15 October 2012

Treating Alcohol Dependence Through Patient Insight Rather Than Abstinence Proposed

On Oct 1997, the journal, Science, published a paper by Alan Leshner. The editorial piece, Addiction Is A Brain Disease, And It Matters, notes that addiction is a "chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impact society's overall health and social policy strategies and help diminish the health and social costs associated with drug abuse and addiction..."

Leshner also suggests that treatment for addiction should include biological, behavioral, and social-context components to be effective.

On a related note, it was announced earlier this year that the Diagnostic and Statistical Manual of Mental Disorders V (DSM-5) to be published in 2013 will categorize both abuse and dependence categories into a single diagnosis in which a person has to meet two or more items for a diagnosis. DSM-5 provides a common language and standard criteria for the classification of mental disorders. With the coming DSM-5, a person can have an "alcohol use disorder" or a "drug use disorder" but not specifically abuse of or dependence on alcohol or other drugs.

This decision has been met with criticism since this might result in a higher amount of people being diagnosed with alcohol abuse compared to now. Critics say that this move may cause a an increased spending on health care for affected people as well as lowering the standard on categorizing the behavior.

Video: Substance Abuse Disorders

Taking a cue from Leshner's paper, researchers are developing new treatments to address alcohol abuse on a psychoanalytic level. They are targeting the treatment to address the patient's insight to his disease rather than developing it before initiating treatment.

They believe that this would better benefit the patient since it reduces craving compared to current treatment that promotes abstinence without addressing the patient's psychological dependence on the substance.

Their approach involves:
  • Motor Rehabilitation
    • Through the Stop-Signal Reaction Time (SSRT) test, the patient slowly develops inhibitory behavior that can assist in resisting the temptation to give in to his impulse to drink.
  • Environmental enrichment
    • By stimulating the patient's environment through increased social interaction, higher motor activity, and larger cognitive stimulation, the patient overcomes the craving and dependence on the substance replaced with a more focused and awareness of the environment and his interactions with it.
  • Reducing harmful alcohol consumption (anti-craving)
    • Using medication that staves off craving (such as baclofen), it allows the patient to focus more on developing better insight and high motivation to achieve abstinence, rather than the other way around.
  • Deep Brain Stimulation (DBS)
    • Using a surgically implanted device in the brain, DBS sends an electronic impulse to a specific part of the brain and directly changes brain activity (such as the craving mechanism) in a controlled manner

Researchers believe that by first treating the psychological behavior of the patient, the physical component of the disease will follow. Current treatments first prepares the patient psychologically before any treatment is administered which researchers feel may force the patient into relapse.

By addressing brain and behavioral activity first and combining it with medication to assist in addressing the craving, rather than just pushing the patient into abstinence through treatments, they feel that the patient has a higher chance of curing himself of the disease.


European College of Neuropsychopharmacology
New approaches in the treatment of alcohol dependence
Addiction is a brain disease, and it matters
Changes To Criteria For Substance Use Disorders In Next Diagnostic and Statistical Manual of Mental Disorders (DSM-V)
New Tool Developed To Monitor Patients Undergoing Deep Brain Stimulation (DBS)
Cognitive Behavioral Therapy (CBT) As An Effective Prevention in the Development of Psychotic Symptoms And Schizophrenia
Deep Brain Stimulation As Treatment for Unipolar and Bipolar Depression
MIT News: Astrocyte Brain Cells Plays Key Role In Processing Sensory Information
Freud's Theory On Unconscious Conflict And Conscious Symptoms of Anxiety Disorder Under Study
The Science of Understanding Stress