Understanding Alcohol Use Disorder

Alcohol Use Disorder (AUD) is a complex chronic condition characterized by persistent or recurrent problematic alcohol use leading to impairment or distress. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines specific criteria for diagnosing AUD, including:

• Impaired control (e.g., drinking more or longer than intended, unsuccessful attempts to cut down or quit)
• Social impairment (e.g., failure to fulfill major role obligations, continued use despite social problems)
• Risky use (e.g., drinking and driving, drinking despite physical problems)
• Tolerance and withdrawal (physiological adaptations requiring increased amounts of alcohol to achieve the desired effect and experiencing withdrawal symptoms when alcohol use decreases)

Alcohol: The Substance

Alcohol, or ethanol, is a central nervous system depressant derived from the fermentation of grains, fruits, or other substances containing sugar. It’s widely available and socially accepted, making it one of the most commonly abused substances.

Street Names: While alcohol itself doesn’t have specific street names, alcoholic beverages often do. For example, beer might be referred to as “brew,” “hops,” or “sudz,” while liquor might be called “spirits,” “booze,” or “hard stuff.”

Methods of Use: Alcohol is typically consumed orally in various forms, including beer, wine, and spirits.

Symptoms of Intoxication: The effects of alcohol depend on the amount consumed, individual tolerance, and other factors. Common symptoms of intoxication include:

• Impaired judgment and coordination
• Slurred speech
• Euphoria
• Aggression
• Blackouts
• Nausea and vomiting

Symptoms of Withdrawal: Alcohol withdrawal can range from mild to severe and can include:

• Tremors
• Anxiety
• Insomnia
• Sweating
• Nausea and vomiting
• Seizures
• Delirium tremens (in severe cases)

Treatment of Alcohol Use Disorder

A comprehensive treatment approach for AUD typically includes a combination of pharmacotherapy, psychotherapy, and psychosocial support.

First-Line Treatment Options

• Psychotherapy: Cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), and support groups (e.g., Alcoholics Anonymous) are effective in addressing underlying psychological factors and coping skills.
• Medication: Pharmacotherapy can be a valuable adjunct to psychotherapy, reducing cravings and relapse risk.

Naltrexone: A Closer Look

Naltrexone is an opioid receptor antagonist FDA-approved for the treatment of AUD. It works by blocking the reinforcing effects of alcohol, reducing cravings and the likelihood of heavy drinking.

• Mechanism of Action: Naltrexone blocks opioid receptors in the brain, preventing the release of dopamine associated with alcohol consumption. This reduces the pleasurable effects of alcohol, making it less rewarding.
• Common Side Effects: Nausea, headache, and insomnia are common side effects. Liver enzyme elevations have been reported but are usually transient.
• Administration: Naltrexone is available in oral and injectable formulations. The oral form is taken daily, while the injectable form (Vivitrol) provides a longer-acting effect with a single monthly injection.
• Monitoring: Baseline liver function tests are recommended before initiating treatment, with periodic monitoring thereafter. Blood pressure and heart rate should also be monitored.

Non-Pharmacologic Interventions

• Psychotherapy: As mentioned earlier, CBT and MET are essential components of treatment.
• Support Groups: Participation in support groups like Alcoholics Anonymous can provide social support and coping strategies.
• Lifestyle Modifications: Addressing stress management, nutrition, and exercise can contribute to overall well-being and reduce the risk of relapse.

Note: It’s important to emphasize that naltrexone is most effective when combined with psychotherapy and other supportive measures. Individualized treatment plans should be tailored to the specific needs of each patient.