Alcohol—The Biggest Drug Threat in America

Did you know that alcohol is the biggest drug threat in the world? That’s not an exaggeration, because in sheer numbers, alcohol is the most used, most abused, and deadliest intoxicant – by far. Alcohol is also involved in more crimes and more accidents than any other drug. Look at some of the statistics. Directly or indirectly, alcohol causes:

• Nearly 90,000 American deaths every year.
• Almost 2.5 MILLION lost years of life.
• 10% of all adult deaths between the ages of 20 and 64.
• Over 10,000 drunk-driving fatalities every year.
• That’s one death every 50 minutes.
• Approximately 2200 alcohol poisoning deaths annually.
• That’s 6 deaths per day.
• Sexual assault
• Over 200 serious health problems.
• $224 BILLION annual damage to the US economy

With that in mind, it’s not surprising that in a 2016 survey, 76% of Americans believe that alcohol is the single biggest drug threat in their communities.

• Alcohol – 76%
• Opioid painkillers – 67%
• Heroin – 53%
• Marijuana – 53%

The attitude behind the results of the survey are somewhat surprising, however, because the clear majority of American adults DO drink:

• 86% report lifetime
• 70% report past-year use
• 56% admitted to drinking within the past month

But that also means there are more problem drinkers. According to the National Institute on Alcohol Abuse and Alcoholism, more than 15 million adults and over 600,000 adolescents meet the criteria for an Alcohol Use Disorder (AUD) diagnosis.

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Drinking Levels Defined

Supposedly-safer or “moderate” drinking is defined as no more than drink per day for women, and no more than two drinks per day for men. Anything above this is considered heavy drinking and increases the likelihood of developing a drinking problem. The risk of developing an AUD rises with consumption. For example, the NIAAA says that a “low” risk of AUD begins at: Women:

• 3 drinks per day
• 7 drinks per week

Men:

• 4 drinks per day
• 14 drinks per week

Significantly, even though this is an elevated hazard level, only 2% of “low-risk” drinkers develop an AUD. “High-risk” drinking occurs when: Women:

• 4 or more drinks per day
• 8 or more drinks per week

Men:

• 5 or more drinks per day
• 15 or more drinks per week

Of special relevance, the top 10% of drinkers – those who are most likely to be alcoholic – consume an average of 74 drinks per week.

What Is a “Standard” Drink?

According to the National Institutes Of Health, the definition of a “drink” depends on the type of alcohol consumed and the common serving sizes: Beer, 5% alcohol:

• 12 ounces – 1
• 16 ounces – 1.3
• 22 ounces – 2
• 40 ounces – 3.3

Malt Liquor, 7% alcohol:

• 12 ounces – 1.5
• 16 ounces – 2
• 22 ounces – 2.5
• 40 ounces – 4.5

Wine, 12% alcohol:

• 5 ounces – 1
• 25-ounce bottle – 5

80-proof “Hard” liquor, 40% alcohol:

• 1.5-ounce shot – 1
• 1 pint (16 ounces) – 11
• A fifth (25 ounces) – 17
• 1.75 L (59 ounces) – 39

The amount of alcohol found in mixed drinks can vary considerably. For example, a large Long Island Iced Tea will contain up to five shots of liquor. The amount of alcohol a person drinks can add up quicker than you might think. Even a daily habit of a cocktail after work and a couple of glasses of wine at dinner can cross the line into dangerous drinking.

What Is Binge Drinking and Why Is It Dangerous?

Binge drinking is unhealthy alcohol-related behavior. It is the consumption of a large quantity of alcohol in a short period of time. Two different official agencies set levels for a definition of binge drinking –

1. The NIAAA quantifies binge drinking as 4 drinks for women/5 drinks for men within a two-hour period.
2. The Substance Abuse and Mental Health Services Administration sets the threshold at the consumption of 5 or more drinks on the same occasion at any point within the past 30 days, regardless of gender.

