At a glance......
- 1 Neurobiology and Pathophysiology
- 2 Causes of Alcoholism
- 3 Symptoms of Alcoholism
- 4 Diagnosis of Alcoholism
- 5 Treatment
- 6 Complications
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What Is Alcoholism?/Alcoholism is the most serious form of problem drinking and describes a strong, often uncontrollable, desire to drink. Sufferers of alcoholism will often place drinking above all other obligations, including work and family, and may build up a physical tolerance or experience withdrawal symptoms if they stop.
Alcoholism is sometimes known as alcohol addiction or alcohol dependence. It’s slightly different from harmful drinking which is an occasional pattern of drinking which can cause damage to your health.
Alcoholism, excessive and repetitive drinking of alcoholic beverages to the extent that the drinker repeatedly is harmed or harms others. The harm may be physical or mental; it may also be social, legal, or economic. Because such use is usually considered to be compulsive and under markedly diminished voluntary control, alcoholism is considered by a majority of, but not all, clinicians as an addiction and a disease.
Neurobiology and Pathophysiology
The acute and chronic effects of alcohol on brain physiology have been well studied and help to rationalize the investigation of psychotropic drugs in the treatment of AUD. In particular, neurotransmitter pathways involved in learning and reward have proven to be effective targets, based on the mechanisms of action of two currently approved AUD drugs, acamprosate and naltrexone. Other compounds under current investigation similarly produce effects by targeting monoamine (eg, serotonin [5-HT], norepinephrine, dopamine) or amino acid (eg, glutamate, γ-aminobutyric acid [GABA]) neurotransmitters.
Causes of Alcoholism
While there are various reasons as to why people start drinking, some of the most common are to:
- Relieve stress – Relying on alcohol to reduce daily life stressors can impact the likelihood of developing alcoholism. Since alcohol is a depressant and a sedative, drinking produces feelings of pleasure. However, frequent drinking builds tolerance, requiring you to consume more alcohol in order to achieve the same effects.
- Feel good – Consuming alcohol can provide some people with a break from reality. It offers a sense of relief from underlying issues your mind may be trying to escape from. However, continual alcohol use to get through the day or week can turn into a serious drinking problem.
- Cope with loss – Losing a family member or friend can take a toll on you emotionally, physically and mentally. Alcohol can ease the grief you are feeling and is used to get through difficult times. Depending on alcohol, even temporarily, can spiral into a drinking problem.
- Overcome anxiety – Some people are naturally anxious, causing them to perpetually worry. Drinking lowers an individual’s inhibitions and makes them more comfortable in social situations. Over time though, this can lead to addictive behaviors.
- Lack of Connection – Many people drink because they don’t feel adequately connected to others. They believe that alcohol will either feel the void or possibly make it easier for them to forge new bonds. However, the opposite typically ends up being true.
- Shame – Shame is one of the most difficult emotions for many to cope with, and it is also one of the most traumatic. While alcohol can temporarily mask shame with false feelings, it also causes many individuals to engage in reckless or foolish behaviors that can later cause them to feel even greater shame, which can cause a downward spiral.
- Trauma – Alcoholism treatment experts are seeing some type of trauma in virtually every patient that they treat. There are many forms of trauma, but they all painful events where the victim didn’t have an empathetic witness. For many, treating unresolved trauma is the key to their recovery.
Effects of Long terms
Eventually, regular heavy drinking may cause at least one of the following problems:
- Fatigue – The person feels tired most of the time.
- Memory loss – Alcohol affects short-term memory in particular.
- Eye muscles – The eye muscles can become significantly weaker.
- Liver diseases – There is a higher chance of developing hepatitis and cirrhosis, an irreversible and progressive condition.
- Gastrointestinal complications – Gastritis or pancreas damage can occur. These will undermine the body’s ability to digest food, absorb certain vitamins, and produce hormones that regulate metabolism.
- Hypertension – Regular heavy drinking is likely to raise blood pressure.
- Heart problems – There is a higher risk of cardiomyopathy (damaged heart muscle), heart failure, and stroke.
