Alcohol Use Disorder

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What is Alcohol Use Disorder?

Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD is the overarching term for conditions commonly referred to as alcohol abuse, alcohol dependence, alcohol addiction and the widely used alcoholism [1].

While alcohol may seem like a normal part of social life for many people, in this specific type of substance use disorder, a person’s relationship with alcohol and their drinking habits can be considered “unhealthy.” This unhealthy relationship can take the form of daily alcohol use, binge drinking (the heavy consumption of alcohol over a short period of time) or both [2].

AUD can be mild, moderate or severe, based on the number of symptoms a person experiences. Some of the signs and symptoms include intense cravings to drink alcohol, continuing to drink despite you knowing it’s causing problems, failing to cut down alcohol consumption despite the desire to do so and being unable to limit the amount of alcohol you drink [3].

AUD is a complex disorder. As such, every case is different, and there is no singular cause of AUD. A range of internal and external factors contribute to the development of the disorder. Internal factors include certain underlying mental disorders, one’s personality, genetics, as well as a family history of AUD. Externally, environmental factors such as where someone resides, socioeconomic status, social and cultural norms, and level of education can all impact a person’s likelihood of developing AUD [4].

Together, these factors lead to unhealthy drinking patterns and the overall excessive consumption of alcohol. Excessive alcohol consumption puts a person at risk of developing various other health conditions, including cancer, liver disease and heart disease. Moreover, unhealthy drinking can damage the brain, leading to mental health problems or exacerbating existing problems [2].

People diagnosed with AUD are 3.7 times more likely to have major depressive disorder (MDD), with women with AUD more likely to experience MDD than men [5]. Furthermore, anxiety is often experienced comorbidly alongside AUD. This is primarily a consequence of heavy, prolonged alcohol consumption and its impact on a person’s biological and psychosocial factors [6].

Many people with underlying mental health issues may turn to alcohol as a coping mechanism to distance themselves from stress or challenges they have previously encountered or may currently be facing. Up to a third of people who have experienced a traumatic event in their lifetime report problems with alcohol consumption [7]. In military service members and veterans with PTSD, the likelihood of them developing AUD is higher than in the general population. Thus, the prevalence of AUD in this population is exceptionally high [8].

Across the globe, AUD is the most prevalent of all substance use disorders. While the consumption rate varies from country to country, The Global Burden of Disease initiative estimated there were over 100 million cases of AUD worldwide in 2016. The same study found that excessive alcohol consumption accounts for many years lived with disability, a metric used to reflect its impact on quality of life [9]. Furthermore, alcohol consumption causes 2.8 million premature deaths yearly [10].

Overall, excessive alcohol consumption and subsequent AUD represent a significant threat to public health. AUD can lead to a wide range of problems for an individual and severely impact their quality of life.

How is Alcohol Use Disorder treated?

Treatments for AUD vary from person to person. Treatment is based on the needs of the individual with common approaches including medications, counselling and behavioural therapies. Given that people often become dependent on alcohol, withdrawal symptoms are common once treatment begins. Alleviating these symptoms, stopping or reducing alcohol consumption and providing people with the knowledge necessary to stop or maintain a healthy level of alcohol use is the general aim of treatment [2].

Treatment often involves a medically supervised detox and medication may be required to manage subsequent withdrawal symptoms. Medications such as benzodiazepines are often given to help manage withdrawal symptoms. Overall, there exist three Food and Drug Administration-approved medications for AUD: 1) disulfiram produces unpleasant physical reactions such as vomiting if a person consumes alcohol, 2) acamprosate helps combat cravings once drinking has stopped and 3) naltrexone blocks the good feelings alcohol causes [3].

Talk therapy is usually the next point of call. Cognitive behavioural therapy (CBT) and motivational enhancement therapy are commonly used. The overall aim of therapy is to help individuals better understand their problems and provide support during the recovery process. Mutual-support groups are often very beneficial. Perhaps the most famous of these groups is the 12-step program from Alcoholics Anonymous (AA). Such programs allow individuals to support one another throughout their recovery processes [1].

Despite medications and therapy programs, many people relapse during the treatment process or once the process has ended. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that roughly 90 per cent of people with AUD are likely to experience at least one relapse over the four-year period following treatment [11]. Many reasons have been put forward as to why people may relapse, with much of them relating to the chronic nature of the disease of addiction. Individuals may also face certain problems that cause them to return to drinking behaviours [12].

AUD is a highly prevalent disorder, and with treatments having somewhat limited efficacy, researchers are constantly looking for novel interventions to help people with AUD and better understand the nature of this disorder. One class of psychoactive compounds that have recently found their way back into the laboratory regarding the treatment of AUD are psychedelics.