23% of current alcohol users can be classified as binge drinkers. Binge drinking is hazardous for several reasons:

• Rapid intoxication results in a dangerous loss of control.
• Blackout drinking can leave a person vulnerable to violence or sexual assault.
• A 2017 research article published in Frontiers in Behavioral Neuroscience suggests that binge drinkers may suffer permanent brain damage to the areas responsible for attention and working memory.
• Chronic binge drinking can quickly lead to tolerance and dependence, hastening the development of AUD. Significantly, recent research has concluded that the human brain starts “learning” to crave alcohol from the very first drink.

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What Is Alcoholism?

“A lot of alcoholics talk about how they look back and can see that they never knew, never really could predict, when they’d get too drunk, when they’d cross the line from what felt like normal heavy drinking into raging, out-of-control drinking.” ~Caroline Knapp, Drinking: A Love Story Alcoholism, properly called Alcohol Use Disorder, is a medically-identifiable and diagnosable illness characterized by compulsive and excessive drinking, to the point that it results in physical, mental, social, and legal problems. Excessive drinking, especially over the long-term, causes neurochemical changes within the brain. The areas affected are associated with learning, high reasoning, decision-making, reward, and motivation. Impairment of these regions reduces a person’s ability to make rational decisions or resist cravings for alcohol. AUD can be identified by the “ABC’s of Alcoholism”:

• The inability to Abstain from alcohol. – The person cannot regulate when or how much they drink
• Impaired Behavior control. – The person is unable to control their behaviors.
• Craving for alcohol and other intoxicants. – The person becomes obsessed with obtaining and consuming alcohol, and an inordinate amount of their time will be spent engaging in compulsive alcohol-seeking.
• Diminished capacity to recognize the cause (excessive drinking) and the effect (consequences).
• Muted Emotional response—Little-to-no internal motivation to change or seek help. Typically, the impetus comes from external pressure – family intervention, court orders, etc.

It is also important to define what AUD is NOT:

• AUD is not a moral failing.
• AUD is not a sign of weakness of character.
• AUD is not merely a bad habit.
• AUD is not a choice.

What Causes Alcoholism?

Addiction in any form is a complicated disease. The development of an AUD is influenced by several factors. To different degrees, each factor plays a significant role in determining whether or not an at-risk person ever fully develops the disorder. But just as significant, these factors can also influence how the AUD manifests and progresses.

• Genetics – So far, a single identifiable “alcoholism gene” has not been found. However, it is known that alcoholism does run in families like other chronic diseases – diabetes, hypertension, heart disease, and cancer, for example. Up to half of a person’s risk of alcoholism is due to genetic vulnerability.

The National Center for Biotechnology Information put out a report titled “Genes and Addiction”, surmising “Addictions are moderate to highly heritable”. This means that a person’s addiction risk is directly proportionate to how close their genetic relationship is to another person with a Substance Use Disorder.

• Home and/or Social Environment –Regular exposure to drinking – especially during childhood or adolescence – is nearly as powerful an influence as genetics. The impact is greatest when a child witnesses parental drinking or intoxication.

In 2013, a study of twins was conducted by the Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University. This study concluded that a younger teenager’s likelihood of using nicotine, marijuana, or alcohol is influenced far more by friends and family than genetic vulnerability. Biological influence doesn’t peak until young-to-middle adulthood.

• Personal Habits and Behavior – When someone is already genetically-susceptible to alcoholism, and then they are subsequently exposed as a child to alcohol abuse, it raises their lifetime risk of problematic drinking. This means they must be extra-cautious when using alcohol or any potential drug of abuse.

In other words, even “normal” experimentation or use can rapidly lead to abuse, dependence, and addiction, because their brain has been “primed” for excessive drinking.

What Other Factors Can Lead to or Worsen Alcoholism?