- Diabetes – There is a high risk of developing diabetes type 2, and people with diabetes have a high chance of complications if they regularly consume more alcohol than is recommended. Alcohol prevents the release of glucose from the liver, resulting in hypoglycemia. If a person with diabetes is already using insulin to lower their blood sugar levels, hypoglycemia could have serious consequences.
- Menstruation – Excessive consumption of alcohol can stop or disrupt menstruation.
- Erectile dysfunction – There may be problems getting or sustaining an erection.
- Fetal alcohol syndrome – Consuming alcohol during pregnancy increases the risk of birth defects. The newborn may have a small head, heart problems, shortened eyelids, and developmental and cognitive problems.
- Thinning bones – Alcohol interferes with the production of new bone, leading to a thinning of the bones and an increased risk of fractures.
- Nervous system problems – There may be numbness in the extremities, dementia, and confused or disordered thinking.
- Cancer – There is a higher risk of developing several cancers, including cancer of the mouth, esophagus, liver, colon, rectum, breast, prostate, and pharynx.
- Accidents – There is a higher chance of injuries from falls, road traffic accidents, and so on.
- Domestic abuse – Alcohol is a major factor in spouse-beating, child abuse, and conflicts with neighbors.
- Work or school problems – Employment or educational problems and unemployment are often alcohol-related.
- Suicide – Suicide rates among people with alcohol dependence or who consume alcohol inappropriately are higher than among those who do not.
- Mental illness – Alcohol abuse increases the risk of mental illness, and it can make existing mental illnesses worse.
- Problems with the law – People who consume alcohol are significantly more likely to spend time in court or in prison, compared with the rest of the population.
Alcoholism Short & Long-Term Physical Health Issues
Short- and long-term physical effects associated with AUD can include
- Heart problems like cardiomyopathy (enlarged, inefficient heart muscle), arrhythmias (irregular heartbeat), high blood pressure, and stroke.
- Liver disease, including steatosis (fatty liver), alcoholic hepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma.
- Pancreatic problems like pancreatitis, an acutely painful inflammatory condition that can progress to chronic disease. Pancreatitis can affect a range of pancreatic functions, including the normal release of digestive enzymes.
- Certain types of cancer, including head and neck cancer, esophageal cancer, liver cancer, breast cancer, and colorectal cancer.
- A weakened immune system, which can increase your risk of infection and contraction of diseases like pneumonia and tuberculosis.
- Cognitive problems, such as memory loss or problems thinking clearly.
- Blackouts (periods of time in which you cannot recall events).
- Serious brain damage and disorders like Wernicke–Korsakoff Syndrome, which leads to confusion, impaired optic nerve function, profound movement deficits, and problems with memory recall and consolidation.
- Mood disorders, like major depressive disorder or bipolar disorder.
- Anxiety disorders, especially panic disorder and social phobia.
- Failing to meet work, school, or home obligations.
- Giving up activities you used to enjoy in order to drink or recover from alcohol.
- Experiencing significant interpersonal problems (such as divorce) because of alcohol use.
- Domestic abuse.
- Financial problems.
Symptoms of Alcoholism
- Lost control over your drinking – You often drink more alcohol than you wanted to, for longer than you intended, or despite telling yourself you wouldn’t.
- Want to quit drinking, but you can’t – You have a persistent desire to cut down or stop your alcohol use, but your efforts to quit have been unsuccessful.
- Given up other activities because of alcohol – You’re spending less time on activities that used to be important to you (hanging out with family and friends, going to the gym, pursuing your hobbies) because of your alcohol use.
- Alcohol takes up a great deal of your energy and focus – You spend a lot of time drinking, thinking about it, or recovering from its effects. You have few if any interests or social involvements that don’t revolve around drinking.
- Drinking even though you know it’s causing problems – For example, you recognize that your alcohol use is damaging your marriage, making your depression worse, or causing health problems, but you continue to drink anyway.