Psychedelic and Alcohol Use Disorder

Research into the potential of psychedelics to treat substance use disorders, particularly AUD, dates back to the first era of psychedelic research in the 1950s and 1960s. In the 1950s, Humphrey Osmond and his colleagues began treating alcoholics in Canada with LSD and achieved significant recovery rates [13].

These researchers also engaged with Alcoholics Anonymous groups, and co-founder of the AA, Bill Wilson, believed that LSD could help alcoholics achieve a “spiritual awakening and start on the path of recovery [14].”

To learn more about how psychedelics treat substance use disorders in general, check out our addiction topic page. This section will explore psychedelics and alcohol use disorder specifically, the state of research, and companies working in this space.

Psilocybin

A double-blind, active placebo-controlled study led by Michael Bogenschutz at NYU Langone Health was the first to test psilocybin for AUD in a double-blind study. It found that psilocybin significantly reduced the number of heavy drinking days (10% versus 24% in the placebo group) during the 32-week (7 months) follow-up period. This trial involved 95 participants who received psilocybin twice at doses of 25-40mg/70kg. A small study with ten participants by the same group preceded this study.

A systematic review from 2022, which included 20 human studies and seven animal studies, found that the human data on using psychedelics to treat AUD was promising. However, the sample sizes were still small. Psilocybin was the most well-studied psychedelic in this context. The animal studies showed conflicting results, leading the authors to call for more research to understand both the biological and psychological factors involved.

A study in mice identified a deficiency in mGluR2 function, a receptor for the neurotransmitter glutamate, as a common mechanism for increased alcohol-seeking behaviour and impaired cognitive flexibility in rodent models of AUD. Psilocybin was shown to restore prefrontal mGluR2 levels and reduce relapse behaviour. This suggests that psilocybin can treat AUD on a physiological level as well as a psychological level.

Ketamine

Elias Dakwar and the team at Columbia University have explored the effects of using intravenously administered ketamine to treat AUD. In their double-blind placebo-controlled study, a single ketamine infusion in tandem with motivational enhancement therapy to treat AUD found that ketamine significantly increased the likelihood of abstinence, delayed the time to relapse, and reduced the likelihood of heavy drinking days compared with midazolam.

At the University of Exeter, Celia Morgan and colleagues investigated ketamine infusion as an adjunct to prevent-based psychological therapy in AUD. The trial (n=96) assessed the effectiveness of 1) three weekly ketamine infusions (56mg/70kg i.v. over 40 minutes) plus psychological therapy, 2) three saline infusions plus psychological therapy, 3) three ketamine infusions plus alcohol education, or 4) three saline infusions plus alcohol education. It was found that participants in the ketamine groups abstained from alcohol for a significantly longer number of days at a 6-month follow-up, while the greatest abstinence was in the ketamine plus therapy group. However, relapse times didn’t differ across the four groups.

Interviews with participants (n=12) in a trial investigating the effects of ketamine in AUD identified several common themes amongst the participants. Subjective feelings of dissociation and detachment from one’s sense of self and physical body were accompanied by seemingly paradoxical feelings of connectedness with the universe and of decreased self-importance and self-absorption, which transformed the patients’ self-reported relationship to alcohol.

MDMA

After making a case for utilizing MDMA-assisted therapy to treat alcohol disorder in 2017, Ben Sessa and colleagues conducted the world’s first clinical trial investigating the safety and tolerability of MDMA in patients with AUD. 

Published in 2021, this trial found that not only was MDMA well tolerated by participants (n=13), alcohol consumption at nine months post-trial was 18.7 units per week compared to 130.6 units per week before the trial began. While placebo-controlled trials are needed, the findings of this study emphasize the potential of MDMA for substance use disorders.

A trial run by MAPS assessed patterns of alcohol and substance use in patients receiving MDMA-assisted therapy for PTSD. MDMA was associated with a significant reduction in Alcohol Use Disorder Identification Test (AUDIT) scores compared to placebo.

Ayahuasca

Many review articles point to the therapeutic potential of using ayahuasca for treating substance use disorders, including AUD. While few randomized-controlled trials have taken place with ayahuasca, a range of survey studies and positive anecdotal reports surround this psychedelic’s ability to help those with AUD. These positive benefits primarily come from Indigenous populations who use ayahuasca for religious purposes and the many people who have travelled to countries like Peru and Colombia, where they can participate in ayahuasca ceremonies led by Indigenous groups.

A qualitative interview study (n=32) of Santo Daime Church members who use ayahuasca as a religious sacrament reported that this population attributed psychological and physical benefits to their ayahuasca use. Moreover, 22 out of the 24 participants who had reported a history of drug or alcohol dependence were said to be in complete remission, which they attributed to their participation in the church.