While not considered direct contributors, there are factors that can strongly influence the likelihood of AUD. People who struggle with any of these issues may “self-medicate” in an attempt to cope with emotional pain:

• Acute stress
• Depression
• Anxiety
• PTSD
• Bipolar disorder
• Schizophrenia
• Disordered eating

How Is a Medical Diagnosis of Alcoholism Made?

Alcoholism is one manifestation of a larger illness – Substance Use Disorder. Per the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), put out by the American Psychiatric Association, a diagnosis for an AUD may be appropriate when the person demonstrates three or more of these symptoms:

• Alcohol tolerance – Resistance to alcohol’s effects. This means the person must increase their consumption in order to become intoxicated or feel alcohol’s pleasurable effects.
• Loss of control – an inability to choose when or how much to drink.
• Inability to quit or cut back— broken promises, failed attempts at rehab, etc.
• Obsession with acquiring, using, or recovering from alcohol — to the point that it interferes with other areas of life.
• Abandonment of interests and responsibilities – loss of interest in hobbies or outside activities, social withdrawal, neglect of obligations
• Continued drinking despite negative consequences – health concerns (hangovers, alcohol poisoning, cirrhosis), relationship issues (arguments, breakups, separation, divorce), financial worries (suspension, termination, unpaid bills), or legal entanglements (arrests, convictions, fines, attorney’s fees)
• Physical dependence – changes within the brain that causes the person to experience withdrawal – psychological and physical distress – whenever alcohol isn’t available. Alcohol withdrawal can begin as early as six hours following the last drink.

Symptoms of Alcohol Withdrawal

Alcohol detox is the process of clearing alcohol completely from a person system, usually in preparation for a rehab program. But quitting drinking after chronic, long-term abuse sends the person’s alcohol-dependent brain into an extremely dangerous state of hyperexcitability, producing a profoundly opposite effect of what is seen during drinking. Alcohol withdrawal has the potential to be fatal. For this reason, an alcohol-dependent person should NEVER stop drinking abruptly or cold turkey. Alcohol detox should ALWAYS be done under the close supervision of qualified medical personnel. Here’s what you need to know about alcohol detox and the withdrawal process:

• Alcohol detox typically takes 3-4 days, but in cases of extreme addiction, it may take up to one week. Minor symptoms may occur periodically for months.
• Roughly half of detoxing alcoholics suffer withdrawal symptoms when they give up alcohol.
• 1 in 5 will experience “the DT’s”, delirium tremens.
• This syndrome is identified by rapid-onset confusion, distressing hallucinations, extremely high body temperatures, and seizures.
• The DTs usually presents two days into withdrawal and persist for up to five days.
• Risk factors include:
  • Age – the older the patient, the greater the danger
  • Long-term alcoholism – 10+ years
  • Previous alcohol withdrawal symptoms, especially among the heaviest drinkers
• Up to 40% of individuals suffering from the DTs will die unless they receive treatment.
• 15% of delirium tremens patients pass away, even after receiving alcohol withdrawal treatment.
• Other symptoms include:
  • Acute anxiety
  • Extreme irritability
  • Profound agitation
  • Potentially-fatal seizures
  • Dangerously-elevated core body temperature
  • Irregular heartbeat
  • Hypertension
  • Profuse sweating
  • Nausea and vomiting, to the point of dry heaving
  • Insomnia
  • Hallucinations auditory, visual, and tactile

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Why is Alcohol so Addictive?