- Experiencing temporary blackouts or short-term memory loss
- Exhibiting signs of irritability and extreme mood swings
- Making excuses for drinking such as to relax, deal with stress or feel normal
- Choosing to drink over other responsibilities and obligations
- Becoming isolated and distant from friends and family members
- Drinking alone or in secrecy
- Feeling hungover when not drinking
- Changing appearance and group of acquaintances you hang out with
- Being unable to control alcohol consumption
- Craving alcohol when you’re not drinking
- Putting alcohol above personal responsibilities
- Feeling the need to keep drinking more
- Spending a substantial amount of money on alcohol
- Behaving differently after drinking
- Mental confusion
- Being unable to wake the person.
- Slow (fewer than 8 breaths per minute) or irregular (10 seconds or more between each breath) breathing.
- Bluish skin color
Diagnosis of Alcoholism
At least three of the following criteria should have been present during the past 12 months:
- Alcohol tolerance – The person needs a large quantity of alcohol to feel intoxicated. However, when the liver is damaged and cannot metabolize the alcohol so well, this tolerance may drop. Damage to the central nervous system may also reduce tolerance levels.
- Withdrawal symptoms – When the individual abstains from alcohol or cuts down, they experience tremors, insomnia, nausea, or anxiety. They may drink more to avoid these symptoms.
- Beyond intentions – The person drinks more alcohol, or over a longer period than they intended.
- Unsuccessful attempts to cut down – The person is continuously trying to cut down alcohol consumption but does not succeed. They may have a persistent desire to cut down.
- Time consumed – The person spends a lot of time obtaining, using, or recovering from alcohol consumption.
- Withdrawal – The individual withdraws from recreational, social, or occupational activities that they previously participated in.
- Persistence – The person continues consuming alcohol, even though they know it is harming them physically and psychologically.
- Gamma-glutamyl transferase (GGT) – a liver enzyme that is increased by heavy alcohol intake and also by many other conditions that affect the liver
- Mean corpuscular volume (MCV) – which measures the size of red blood cells; usually measured as part of a complete blood count (CBC) test; the MCV may increase over time in those who are heavy drinkers but may also be affected by many other conditions.
- Aspartate aminotransferase (AST) – and alanine aminotransferase (ALT), enzymes that can indicate liver damage, which is often related to alcohol use
- Carbohydrate-deficient transferrin (CDT) – which can indicate relapse to heavy drinking following a period of abstinence but may be less sensitive for women and younger people
- Ethyl glucuronide (EtG) and Ethyl sulfate (EtS) – biomarkers and direct analytes of the breakdown of alcohol; commonly found in urine testing
- Phosphatidyl ethanol (PEth) – a marker, typically measured in blood, that is used to indicate moderate to heavy drinking
- Comprehensive metabolic panel (CMP) – or liver panel, groups of tests that are used to evaluate organ and liver function
- Magnesium – which can be low in those who are alcoholic due to insufficient dietary intake and loss by the kidneys
- A blood alcohol level (ethanol test) – can be used to determine if a person has been drinking alcohol recently but does not diagnose alcoholism.
- Do-it-yourself – Some people with an alcohol problem manage to reduce their drinking or abstain without seeking professional help.
- Counseling – A qualified counselor can help the person share their problems and then devise a plan to tackle the drinking. Cognitive-behavioral therapy (CBT) is commonly used to treat alcohol dependency.
- Treating underlying problems – There may be problems with self-esteem, stress, anxiety, depression, or other aspects of mental health. It is important to treat these problems, too, as they can increase the risks posed by alcohol. Common alcohol-related issues, such as hypertension, liver diseases, and possibly heart diseases, will need to be treated too.
- Residential programs – These can offer expert professional help, individual or group therapy, support groups, training, family involvement, activity therapy, and a host of strategies for treating alcohol abuse. Being physically away from access to temptation is helpful for some people.
- Cognitive–Behavioral Therapy – can take place one-on-one with a therapist or in small groups. This form of therapy is focused on identifying the feelings and situations (called “cues”) that lead to heavy drinking and managing stress that can lead to relapse. The goal is to change the thought processes that lead to excessive drinking and to develop the skills necessary to cope with everyday situations that might trigger problem drinking.
- Motivational Enhancement Therapy – is conducted over a short period of time to build and strengthen motivation to change drinking behavior. The therapy focuses on identifying the pros and cons of seeking treatment, forming a plan for making changes in one’s drinking, building confidence, and developing the skills needed to stick to the plan.
