also, the way we think about treatments doesn't always represent the full story.

Here in the United States, common treatments include rehab

and those anonymized, 12-step group therapy programs.

But those are far from the only treatments for alcohol use disorder,

nor are they necessarily the most effective.

What many people don't realize is that there are so many ways to treat AUD.

So many, in fact, that doctors and patients have choices when it comes to treatment and recovery.

It's not all about checking into rehab or starting a 12-step program; there's tons of stuff.

So here are some of the ways that we can treat AUD.

The term “alcohol use disorder” officially comes from the

Diagnostic and Statistical Manual of Mental Disorders, or DSM,

the manual psychiatrists use to diagnose mental illnesses.

The 5th edition of the DSM lists 11 criteria for AUD, including having cravings for alcohol,

continuing to drink even though you suspect it might be causing problems,

and actually having job or life problems caused by drinking.

But patients don't have to check all 11 boxes.

If they meet at least 2 criteria, medical professionals may diagnose them with mild AUD.

And if they meet more than 2, doctors may bump up that diagnosis to moderate or severe.

Before we talk about what's involved with AUD treatments, though,

we should establish what doctors actually want as a result of that treatment,

Most of the time, the treatment goal is abstinence, for patients to stop drinking entirely.

But that's not always the case, and in some circumstances,

it may be appropriate to try and shoot for more moderate, controlled drinking habits.

That can come up when patients don't want to, or don't think they can, stop drinking completely.

Because ultimately, it's more important to engage these folks in treatment, even if it means compromising.

Like anything else, it's something to be figured out between a patient and their doctor.

But regardless of what the goal is, there's a wide range of

behavioral treatment programs that can be applied to alcohol use disorder.

At least in the U.S., the most well-recognized are probably those 12-step programs.

One example is Alcoholics Anonymous, but there are others,

some based on religious or spiritual beliefs, and others that are more secular.

Either way, doctors refer to such programs as 12-step facilitation.

But despite the number of people who go through these programs,

there's not actually much evidence about how well they work,

because these things are really hard to study.

Scientists have looked at them, but their research often examines such a range of outcomes

that it's hard to compare one paper to another.

And it's kinda hard to recruit study participants when you don't know who they are.

One 2006 review sorted through the literature about these programs,

and it actually suggested that none of the studies out there

provided convincing evidence in favor of the 12-step approach.

The most encouraging thing they could offer was one study, which did find

some indication that AA might help get patients into treatment and keep them there.

That doesn't mean these programs are bad, though, just that the research is a bit fuzzy.

Outside of studies, many patients have reported that the support provided by group therapy is helpful,

so many doctors keep twelve-step programs on the table.

Now, treatments like this aren't the only kind of behavioral intervention.

Behavioral interventions can cover all kinds of things,

from a brief meeting with a primary care doctor to residential rehab programs.

But unfortunately, the story surrounding them is the same.

It's really hard to study for various reasons,

so there's not much clear evidence about whether or not they work.

Groups like the World Health Organization keep recommending them, though,

because they provide psychological and social support, which is definitely something.

So if these programs work for people, they are definitely worth it.

Regardless, there are forms of behavioral treatment

that do have some pretty good evidence that back them up.

Cognitive behavioral therapy, for example, is a form of therapy that focuses on

helping people identify and change unhelpful thoughts and behaviors.

It's been shown to be effective for substance abuse time and time again in the medical literature,

Brief interventions are also highly effective for alcohol use, maybe surprisingly.

These are exactly what they sound like: short, one-off meetings with patients for as little as 5 minutes.

Studies have shown that even such a minimal treatment can decrease heavy drinking 20 to 30%,

and have measurable benefits up to 2 years down the line.

They're targeted at people whose behavior represents a risk of developing alcohol problems,

rather than those who already have some form of dependence,

which might help explain why a short conversation can be so effective.

Because of their one-off nature, brief interventions are a way to reach people

who show up to a hospital or their doctor's office for whatever reason,

so doctors consider them the first line of treatment.

But while therapy in all its various forms can really help people, it's also not the only option.

In the US, there are a handful of drugs that are approved to treat alcohol use disorder,

including naltrexone, disulfiram, and acamprosate.

Naltrexone is available in both pill and injectable forms,

and it was originally designed to treat opioid dependence.

But it also helps treat alcohol dependence,

probably by decreasing the amount of dopamine released in the brain in response to alcohol.

Since dopamine is associated with a pleasant, rewarding feeling,

naltrexone makes it feel less rewarding to drink.

Multiple studies have shown that naltrexone reduces both a return to binge drinking

and a return to any drinking in patients who have quit alcohol.

Though the size of the effect isn't as big as doctors might like.

AUD isn't just about the cravings, though.

Chronic alcohol use and dependence also produce a host of changes in the brain,

and acamprosate aims to change them back.

For example, alcohol can mess with the signaling done by the neurotransmitter NMDA,

which is involved in learning and memory.