“…heavy drinkers have brain changes that lead to increased feelings of pleasure from alcohol consumption.” ~Dr.  Jennifer Mitchell, Ph.D., Clinical Project Director at the Gallo Center, Adjunct Assistant Professor of Neurology, the University of California San Francisco The ethanol found in alcohol causes neurochemical changes within the drinker’s brain, in essence, “fooling” the brain into thinking that alcohol is necessary to feel normal. Drinking affects several neurotransmitters linked to the brain’s reward system, notably dopamine, GABA, serotonin, glutamate, and endorphins. These neurotransmitters are associated with:

• Reward
• Pleasure
• Learning
• Motivation
• Compulsive behavior
• Memory
• Mood
• Decision-making
• Cognition

Whenever a human being performs an action that promotes survival – eating or sex, for example – the brain rewards the individual with pleasurable sensations. The person learns to associate the action with the reward, motivating them to repeat the action. The use of alcohol and other intoxicants mimics that natural biological response. After a drink, a person feels happier, at ease, and more relaxed. Best of all, those feelings last longer than naturally-stimulated responses. But over time and with chronic heavy drinking, the neurotransmitter response becomes impaired. The first effect is tolerance – the need for constantly-increasing amounts of alcohol to feel the same effects. Eventually, however, the brain’s receptors become fatigued due to constant artificial over-stimulation. Natural production of pleasure-inducing neurotransmitters slows down to the point that the alcoholic cannot experience pleasure or motivation unless they are drinking. But it also means that they cannot even feel normal unless they are under the influence of alcohol. And, when the person stops drinking, the shock to the system triggers harshly-unpleasant symptoms of withdrawal that are so painful as to push the person back into active drinking.

The Consequences of Excessive Drinking

“Far more people have had their health destroyed by intemperate drinking than those whose health has benefited from it.” ~Reverend Cecil Newell, Pilgrims Long-term alcohol abuse can have a disastrous impact on a person’s physical and mental health. Both directly and indirectly, approximately 88,000 Americans die every year because of alcohol-related causes. That works out to 2,570,870 lost years of life.

• 10% of Americans lose about 30 years of life because of problem drinking.
• Men account for 77% of alcohol-related deaths.
• Alcohol abuse is the third-leading cause of preventable death in America.

Alcoholism and Serious Health Concerns

The World Health Organization estimates that there are over 200 diseases and injury conditions attributable to alcohol, including:

• Brain size – decreased volume, even at “moderate” drinking levels
• Brain cell function – “moderate” drinking led to up to a 40% decrease in brain cell production
• Memory loss – doubled risk
• Cognitive impairment – long-term “low-risk” drinking can mean an additional six years of mental decline later in life
• “Wet Brain” syndrome – a fatal degenerative brain condition caused by thiamine deficiency. 80% of alcoholics are thiamine-deficient.
• Night blindness
• Optical neuropathy
• Macular degeneration
• Cataracts
• Cellular aging
• Ringworm
• Hives
• Eczema
• Psoriasis
• Rhinophyma
• Rosacea
• Porphyria cutanea tarda – an allergy to sunlight
• Hyperpigmentation
• Jaundice
• Caput medusa – distended abdominal blood vessels
• Palmar erythema – reddened palms
• Spider telangiectasis – burst blood vessels
• Lingua villosa nigra— also known as “black hairy tongue”
• Swollen tongue
• Tooth decay
• Gingivitis
• Chielitis – inflammation of the lips
• Myopathy – up to 60% of alcoholics suffer from a breakdown of muscle tissue
• Alcoholic polyneuropathy – nerve pain and weakness in the legs
• Cardiomyopathy
• Atherosclerosis – hardening of the arteries
• Hypertension
• Bone loss
• Pancreatitis
• Type II diabetes
• Cirrhosis of the liver
• Liver fibrosis
• Fatty liver
• Alcoholic hepatitis

Drinking and Cancer

“From a cancer prevention perspective, the less you drink, the lower your risk of and alcohol-related cancer and, obviously, if one doesn’t drink at all, then that’s the lowest risk.” ~ Dr. David Nelson, Director, Cancer Prevention Fellowship Program, US National Cancer Institute Research has revealed that any supposed health benefit provided by alcohol is far outweighed by an elevated risk of cancer. Some estimates conclude that drinking is responsible for 10 times as many deaths as there are lives it has saved. Significantly, the American Journal of Public Health reports that, annually, the use and abuse of alcohol causes 3.5% of all cancer deaths in America – roughly 1 in 30. This works out to 19,500 lost US lives annually. It appears that the cancer risk is dose-dependent because two-thirds of all alcohol-related cancer deaths are among drinkers consuming three or more alcoholic beverages daily.

