The Complexities of Treating Alcoholism
March 31, 2000 (Atlanta) -- The drinking often starts when they are young, age 14 or 15. By the time they hit 20, they are showing signs of dependency: they miss work, have legal and money problems, and earn too many traffic tickets. By the time they reach 40, they are looking for help.
"You're talking about people who have over-relied on alcohol for decades to manage anger, loneliness, shyness, conflict, all the stuff of life, and they really haven't gotten their skills up in a lot of areas. It's a very progressive disorder," Barbara Mason, PhD, tells WebMD. Mason is a professor of psychiatry and behavioral sciences and director of the substance abuse division at the University of Miami.
The origins of alcoholism have long been debated. "Even ancient peoples thought about alcoholism as a disease, as opposed to a behavioral or moral problem," says Karen Drexler, MD, an addiction psychiatrist and assistant professor of psychiatry/behavioral sciences at Emory University Health Sciences Center in Atlanta.
"I think the difficulty in understanding alcoholism as a disease is that most of us are able to drink alcohol and not become addicted to it. It makes it a conundrum for those who have not been addicted to understand," Drexler tells WebMD.
About 90% of Americans drink some alcohol; between 15% and 25% can become addicted at some point of their lives. The risk is higher if alcoholism runs in your family, says Drexler. "There's very active research going on to understand what genes contribute to the risk. There have been a couple of candidates that haven't been borne out, but I think in the next few years we will know."
Researchers have identified a gene that controls production of aldehyde dehydrogenase, an enzyme that processes alcohol. If you inherit a gene that doesn't function correctly, the alcohol by-product acetaldehyde is not fully broken down and builds up in the system. "It makes you feel really sick," Drexler says.
Antabuse, the long-time alcoholism treatment drug, works on the same principle. By blocking alcohol's metabolism, it causes serious reactions: shaking, vomiting, and sweating.
"Antabuse works very well, if you take it," Drexler says. However, Antabuse has never been a cure-all. Many people with liver and heart disease can't take it; others are afraid of the intense reactions it causes. "I have a whole case series of patients who say that Antabuse has saved their lives, but I have more who have been afraid to take it," Drexler says.
Because alcohol acts on the brain's reward pathways, the amount consumed also controls the disease's development, Drexler says. "So even if you don't have a strong family history of alcoholism, if you drink heavily, you can develop it. We know that alcohol, like other addicting processes, acts on this reward pathway, activates it in an artificial and more powerful way than natural rewards do, like food, love, accomplishments."