The U.S. Centers for Disease Control and Prevention recently came out with a study that found six Americans die every day on average from alcohol poisoning.
Perhaps more surprising is that it turns out that most deaths from drinking too much involve middle-aged adults, not teens or college students.
The study doesn’t point at causation, but the CDC did raise new questions for further research. Although more research is always a good thing, it’s unwise to think that we don’t already know a lot about drinking and alcoholism. For example, “drinking too much” is not always “alcoholism.”
Breakthroughs in genetics, neurobiology and neuropharmacology have led scientists to know that some people who drink harmfully may develop a full-blown disease, leaving them unable to stop drinking without help.
Many people drink too much to get high, to celebrate, or to overcome anxiety or depression and never have any long-term negative effects. However, 10 to 15 percent of people who use alcohol develop the disease of alcohol dependence.
People who argue about whether “alcoholism” is a disease are like blind persons examining an elephant they believe only the parts they touch.
If someone is familiar with the part of alcoholism that is the pain caused by an abusive alcoholic parent, her belief is shaped by that experience.
If they have been touched by their own alcohol use, that will define their belief about whether they have a drinking problem.
But alcohol dependence, the brain disease, is a definitive, diagnosable, brain pathology in the realm of epilepsy, Parkinson’s and Alzheimer’s.
This means that one of the causes of what is popularly called “alcoholism” is a neuropsychiatric problem in which something has gone wrong in specific parts of the brain, mostly in the brain’s “reward pathway.”
The brain disease is similar to a schizophrenic person losing the ability to dampen “internal voices.” People who are alcohol dependent require powerful intervention and intensive treatment that can be expensive and prolonged.
Problem drinking, on the other hand, is a self-controllable condition that may be reduced by education, punishment, maturity, will-power or simply learning from an embarrassing or costly experience.
Research that has helped clarify the differences between alcohol dependent and problem drinkers has been massively underreported.
For instance, the long-awaited connection between neuroscience and psychological counseling has now been discovered. Recent brain scan studies show clearly that counseling methods such as cognitive behavioral therapy (CBT) change brain function in a positive way.
This strongly suggests that 12-step programs and other “talk therapies” normalize the brain’s reward pathway, likely involving a change in reward pathway neurotransmitter systems that have gone wrong.
Anti-craving and abstinence-enhancing medications are sufficiently effective that they have helped significant numbers of dependent drinkers stay clean and sober, especially by preventing relapse. Continuing genetic studies are expected to provide even better reward system-targeting medications.
And finally, studies on 12-step programs themselves have now reached the point at which some alcohol researchers are calling them “evidence based” or research-proven. They recommend that such programs when used in the best holistic treatment centers should be reimbursed by insurance companies.
So what can we do when so many middle-aged Americans are dying from alcohol poisoning? We must educate everyone that some people can moderate their drinking through a simple understanding of the dangers of alcohol poisoning, while other people cannot control their drinking without effective treatment of their disease.
More funding available for research on more effective alcohol intoxication prevention methods is badly needed.
Such knowledge is huge for anyone suffering from alcoholism or other drug addictions, and for those worried about the future of a loved one’s drinking and drug use.
Carlton K. Erickson is a Distinguished Professor of Pharmacology and Toxicology and director of the Addiction Science Research and Education Center in the College of Pharmacy at The University of Texas at Austin.
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