The Effect Drinking Has on Specific Cancers

• Breast Cancer – Overall, each daily drink increases the risk by 7%. In females, however, the hazard is far worse – after just two drinks per day, a woman’s risk of breast cancer jumped by 33%
• Head and Neck Cancers (tracheal, esophageal, mouth) – Individuals who both drink and smoke have the likelihood that is 35 times greater than people who do neither. In fact, 75% of head and neck cancers are among those who do both.
• Colon Cancer – Taking even one drink per day increases the risk by 70%.
• Pancreatic Cancer – 3+ drinks of “hard” liquor per day raises the risk of death by 36%.
• Liver Cancer – Up to 36% of all liver cancer cases are caused by excessive drinking.
• Melanoma – each daily drink increases the risk by 14%

Alcohol Abuse and Liver Damage

Excessive drinking is the leading cause of cirrhosis of the liver and liver disease deaths. Recently, a long-term Swedish study concluded that drinking during young adulthood may cause liver problems later in life.

Liver Diseases Tied to Drinking

The study commenced in 1969 and involved more than 49,000 Swedish soldiers between the ages 18 of and 20. 39 years of follow-up through 2009 revealed that nearly 400 of those men suffered from severe liver disease, including:

• Cirrhosis – characterized by excessive scarring of the liver.
  • Annually, there are approximately 493,000 global alcohol-related cirrhosis deaths.
  • In the United States, 40% of cirrhosis deaths are attributable to alcohol.
• Liver Cancer –
  • Up to 36% of liver cancer cases are caused by excessive drinking.
  • 90% of patients with liver cancer also have cirrhosis.
• Esophageal Varices – swollen veins caused by increased blood pressure within the liver
• Hepatorenal Syndrome – a common complication of cirrhosis, this is progressive kidney failure. The mortality rate is extremely high.
  • Within the first year of their diagnosis, 18% of HRS patients die.
  • 39% will die within five years.

For those with the condition, the only long-term effective treatment option is a liver transplant.

• Hepatic encephalopathy – Cognitive problems attributable to liver failure. Symptoms:
  • Swelling of the brain
  • Confusion
  • Disorientation
  • Memory loss
  • Amnesia
  • Personality changes
  • Loss of inhibition
  • Irritability
  • Inverted sleeping pattern

40% of people with cirrhosis will develop HE. In dual cases, over half will die within a year. There are no effective medical treatments for alcohol-induced liver disease.

Special Concerns for Men

Men are more likely to abuse alcohol than women are, and are therefore at elevated risk of harm. According to the Centers for Disease Control and Prevention:

• Almost 6 out of 10 men admit to binge drinking within the last month.
• Roughly 1 out of 4 men will binge drink an average of 5 times per month, consuming an average of 8 drinks per occasion.
• Men are more likely than women to be alcohol-dependent within the past year, 4.5% versus 2.5%.
• Excessive drinking affects male hormonal levels, resulting in:
  • Impotence
  • Infertility
  • Reduced secondary sexual characteristics
• Alcohol use increases the likelihood of risky sexual behavior.
• Men are more likely than women to commit suicide while intoxicated.
• Among drivers involved in fatal accidents, men are twice as likely as women to have been impaired by alcohol at the time.