- Marital and Family Counseling – incorporates spouses and other family members in the treatment process and can play an important role in repairing and improving family relationships. Studies show that strong family support through family therapy increases the chances of maintaining abstinence (stopping drinking), compared with patients undergoing individual counseling.
- Brief Interventions – are short, one-on-one or small-group counseling sessions that are time-limited. The counselor provides information about the individual’s drinking pattern and potential risks. After receiving personalized feedback, the counselor will work with the client to set goals and provide ideas for helping to make a change.
In the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram.[rx]
- Acamprosate – may stabilize the brain chemistry that is altered due to alcohol dependence via antagonizing the actions of glutamate, a neurotransmitter that is hyperactive in the post-withdrawal phase.[rx] By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity.[rx] Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.[rx][rx]
- Naltrexone – is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opioids. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body reduces the pleasurable effects from consuming alcohol.[rx] Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking.[rx] Nalmefene also appears effective and works in a similar manner.[rx]
- Disulfiram – prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is a discomfort when alcohol is ingested: an extremely fast-acting and long-lasting, uncomfortable hangover.
- Disulfiram inhibits an enzyme used to metabolize alcohol and causes very unpleasant effects when even small amounts of alcohol are consumed. When used as prescribed, these effects may begin to be felt as soon as 10 minutes after consuming alcohol and include anxiety, headache, flushing of the face, sweating, blurred vision, nausea, and vomiting. Typically, effects can last for 1 hour or more. Through its aversive reaction with alcohol, disulfiram is used to discourage continued drinking behavior.
- Nalmefene – Nalmefene is an opioid receptor modulator that is approved by the Committee for Medicinal Products for Human Use of the European Medicines Agency for use in the European Union.[rx] Nalmefene was approved for marketing in February 2013 and is approved for “the reduction of alcohol consumption in adult patients with alcohol dependence who have a high drinking risk level.”[rx] It works in a similar fashion to naltrexone, as an opioid antagonist at μ and δ receptors, and as an agonist at κ receptors.[rx] It is hypothesized that the blockade of opioid receptors interferes with the reinforcing effects of alcohol, in turn reducing alcohol cravings.[rx]
- The anti-smoking drug varenicline – significantly reduced alcohol consumption and craving among people with alcoholism.
- Gabapentin – a medication used to treat pain conditions and epilepsy, was shown to increase abstinence and reduce heavy drinking. Those taking the medication also reported fewer alcohol cravings and improved mood and sleep. The anti-epileptic medication topiramate was shown to help people curb problem drinking, particularly among those with a certain genetic makeup that appears to be linked to the treatment’s effectiveness.
Several other drugs are also used and many are under investigation.
- Benzodiazepines, while useful in the management of acute alcohol withdrawal if used long-term can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. This class of drugs is commonly prescribed to alcoholics for insomnia or anxiety management.[rx] Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for relapse into alcohol abuse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.[rx][rx]
- Calcium carbimide works in the same way as disulfiram; it has an advantage in that the occasional adverse effects of disulfiram, hepatotoxicity, and drowsiness, do not occur with calcium carbimide.[rx]
- Ondansetron and topiramate are supported by tentative evidence in people with certain genetics.[rx][rx] Evidence for ondansetron is more in those who have just begun having problems with alcohol.[rx]
Evidence does not support the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), antipsychotics, or gabapentin.[rx]
- Antipsychotics (e.g., haloperidol) — Individuals with a co-occurring thought disorder (e.g., schizophrenia) might be administered antipsychotic medications. Caution will be used since certain antipsychotic agents may also lower the seizure threshold.
- Anticonvulsants (e.g., carbamazepine) — Anticonvulsant therapy should not be used with isolated alcohol withdrawal seizures; however, carbamazepine may have some utility in the outpatient management of mild alcohol withdrawal.
- Centrally Acting Alpha-2 Agonists (e.g., clonidine) — Certain types of antihypertensive medications, such as clonidine, have been shown to reduce adrenergic symptoms, but don’t prevent seizures. These drugs may assist in controlling mild or non-complicated alcohol withdrawal symptoms such as high blood pressure, sweating, anxiety, irritability, and tremors.
