A recent study evaluated the effects of a substance present in hallucinogenic mushrooms on heavy alcohol use.

What are the main treatments for alcoholism?

There are several treatment options for recovering from alcoholism, but it is necessary to obtain medical advice to identify which is most suitable for the patient.

Alcohol dependence is a complex condition that affects millions of people around the world, harming the physical and mental health of the person with this condition, as well as their interpersonal relationships. However, despite the harmful effects of alcoholism, recovery is possible when the process is carried out through appropriate treatment.

But what types of treatment are available for people diagnosed with alcohol dependence?

Although some believe that treatment is only possible through Alcoholics Anonymous or by controlling alcohol consumption at home, there are other options that are offered in different settings and that can be highly effective.

Main treatment options

Psychotherapeutic treatment

Psychotherapy is important in the treatment of alcoholism because it addresses underlying emotional issues, allowing us to understand what leads the addict to abuse alcoholic beverages and learn how to deal with problems without resorting to these substances. Furthermore, it is a fundamental aid in preventing relapses and creating a sober and healthy life plan. Counting on the aid of a therapist can help develop strategies for coping with the disease.

Among psychotherapeutic treatments, Cognitive Behavioral Therapy (CBT) is usually highly recommended for disorders related to alcohol abuse, as it emphasizes the relationship between thoughts, behaviors and emotions. Through CBT, it is possible to deconstruct preconceived thoughts, such as “I'm just going to drink a little, then I'll stop” or “if I don't drink, I won't be able to relax”, among others.

Pharmacological treatment

In addition to psychotherapeutic interventions, there are medications that can assist in treatment, reducing the desire to drink and anxiety, and relieving withdrawal symptoms when the person stops or reduces alcohol intake.

Three drugs, approved by the Food and Drug Administration (FDA), are used as the basis of treatments: disulfiram, naltrexone and acamprosate.

• Disulfiram is an enzyme inhibitor that causes adverse effects such as nausea, vomiting and even seizures if used in conjunction with alcohol consumption. Thus, it causes the addict to create an aversion to alcoholic beverages due to these effects.
• Naltrexone acts as an antagonist at opioid receptors, reducing the pleasurable effects of alcohol, cravings and feelings of euphoria caused by the substance.
• Acamprosate acts by reducing glutamate-induced calcium uptake, suppressing conditioned responses to alcohol and alleviating withdrawal symptoms.

It is important to emphasize that these medications should always be used under medical advice.

Mutual aid groups

Mutual aid groups, such as Alcoholics Anonymous (AA), are popular among those who want recovery and are a good way to get support, especially for people with spiritual inclinations or those who cannot afford medical treatment or are unable to access public treatments.

Family therapy

Alcohol dependence affects not only the alcoholic, but everyone around them, which is why the family can also – and should – resort to therapeutic support in order to better understand the disease, its symptoms and consequences, as well as receive guidance on the best way of dealing with the addict and his/her dependency.

Often, the family “gets sick” with the person with alcohol dependence, which is why family support is essential so that everyone can get support to better understand the disease and deal with the condition throughout the recovery process.

It is worth remembering that the family plays a very important role in treatment and recovery, as it is they who will help the alcoholic to adhere to and remain in treatment, as well as to overcome difficulties and establish a new lifestyle.

Physical activity

According to research (1), practicing physical activity can reduce the risk of mortality and reduce imbalances caused by alcohol, such as changes in sleep, muscle weakness, irritability and low self-esteem. Furthermore, practicing sports provides more interaction and contact with other people, which can help prevent relapses.

How to identify the best treatment option?

Just as there are a diversity of treatment options, there are also different profiles of people with alcohol dependence, which is why seeking help from medical professionals is the best way to identify the disease and be redirected to the most appropriate treatment. These professionals are the ones who will be able to carry out a detailed and multidisciplinary assessment to understand the alcoholic's profile, consumption patterns, whether the dependence is due to emotional, physical or interpersonal problems, and other issues.

This means that when it comes to treatment, there is no single option that fits everyone, and what works for one patient may not work for another.

References:

Referências:

1 Hallgren, M., Vancampfort, D., Giesen, E. S., Lundin, A., & Stubbs, B. (2017). Exercise as treatment for alcohol use disorders: systematic review and meta-analysis. British journal of sports medicine, 51(14), 1058–1064. https://doi.org/10.1136/bjsports-2016-096814

Rangé BP, Marlatt GA. Terapia cognitivo-comportamental de transtornos de abuso de álcool e drogas. Rev Bras Psiquiatr. 2008;30(SUPPL. 2):s88-s95. doi:10.1590/S1516-44462008000600006

National Institute on Alcohol Abuse and Alcoholism (NIAAA). What to Know about Alcohol Treatment. https://alcoholtreatment.niaaa.nih.gov/what-to-know

New Considerations on the Treatment of Alcohol Use Disorder: Problems and Solutions

A recent study (1) suggests that alcohol use disorder (AUD) remains underdiagnosed, despite the availability of effective therapies and medications. Key points highlighted include addressing stigma, improving screening, and investing in new approaches to increase access to treatments.