Special Concerns for Women

Drink for drink, women are far more vulnerable to alcohol’s effects than men. Part of the reason for this, of course, is the difference in the average woman’s size, compared to that of the average man. But women also metabolize alcohol differently. This is because women have less body water than similarly-sized men. After consuming the same number of drinks, a woman will have a higher concentration of alcohol in her blood than would a man. This means that among alcohol abusers, women are more vulnerable than men to:

• Alcoholic hepatitis
• Cirrhosis
• Alcohol-induced brain damage
• Heart disease
• Breast cancer
• Sexual victimization
• Domestic or dating violence

Underage Drinking – It IS a Big Deal

Alcohol kills over 4700 young Americans every year. To frame that number correctly, that is more lost lives than from all other drugs COMBINED. According to the National Survey on Drug Use and Health, 1 out of every 5 American adolescents and young adults between the ages of 12 and 20 drink regularly. But here’s the thing – binge-drinking accounts for 90% of the alcohol consumed by underage drinkers. In other words, binge drinking is virtually the ONLY way that teenagers drink. And they do it a LOT—11% of all the alcohol consumed in the US is by adolescents, teens, and not-yet-legal young adults. This is such a problem because the human brain is at its greatest vulnerability to the harmful and addictive effects of alcohol during the formative adolescent and young adult years.  Of special relevance, the brain does not finish maturing until the early-to-mid-20s. How much does alcohol affect an immature brain? An adolescent who starts drinking before the age of 15 is six times more likely to eventually develop an AUD than someone who waited until they were of legal age.

Is Alcohol a Gateway Drug?

“That alcohol was the most widely used substance among respondents, initiated earliest, and also the first substance most commonly used in the progression of substance use.” ~the Journal of School Health Researchers from the University of Florida and Texas A&M evaluated data from 2016 Monitoring the Future study and made the following discoveries:

• 54% of 12th-graders say that alcohol was their first drug used.
• Adolescents who first used alcohol in the 6th or 7th grades will later go on to try an average of two other illicit substances.
• Those teenagers who wait until the 12th grade to take their first drink will only try an average of .4 other substances.

Researchers went on to write, “Overall, early onset substance initiation, whether that is alcohol, tobacco, or other drugs, exerts a powerful influence over future health risk behavior.”

Deadly Interactions – Mixing Alcohol with Other Drugs

Alcohol is a Central Nervous System depressant, meaning it has an effect on breathing, heart rate, and blood pressure. Drinking while taking certain prescription or over-the-counter medications can be dangerous, and even fatal. Benzodiazepine Tranquilizers (Xanax, Valium, Klonopin, etc.) Both alcohol and “benzos” are sedating CNS depressants. Mixing the two leads to magnified effects:

• Confusion
• Dizziness
• Impaired memory
• Irritability
• Aggression
• Unconsciousness
• Coma

Between 2005 and 2011, there were nearly 164,000 emergency room visits for alcohol/benzodiazepine interactions. Opioids (OxyContin, Vicodin, Heroin, fentanyl, etc.) “Unfortunately, we’re seeing more fatalities and people in emergency rooms after having misused or abused legally prescribed opioids, like oxycodone, while having consumed alcohol.” ~ Dr. Albert Dahan Because opioids are CNS depressants that significantly suppressed normal breathing, mixing painkillers with alcohol can lead to death by respiratory depression. This effect is even more profound in elderly patients. Antidepressants (Prozac, Cymbalta, Wellbutrin, Zoloft, etc.) Alcoholism and depression often co-occur, which makes a dangerous interaction between medication and alcohol all-to-likely. Potential side effects may include dangerously-elevated blood pressure, cognitive impairment, drowsiness, dizziness, deepened depression, and suicidal thoughts. Stimulants (Adderall, Ritalin, Vyvanse, cocaine, etc.) Illicit and prescription stimulants counteract the sedating effects of alcohol. This means that drinkers consume far more alcohol well past the point where they would normally pass out. This increases the risk of potentially-fatal alcohol poisoning.

How Is Alcoholism Treated?

