Alcohol Use Disorder

Key Insights

• Alcohol use disorder (AUD) is the most common substance use disorder. AUD is complex in nature, with no singular cause and a range of symptoms. Excessive alcohol consumption puts a person at risk of developing a range of other health conditions such as heart disease and mental health issues.
• AUD is often experienced comorbidly alongside mental health disorders including depression, anxiety and PTSD. People experiencing mental health problems often turn to alcohol as a coping mechanism which can lead to alcohol dependence and exacerbate mental health issues.
• Psychedelics hold promise for the treatment of AUD. While psychedelics have been well-researched in substance use disorders in general, few studies have looked at AUD specifically. Both ketamine and MDMA are under investigation by Awakn Life Sciences and early clinical trial results are promising.

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 that are 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 strong 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, their 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. In turn, excessive alcohol consumption puts a person at risk of developing a range of other health conditions including cancer, liver disease and heart disease. Moreover, unhealthy drinking can damage the brain and ultimately lead to mental health problems or exacerbate any existing problems [2].

In fact, 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 largely a consequence of heavy, prolonged alcohol consumption and the impact it has 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 chances of them developing AUD are higher than in the general population. Thus, the prevalence of AUD in this population is particularly high [8].

Across the globe, AUD is the most prevalent of all substance use disorders. While the rate of consumption 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 a large number of years lived with disability, a metric used to reflect the impact has on quality of life [9]. Furthermore, alcohol consumption causes 2.8 million premature deaths per year [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 beings with 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 the group Alcoholics Anonymous. Such programs offer individuals the opportunity 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]. A variety of 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 to 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 rates of recovery [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 find out more about how psychedelics are being used to treat substance use disorders in general, check out our previous article. In this section, we will explore psychedelics and alcohol use disorder specifically, the state of research, and companies working in this space.

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 did not differ across the four groups.

Interviews with participants (n=12) in a trial investigating the effects of ketamine in AUD identified a number of 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 led to a transformation of the patients’ self-reported relationship to alcohol.

MDMA

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

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 when 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 exist surrounding this psychedelic’s ability to help those with AUD. These positive benefits largely come from Indigenous populations who use ayahuasca for religious purposes as well as the many people who have travelled to countries like Peru and Colombia where they can take part in ayahuasca ceremonies led by Indigenous groups.

A qualitative interview study (n=32) of members of the Santo Daime Church, 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 full 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 U.K.-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 U.K. as well as in Norway.

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 is focusing on developing novel psychedelic compounds primarily for the treatment of 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.

Ultimately, psychedelics hold promise for the treatment of 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.

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