- Beta-Blockers (e.g., propranolol, atenolol) — Beta-blockers reduce adrenergic symptoms of alcohol withdrawal but do not prevent the development of seizures or delirium tremens.
- Baclofen — Baclofen is a skeletal muscle relaxant and selective agonist of the GABA-B receptor. It has been studied as a therapy for acute alcohol withdrawal and shows the potential to rapidly reduce symptoms. However, its effectiveness in controlling severe symptoms remains unproven.
Antipsychotics are used for the treatment of schizophrenia and bipolar disorder and as an adjunctive treatment for depression and autism. They block various dopamine receptors, and the second-generation antipsychotics are unique in that they also block 5-HT2 receptors. Due to dopamine’s implication in the reward pathways associated with AUD, these medications are targets for current research.
- Aripiprazole – Aripiprazole at higher doses (23.3 mg daily) may be helpful in reducing number of drinks per day[rx] and reducing urges after follow-up drinks (15 mg daily);[rx] however, when measuring number of heavy drinking days, days abstinent,[rx] and subjective craving,[rx] aripiprazole performed poorly against placebo. Despite objective evidence that ventral striatum activation is blunted with aripiprazole[,rx] and that aripiprazole may be as efficacious as naltrexone in reducing craving and increasing time to relapse in patients with a goal of abstinence,[rx] its precise usefulness in alcohol-dependent patients is not clear.
- Olanzapine – Olanzapine reduced alcohol cravings in young adult subjects [x] and reduced the number of drinks per day in AUD patients with higher baseline drinking habits,[rx,rx] but only in individuals with the long version of the D4 dopamine receptor gene (DRD4). When studied in patients with no DRD4 allele stratification, 5–15 mg daily for 12 weeks was not different from placebo in reducing drinking measures.[rx] Given the minimal use of genetic information in AUD patient assessment, olanzapine may be considered on a trial-and-error basis in AUD.
- Quetiapine – Quetiapine 400 mg daily for 6 weeks has shown positive results in drink reduction and impulsivity[rx] and, over 12 weeks, demonstrated reduced drinking in type B alcoholics (early onset, more severe) compared to type A alcoholics (late onset, less severe).[rx] Quetiapine may not be useful in very heavy drinkers[rx] or as an adjunct to naltrexone,[rx] but may be an option to reduce drinking in less heavy drinkers or type B alcoholics.
The majority of antidepressants studied in alcohol dependence use selective 5-HT reuptake inhibitors (SSRIs). These work by blocking the reuptake of 5-HT, allowing increased agonism of 5-HT receptors. 5-HT agonists have shown a reduction in alcohol consumption in animal studies,[rx] and, due to these findings, maybe a future option for AUD treatment.
- Citalopram – Citalopram 40 mg has been found to reduce alcohol consumption in moderate drinkers,[rx]particularly in men;[rx] however, this effect did not carry over to very heavy drinkers.[rx] Potential lack of efficacy in very heavy drinking was further illustrated when subjects with lower baseline average daily drinking had 50% or more reduction in baseline drinking with citalopram 40 mg compared to subjects with higher daily drinking averages.[rx]
- Sertraline – Sertraline 200 mg daily has been found to reduce drinking behaviors in type A alcoholic men;[rx]these results were not seen in type B alcoholic men or women.[rx] Sertraline’s efficacy in less severe alcohol dependence was again replicated in late-onset/low-vulnerability alcoholics who were homozygous for the long allele of the 5-HT transporter.[rx] Its effectiveness as an adjunct to naltrexone is not clear. Trials that evaluated sertraline as adjunctive therapy to naltrexone used 100 mg,[rx,rx]compared to other trials where 200 mg was used when sertraline was tested as monotherapy in AUD.[rx–rx]
- Fluoxetine – Fluoxetine lacks consistent evidence for its usefulness in alcohol dependence. In undiagnosed alcohol-dependent patients, 60 mg daily of fluoxetine reduced total and daily drinks[rx] and significantly reduced craving compared to baseline, but not to placebo;[rx] however, 60 mg did not affect abstinence[rx] or relapse rates in very heavy drinkers (average 18.6 drinks/day),[rx] nor reduce daily baseline or drinks per drinking day when compared to placebo.[rx] When dosed at 40 mg, fluoxetine did not reduce intake levels.[rx] At higher doses of 80 mg, daily fluoxetine reduced alcohol intake the initial week of a 4-week study.[rx]
Anticonvulsants are used for seizure disorders and several have indications for chronic pain conditions and mood stabilization. They have a variety of mechanisms, including blockage of sodium channels, enhancing GABA, antagonizing glutamate receptors, and blocking calcium channels.