“The more you have a treatment that can help you become continuously abstinent, the better you do. You have to figure out how to be abstinent. You still have cravings. You still have friends offering you drugs. You still have to figure out ways not to use. The longer you are able to do that, the more you are developing skills to help you stay abstinent.” ~ Dr. Lisa Onken, National Institute on Drug Abuse AUD is a disease that is best treated through a combination of evidenced-based recovery strategies, combined with holistic total-wellness options including:

• Cognitive Behavioral Therapy
• Individual Counseling
• Peer Group Therapy
• Trauma Processing
• 12-Step Meetings
• Treatment for Co-occurring Conditions
• Relapse Prevention and Response
• Avoiding Triggers
• Medication Assistance
• Healthy Coping Skills
• Stress Reduction
• Effective Communication
• Conflict Resolution
• Exercise
• Yoga
• Acupuncture
• Mindfulness Meditation
• Hypnosis
• Nutritional Guidance
• Art/Poetry/Music therapy
• Pet or Equine Therapy

These therapies can be offered in any combination of residential and/or outpatient programs. One of the most important considerations is the length of treatment. Most experts in the addiction recovery field agree that for treatment to be effective, it must last a MINIMUM of 90 days. To be clear, the length of treatment DIRECTLY affects the chances of successful recovery. A Los Angeles Times article reported that patients remain in treatment for less than 90 days will relapse at over TWICE the rate of individuals who stay in a treatment program for 90 days or more.

What Are Some Anti-Alcohol Medications?

Combining counseling and peer support with anti-alcohol medications is the “gold standard” for a successful recovery from AUD. Used correctly, these medications can ease withdrawal symptoms, reduce cravings, address co-occurring disorders, and ultimately, prevent relapse.

• Acamprosate (Campral) – Acamprosate increases the number of days that a patient can successfully and completely refrain from alcohol use. Importantly, it also helps with insomnia frequently suffered during early recovery. Acamprosate is the first-line option for alcoholics already suffering from liver damage or disease.
• Baclofen (Gablofen, Kemstro, Lioresal)– Although this anti-spastic muscle relaxant has not been specifically approved by the Food and Drug Administration for the treatment of AUD, it has, nonetheless, been used “off-label” effectively. In addition to possessing sedative and anti-anxiety properties, people who take baclofen for at least three months are far more likely to abstain from drinking – 71% versus 29%. Importantly, baclofen carries no potential for abuse.
• Benzodiazepine Tranquilizers (Valium, Librium, Klonopin) – These tranquilizers are commonly prescribed to treat such alcohol withdrawal symptoms as insomnia, anxiety, or seizures. While they are safe over the short-term, caution is urged, because “benzos” are highly-addictive in their own right.
• Calcium Carbamide (Temposil) – This is an “alcohol aversion” drug – it interferes with how alcohol is metabolized by the body. If a person taking Temposil consumes any amount of alcohol, they will rapidly suffer an extremely unpleasant reaction:
  • Sweating
  • Severe headache
  • Rash
  • Rapid heartbeat
  • Shortness of breath
  • Extreme nausea
  • Uncontrollable vomiting

When Temposil is used as part of a treatment program that includes behavioral counseling, success rates are over 50%.

• Carbamazepine (Tegretol) – Although this medication is primarily used to treat neuropathic pain and epilepsy, it is particularly effective at helping individuals who have previously failed at detoxing from alcohol.
• Disulfiram (Antabuse) – This is another medication used in “aversion therapy”. If a person taking Antabuse consumes even a minuscule amount of alcohol, within five minutes, they will suffer:
  • Throbbing headache
  • Flushed skin
  • Shortness of breath
  • Accelerated heartbeat
  • Severe nausea
  • Copious vomiting, to the point of dry heaving

Significantly, Antabuse is effective when any alcohol has been consumed within the previous 12 hours. It is also length-dependent. In other words, the longer the medication is taken, the stronger its anti-alcohol affects become.

