Alcoholism, how it affects the Brain, why Doctors struggle and the 2 Treatments that seem to Work

It is very difficult to treat.

Unfortunately there is no Magic Bullet like in the treatment of opioid use disorder. The medicine for heroin users almost instantly cures their cravings. Sadly, there is no perfect pill for alcoholism.

The opioid problem is an epidemic. An epidemic is when many people are dying in a short period of time. Yet alcohol seems to cause way more suffering overall.

From my experience in Addiction Medicine, it seems as though alcohol use disorder is one of the hardest problems to treat. Very few are successful. Studies show that 70% of people relapse within a year after getting sober. There is hope, I have met a few that achieved sobriety. I always ask them how. Most of the recovering alcoholics will give two explanations for their success.

The medicines actually work and they attend multiple AA groups every week. That’s it, meds and friends. MEDS and FRIENDS.

I’ll explain the meds next but remember, addiction usually leads to isolation and the absence of friendship. Many times it is rooted in past trauma that a patient, a human being simply tries to escape.

The most successful patients are those who have a solid sponsor who they talk with a few times per week, attend AA meetings several times per week and have accepted that they have ZERO control over alcohol.

Relapse happens.

I’ve seen it a few times now that someone gets sober for a few days, weeks or even months and suddenly disappear from my clinic for a while. Eventually the cat drags them back. Usually they achieved a period of sobriety but then mistakenly thought they could control the urge to drink. It never works. Unfortunately the frontal lobe that normally exercise self control loses the battle with the primal urge to drink more and more.

Why does alcohol have such a strong grip on the brain?

Alcohol is one of the oldest psychoactive substances known to man. They found evidence in China that people used alcohol as early as 7000 BC. Alcohol is also one of the simplest molecules. The complexity of chemicals is based on how many carbon atoms they contain. Heroin and THC (cannabis) contains 21 carbon atoms, Cocaine and Xanax has 17, Ecstasy has 11. Alcohol only has 2, that’s it! Most substances of abuse act on one neurotransmitter system, alcohol acts on most of them. Maybe that hasto do with its addictive potential. The more obvious reason is that it is readily available. If cocaine and meth were sold at every gas station we would have just as large a problem on our hands.

How does this tiny molecule cause so much havoc in the brain?

Once alcohol enters the brain it acts on multiple receptors but its main effect is on the Gaba System. Gaba is a tiny neurotransmitter that acts like the break in your car. It is the main inhibitory chemical in the brain. It tells the brain to slow down. This explains why alcohol has a calming effect and in high doses can be sedating and even cause black outs or a coma.

The brain also has the opposite neurotransmitter, called Glutamate. This one acts like the gas pedal your car. It is the main excitatory chemical in the brain. It tells the brain to go go go. Normally the Gaba and Glutamate systems are in perfect balance.

When a person drinks alcohol regularly, the alcohol will act on the Gaba receptors, therefore telling the brain to slow down. The brain then tries to reach a balance by producing more Glutamate to balance out this external source of inhibition. Since there is alcohol to tell the brain to slow down there is no more need for Gaba, so the brain decreases the amount of Gaba.

The trouble happens when the alcoholic suddenly stops drinking. In the absense of Gaba, the Glutamate system is so active and upregulated that without the alcohol telling the brain to slow down, the brain becomes hyperactive. The glutamate system is unapposed. This is why chronic alcoholics develop the shakes when they don’t drink for a day. In the worst case they can experience life threatening seizures and delerium tremens.

So what is the solution?

Meds;

The medications we use target the Gaba, Glutamate and opioid systems. To detox an alcoholic in the hospital we can give them benzodiazepines to target the Gaba system. We will then slowly decrease them to allow the gaba and glutamate system to normalize. Another drug is called Acamprosate, it suppresses the Glutamate system, therefore decreases the tremors and other effects of alcohol withdrawal. Naltrexone is another great medicine that targets the opioid system, therefore decreases the reward and euphoria associated with alcohol use. Gabapentin among several others are also used to target the Gaba system.

Disclaimer: please consult your doctor before taking any of these medicines, I take no responsibility for your use of these medicines.

Friends;

Alcoholics Anonymous. I was skeptical at first as well. From the patients I’ve met in recovery, going through the twelve steps seems to be crucial to healing. People develop friendships with others going through the same struggle. The human mind is normally very apprehensive to share it’s faults and failures. A strange thing occurs when one does share these past mistakes or problems. It opens up conversation with other people. It leads to acceptance and eventual healing. I think it’s a form of altruistic help or maybe a future rm of solidarity. By sharing one’s faults, mistakes and struggles, one will receive help to overcome them. By humbling the spirit one finds the way to manage these problems. AA seems to empower people to constantly fight the good fight, together. It lends help and understanding where these people have largely been outcast from society.

AA, Alcoholics Accountable

From moment to moment one is faced with a choice. A choice to choose the better path or the other. The other leads to destruction and shame. Regret sinks in when choosing the wrong path. The easy path leads to pain. AA seems to offer a constant reminder and immediate help from a sponsor to choose the better choice. The daily or weekly meetings help to keep accountable to these choices. It’s a precious thing to find a good sponsor. It’s life changing to find a good mentor.

Good luck, fight the good fight…

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