- Gabapentin – Gabapentin titrated to 1,200 mg daily reduced craving after an alcohol cue,[rx] increased days abstinent in subjects with more severe alcohol withdrawal, reduced relapse to heavy drinking in patients with insomnia,[rx and improved other drinking measures.[rx] Gabapentin 600 mg daily found positive benefits in very heavy drinkers.[rx] As an adjunct to naltrexone, gabapentin reduced total drinking and urges.[rx] Reduction in craving was not found in a real-world design amount of drinking.[rx]
- Topiramate – In placebo-controlled, blinded studies using target doses of topiramate of 300 mg daily, topiramate outperformed placebo in multiple drinking measures[rx–rx] and craving.[rx] Topiramate was equivalent to naltrexone in a blinded design measuring relapse and abstinence. Cravin and intake were superior in naturalistic open designs. Topiramate 150 mg daily was compared to disulfiram in a non-blinded randomized study. The study found disulfiram to be superior in abstinence and daily drinks, while topiramate significantly reduced craving compared to disulfiram;[rx] the lack of blinding and the low dose of topiramate, however, suggests that a more robust design with adequate topiramate dosing is warranted before drawing strong conclusions regarding the superiority of either medication. Topiramate can also be considered an effective adjunctive therapy in lower doses (75 mg daily) when combined with psychotherapy for alcohol dependence.[rx]
- Levetiracetam – An open-label trial with levetiracetam on alcohol dependence found positive results;[rx]however, double-blind, placebo-controlled trials failed to find a benefit of levetiracetam for alcohol dependence.[rx,rx] One study found that moderate-to-heavy drinkers taking levetiracetam increased their drinking during the study period.100
- Oxcarbazepine – Oxcarbazepine has been shown to be equivalent in efficacy to acamprosate[rx] and naltrexone[rx] in open-label studies comparing time to first relapse. At higher doses, 1,500–1,800 mg daily, oxcarbazepine was superior to naltrexone in a number of patients who remained alcohol-free.[rx] There are currently no placebo-controlled blinded studies testing oxcarbazepine’s place in alcohol dependence.
- Divalproex sodium (VPA) – VPA significantly decreased relapse to heavy drinking in a blinded study against placebo and also decreased the amount of drinking and craving compared to baseline.[rx] A small non-blinded study found VPA treatment increased abstinence at 6 weeks post-detoxification, though this was not statistically significant.[rx]
Other anticonvulsants (carbamazepine zonisamide, tiagabine, pregabalin)
- Carbamazepine and zonisamide – have placebo-controlled trials supporting their potential use in alcohol dependence.[rx,rx] Zonisamide was significantly better than a placebo in reducing the number of heavy drinking days, reduction in the number of drinks per week, and the urge to drink. Days abstinent were similar to placebo.[rx] Similarly, carbamazepine outperformed placebo in longer time to relapse to heavy drinking.[rx]
- Tiagabine[rx] and pregabalin– [rx] both have open-label trials supporting their potential usefulness in alcohol dependence; however, placebo-controlled and head-to-head trials are needed to ascertain their particular place in therapy.