• Gabapentin (Neurontin, Horizant, Fanatrex) – Although gabapentin is typically prescribed as a pain reliever, it is NOT an opioid, and therefore carries little-to-no potential for addiction. When given at high doses for non-seizure alcohol withdrawal, gabapentin increases the number of days that a patient can remain alcohol-free. Even on non-abstinent days, the use of this medication can decrease the incidence of “heavy” drinking.
• Nalmefene (Selincro) – Primarily dispensed as an opioid reversal medication, this medication shows promise as a means of reducing alcohol consumption:
  • Reduced daily alcohol consumption
  • Fewer days spent drinking
  • Fewer “heavy” drinking days

Nalmefene is typically given to those patients who want to cut back on their alcohol use, but who don’t necessarily want to completely stop drinking.

• Naltrexone (ReVia, Vivitrol) – While mainly given for opioid dependence, naltrexone drugs also blocks the effects of alcohol. With this medication, there is no risk of dependence or abuse. It is available as an oral medication or as a once-a-month doctor-administered injection.
• Phenobarbital (Luminal) – This barbiturate meditation is effective at controlling the tremors and seizures frequently seen during alcohol withdrawal. Importantly, it also reduces anxiety.
• Propranolol (Inderal, InnoPran) – This treatment for high blood pressure is currently being studied as a treatment for AUD because it affects the emotional memory of cues that trigger compulsive drinking.
• Topiramate (Topamax) – Multiple studies have concluded that this anticonvulsant medication may be ineffective treatment for AUD. Patients taking Topamax report:
  • 26% more alcohol-abstinent days
  • 28% less “heavy” drinking days
  • Reduced consumption on non-abstinent days – 3 fewer drinks per day
• Varenicline (Chantix) – Although primarily prescribed as an anti-smoking medication, a 2013 study concluded that patients given varenicline were able to reduce their number of “heavy” drinking days by 22%.

No-Prescription Medications for Alcohol Recovery

In addition to medications that specifically help with cravings and withdrawal, there are other prescription drugs and OTC remedies that can ease the transition from AUD to successful sobriety:

• Thiamine/Vitamin B1 – helps correct the deficiency caused by chronic alcohol abuse
• Pyridoxine/Vitamin B6 – helps restore neurotransmitter production
• Pregabalin (Lyrica) – for seizures and anxiety
• Methocarbamol (Robaxin) – this muscle relaxant helps with spasms
• Imipramine (Tofranil) – lessens depression
• Haloperidol (Haldol) – treats hallucinations and psychosis
• Folic Acid/Vitamin B9 – helps with depression
• Chlorpromazine (Thorazine) – alleviates restlessness and anxiety
• Clonidine (Catapres) – eases anxiety by lowering heart rate and blood pressure. Encouragingly, 85% of patients given both naltrexone and clonidine are able to complete alcohol rehab.

The Bottom Line – Good News about Recovery from Alcoholism

“This study offers recovering alcoholics a sense of hope. Hope that even within two weeks of abstinence, the recovering individual should be able to observe improvements in brain functioning that may allow for better insight and thus ability to remain sober.” ~ Dr. Natalie May Zahr, Stanford University School of Medicine It should be obvious by now that long-term alcohol abuse can have a serious and negative impact on a drinker’s physical and mental health. But a 2012 study offers hope to anyone who has struggled or is currently struggling with an AUD. The study suggests that with abstinence, some of the brain damage caused by excessive drinking may be reversible. Specifically, some areas of the brain may be able to recover from alcohol-induced volume loss. The regions of the brain that show promise and improvement include those associated with coordination, fine motor skills, and cognitive functioning. These findings dovetail nicely with a 2014 study conducted by researchers at the Medical University Innsbruck, which determined that abstinence from alcohol can reverse the bone loss commonly found among problem drinkers. What does all this mean? It means that despite the dangers and the damage, there is hope for a healthier and happier life after active alcoholism. It means that the best time to begin recovery is always RIGHT NOW, before the health consequences worsen further.

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