Alcohol use disorders (AUDs) are a large-scale public health issue, affecting more than 29 million people in the United States and leading to over 140,000 deaths annually. The most severe form of these disorders is alcoholism. It is described by a heuristic model encompassing three interconnected stages: heavy drinking/intoxication, withdrawal/negative affect, and concern/anticipation. This model provides a framework to understand the complexity of the disorder and its various manifestations in relation to treatment.

Defined as a chronic and recurring disorder, alcoholism is characterized by compulsive consumption, loss of control, and negative emotional states in the absence of alcohol. AUDs are classified as mild, moderate, or severe. In the neurobiological realm, AUDs involve three main domains: incentive salience/pathological habits, negative emotional states, and executive function, which are linked to the activation of brain circuits such as the basal ganglia, extended amygdala, and prefrontal cortex. The article also highlights that excessive alcohol consumption deregulates the brain's reward system and alters stress systems, reinforcing the cycle of dependence.

Despite the existence of effective treatments, such as behavioral interventions and approved medications, these resources remain widely underused, highlighting the need for actions to address existing gaps, including broadening the criteria for medication approval, increasing the use of screening and brief interventions, combating stigma, defining a clear and culturally sensitive “recovery” criterion, and promoting both public and professional education.

Evidence-based treatments include a wide range of behavioral therapies, such as cognitive-behavioral therapy, motivational interviewing, acceptance/mindfulness-based approaches, and the 12-step approach, used by mutual aid groups like Alcoholics Anonymous. Combining therapies and medications enhances treatment efficacy, helping to modify alcohol-related attitudes and behaviors.

Among FDA-approved medications, disulfiram, naltrexone, and acamprosate stand out for their different methods of reducing consumption and promoting abstinence. While disulfiram causes severe adverse reactions to alcohol consumption to create unpleasant sensations during drinking, but also making adherence to treatment more difficult, naltrexone blocks the rewarding effects of alcohol; both have proven efficacy in reducing excessive consumption. Acamprosate, on the other hand, helps maintain abstinence by alleviating severe withdrawal symptoms. Additionally, repurposed “off-label” medications such as topiramate and gabapentin also show efficacy, reducing excessive consumption and aiding sleep initiation and maintenance.

Despite the proven effectiveness of treatments, fewer than 8% of adults with AUD receive any form of intervention, and less than 2% have access to approved medications. Significant barriers, such as a lack of public policies, inadequate screening, and stigma, further hinder access. Although the SBIRT model (Screening, Brief Intervention, and Referral to Treatment) is effective for early detection, it remains underused and still rarely implemented by healthcare professionals, whether in public or private systems. Additionally, the lack of appropriate facilities, delays in the approval of new medications, and insufficient investment by the pharmaceutical industry in developing addiction treatments compared to other areas represent additional challenges.

The stigma associated with AUD is particularly damaging, as individuals with this disorder often face judgment that holds them accountable for their condition, which negatively impacts their willingness to seek help. This contributes to fewer than 1 in 10 individuals with AUD receiving treatment annually, while about 20% avoid seeking help due to the fear of being stigmatized. Stigma also affects patients in need of liver transplants and can limit participation in clinical trials due to prejudice.

The article emphasizes that, to address these challenges, it is essential to develop a variety of treatments that recognize individual responses to different approaches, whether behavioral therapies or medications. The definition of recovery has been refined to include not only the remission of AUD but also the cessation of excessive alcohol consumption and biopsychosocial well-being. Early diagnoses and interventions at the initial stages of AUD can prevent its progression to more severe forms, while educational resources such as the Healthcare Professional’s Core Resource on Alcohol and platforms like Rethinking Drinking offer tools to raise awareness among healthcare professionals and the general public.

Finally, the three-stage model of AUD highlights intervention targets at each stage, with assessments covering executive function, incentive salience, and negative emotionality, allowing for more personalized treatments. Research to identify new targets for medications and overcome challenges in the pharmaceutical industry is crucial to driving the development of new treatment options. This approach proposes a more comprehensive neuroscientific understanding, aiming to offer individualized and effective treatments.

References:

1. Divya Ayyala-Somayajula, Jennifer L. Dodge, Adam M. Leventhal, et al. Trends in Alcohol Use After the COVID-19 Pandemic: A National Cross-Sectional Study. Ann Intern Med. [Epub 12 November 2024]. doi:10.7326/ANNALS-24-02157