Other off-label medications
- Ritanserin – Ritanserin is a 5-HT2 receptor antagonist with documented use to improve sleep, mood, and vigilance.[rx] The feedback inhibition of dopaminergic activity related to blocking 5-HT receptors may act as a substitute for alcohol effects.[rx] Multiple large clinical trials revealed poor results with ritanserin when compared to placebo when measuring daily drinks, craving in heavy drinkers,[rx], rx] and relapse rates.[rx]
- Baclofen – Baclofen is a skeletal muscle relaxant that is approved for use in muscle spasticity. It is a GABA-B agonist and, through this mechanism, the dopaminergic response to alcohol may be inhibited.[rx] In addition to a 12-week open-label study,[rx] baclofen 30 mg daily has shown positive benefit compared to placebo in abstinence,[rx]–[rx] craving, and daily alcohol intake.[rx] Higher doses (60 mg/day) produced a more robust response in the reduction of a number of drinks per day compared to 30 mg daily.[rx] Studies that failed to replicate the benefits of baclofen used patients with a lower daily drink intake and no comorbid liver problems who were recruited via advertisements,[rx] as opposed to subjects seeking treatment.
- Ondansetron – Ondansetron is an antiemetic medication that blocks 5-HT3 receptors. Due to alcohol’s activity on 5-HT3, it is thought that ondansetron can be a useful medication in alcohol dependence.[rx] Ondansetron has been studied in four blinded placebo-controlled trials comparing low doses for alcohol dependence. Ondansetron significantly reduced daily drinking in light drinkers. No benefit was seen in heavy drinkers (>10 drinks/day).[rx] Additional studies using weight-based dosing found benefits in craving,[rx] abstinence, and total drinks.[rx] One study showed an increase in craving but reduced drinks per day. When used with naltrexone ondansetron, 0.5 mg reduced cue-induced craving and activation of the ventral striatum.[rx]
- Prazosin -Prazosin is an alpha 1-receptor adrenergic blocker that is used for the treatment of hypertension.[rx] At a titrated target dose of 16 mg daily, prazosin has been shown to reduce stress-induced craving,[rx] drinks per week, and drinking days.[rx] Simpson et al did not see a reduction in craving, though craving was not stress elicited.[rx]
- Varenicline – Varenicline is a nicotine agonist used for smoking cessation.[rx] Varenicline reduced the number of drinks consumed, abstinence, and craving after a priming drink in a 2-hour session in smokers with AUD.[rx] It also reduced number of drinks per week and craving in a 16-week trial, but did not have an effect on total days abstinent.[rx]
- Kudzu extract – The kudzu root has been historically studied for its use in alcoholism; of particular interest are the extracts of the plant. The mechanism is not fully understood, but it is proposed that the extracts of the kudzu root may alter alcohol dehydrogenase or monoamine oxidase–acetaldehyde pathways,[rx,rx]leading to reduced alcohol consumption.
- LSD – According to a retrospective analysis of six studies from the 1960s and 1970s LSD-assisted psychotherapy has potential as a treatment for alcoholism.[rx][rx] Bill Wilson, the founder of Alcoholics Anonymous, believed LSD might help alcoholics achieve sobriety.
Impact on your safety
Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:
- Motor vehicle accidents and other types of accidental injury, such as drowning
- Relationship problems
- Poor performance at work or school
- Increased likelihood of committing violent crimes or being the victim of a crime
- Legal problems or problems with employment or finances
- Problems with other substance use
- Engaging in risky, unprotected sex, or experiencing sexual abuse or date rape
- Increased risk of attempted or completed suicide
Impact on your health
Drinking too much alcohol on a single occasion or over time can cause health problems, including:
- Liver disease – Heavy drinking can cause increased fat in the liver (hepatic steatosis), inflammation of the liver (alcoholic hepatitis), and over time, irreversible destruction and scarring of liver tissue (cirrhosis).
- Digestive problems – Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It can also interfere with the absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis).
- Heart problems – Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause a serious heart arrhythmia called atrial fibrillation.
- Diabetes complications – Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level.
- Sexual function and menstruation issues – Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation.
- Eye problems – Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamin). A thiamin deficiency can also be associated with other brain changes, such as irreversible dementia, if not promptly treated.
- Birth defects –Alcohol use during pregnancy may cause miscarriage. It may also cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime.
- Bone damage – Alcohol may interfere with the production of new bone. This bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding.
- Neurological complications – Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.
- Weakened immune system – Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
- Increased risk of cancer – Long-term, excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, esophagus, colon and breast cancers. Even moderate drinking can increase the risk of breast cancer.
- Medication and alcohol interactions – Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.