This survey study (n=1947) of people attending União do Vegetal (UDV) meetings on substance abuse compared their use of alcohol and tobacco to a national normative sample of Brazilians. While lifetime use of these substances was higher in the UDV-attending groups, the results indicate an association between reduced current alcohol and tobacco use amongst this group who participate in ayahuasca ceremonies.

A large-scale cross-sectional survey study (n=8269) explored the associations between ayahuasca consumption in naturalistic settings and the use of alcohol and other drugs across 40 different countries. Ayahuasca use was both strongly and consistently associated with very low (or even abstinence from) drug or alcohol use, with and without prior substance use disorders.

Psychedelic Companies and Alcohol Use Disorder

The UK-based Awakn Life Sciences is working on using psychedelics to treat AUD. The company is aiming to utilize the therapeutic potential of both ketamine and MDMA to treat this disorder. The aforementioned trials led by Celia Morgan and Ben Sessa are part of the work Awakn is doing to treat AUD. The company already operates ketamine-assisted therapy clinics in the UK and Norway. In May 2023, a Phase III trial started recruiting patients to use ketamine to treat AUD.

Psilera Biosciences has partnered with a team of researchers at the University of Florida to study its proprietary compounds and compare their efficacy to that of the DMT derivative of 4-AcO-DMT or psilacetin, a synthetic form of psilocybin. This research is in the preclinical phase and seeks to determine how their drugs affect alcohol use disorder.

Clearmind Medicine focuses on developing novel psychedelic compounds primarily for treating AUD. The company has developed 5-Methoxy-2-aminoindane (MEAI), a psychoactive compound that exerts a euphoric alcohol-like experience and a reduced desire to consume alcoholic beverages.

Journey Colab is investigating mescaline as a potential treatment for AUD. The focus of their trial, yet to start, is on a strong therapeutic container and using the long plasticity window that mescaline affords.

Ultimately, psychedelics hold promise for treating AUD and other substance use disorders. While further research is needed, the future looks bright for using psychedelics to instil long-lasting change in peoples drinking behaviours and reduce the likelihood of any alcohol-associated harm.

External references for Alcohol Use Disorder and Psychedelics

All resources available on Blossom are directly linked on this topic page. Find even more background about this topic with these external references.

1. NIAAA. (n.d). Understanding Alcohol Use Disorder. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder

2. Yale Medicine. (n.d). Alcohol Use Disorder. Yale Medicine. https://www.yalemedicine.org/conditions/alcohol-use-disorder

3. Mayo Clinic. (n.d). Alcohol Use Disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243

4. Addiction Center. (n.d). Alcoholism Causes And Risk Factors. Addiction Center. https://www.addictioncenter.com/alcohol/alcoholism-causes-risk-factors/

5. McHugh, K., & Weiss, R. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol Research Current Reviews. https://dx.doi.org/10.35946%2Farcr.v40.1.01

6. Smith, J., & Randall, C. (2012). Anxiety and Alcohol Use Disorders. Alcohol Research Current Reviews. https://www.ncbi.nlm.nih.gov/pubmed/23584108

7. U.S. Department of Veteran Affairs. (n.d). U.S. Department of Veteran Affairs. U.S. Department of Veteran Affairs. https://www.ptsd.va.gov/understand/related/problem_alcohol_use.asp

8. Dworkin, E., Bergman, H., Walton, T., Walker, D., & Kaysen, D. (2018). Co-Occurring Post-Traumatic Stress Disorder and Alcohol Use Disorder in U.S. Military and Veteran Populations. Alcohol Research Current Reviews. https://www.ncbi.nlm.nih.gov/pubmed/31198655

9. GBD 2016 Alcohol and Drug Abuse Collaborators. (2018). The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(18)30337-7

10. Ritchie, H., & Roser, M. (2018). Alcohol Consumption. Our World in Data. https://ourworldindata.org/alcohol-consumption

11. NIAAA. (1989). Relapse and Craving. National Institute on Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/aa06.htm

12. Mosel, S. (2022). Alcohol Relapse. American Addiction Centers. https://drugabuse.com/alcohol/relapse/

13. Dyck, E. (2006). ‘Hitting Highs at Rock Bottom’: LSD Treatment for Alcoholism, 1950–1970. Social History of Medicine. https://academic.oup.com/shm/article-abstract/19/2/313/2259116

14. Hill, A. (2012). LSD could help alcoholics stop drinking, AA founder believed. The Guardian. https://www.theguardian.com/science/2012/aug/23/lsd-help-alcoholics-theory