The disastrous effects of alcohol on human life are overwhelming.  Murder, suicide, rape, unemployment, beatings, broken families.... Most of us don't see it, but its huge.  In my new out-patient practice in Champaign, Illinois, one-third of my patients suffering from severe alcoholism, cocaine, and marijuana abuse.  Tobacco abuse is even worse.  One recent patient has been through nine residential treatment programs in central Illinois and is on a waiting list for a tenth as he steals money to support his habit.  Another is fighting off both severe depression and the urges to get drunk and do cocaine.  A third mixes alcohol, marijuana, and cocaine.  All appear to be able to be very capable and productive people, if only they could stop their substance abuse.

Alcoholism has high heritability (50-60%) and is very common: in the US the lifetime prevalence of alcohol dependence is 20% in men and 8% in women (Am J Pharmacogenomics. 2003;3(4):217-32). The way the body breaks down alcohol has been well established.  Genetic variations in the various enzymes along this pathway each appear to affect the tendency to become alcoholic, but no one gene variation is likely to contribute more than a couple percent.  Of course, no one can develop alcoholism unless he or she takes a first drink.  You can't inherit an urge to drink, only a tendency to develop urges more easily.  Alcohol is a depressant drug that is addictive in animals as well as humans.  Variations are only in the ease of addiction.

Treatment for alcoholism and drug abuse has not been very promising according to the results of random assignment studies comparing treatment to less of the same treatment or to no treatment at all.  Alcoholism and drug treatment programs brag about their great success rates, but not one single controlled study out of dozens has clearly demonstrated any long term value.  Out-patient counseling has been demonstrated to be of value, but the benefits are very modest compared to the time and effort invested.  Very few studies have been done comparing two types of treatment.  See Non-Medication Treatment.

In fact, my witnessing how difficult it is to treat substance abuse is what led me into prevention research.  It is better not to start using tobacco, alcohol, marijuana, cocaine, heroin, oxycontin, gambling, etc., than it is to try to treat those who become addicted.  Actually, I do allow that drinking no more than one alcoholic drink per day for those over age 45 does have positive health benefits, but alcohol is much more dangerous than most people think.  I am opposed to drinking before age 45 or using it for anything other than strictly medicinal reasons.  That makes me a real oddball, but I get along fine with alcohol drinkers and try to set a good example by drinking healthy, non-alcoholic alternatives.

Medications are of some value for treating alcoholism, although they help only a very small fraction of patients.  Disulfiram (Antabuse), acamprosate, and naltrexone are covered under Medication Treatment as well as other medicines which have been tried.

Aversion therapy is probably with most successful and easiest way to quit because it helps get rid of the urge to drink.  However, its availability is very limited and no controlled research is available to scientifically demonstrate its value.  I am eager to try out-patient aversion therapy for alcohol dependence.  I hope to randomly assign patients to start multimodal aversion therapy or multimodal therapy without aversion and see which group does better.  People failing in one group would be allowed to switch to the other.  It may not be the best research design, but, believe it or not, it is better than any other research on aversion therapy of alcoholism ever published.  

Anyone wishing to have me work with them, I am happy to treat them for free if they have no insurance.  The best time to stop drinking is now. 

Acupuncture, Laser or Needle, No Benefit:  A randomized trial with sham controls of 48 in-patient alcoholics found no benefit to acupuncture for alcohol withdrawal. Acupuncture for alcohol withdrawal: a randomized controlled trial. Trumpler F, Oez S, Stahli P, Brenner HD, Juni P. Alcohol Alcohol. 2003 Jul-Aug;38(4):369-75

Acupuncture No Benefit: There were few differences associated with treatment assignment and there were no treatment differences on alcohol use measures, although 49% of subjects reported acupuncture reduced their desire for alcohol. The placebo and preference for treatment measures did not materially effect the results. Generally, acupuncture was not found to make a significant contribution over and above that achieved by conventional treatment alone in reduction of alcohol use. 503 patients were randomized in this Minneapolis study. J Subst Abuse Treat 2002 Mar;22(2):71-7

Advice on Tobacco and Alcohol Abuse Often Not Given: A 10 state random telephone survey found that of people who used tobacco or were binge drinkers and who had seen a health care professional within the past year 70% of the smokers and 23% of the binge drinkers had been advised to stop using tobacco or reduce their alcohol drinking. Researchers concluded that many opportunities to help patients were being missed. Physician advice about smoking and drinking: are U.S. adults being informed? Denny CH, Serdula MK, Holtzman D, Nelson DE. Am J Prev Med. 2003 Jan;24(1):71-4

Artichoke Extract Doesn't Help Hangovers: An artichoke extract is being promoted by the health food industry for drinking hangovers. In a carefully done 15-person DB PC crossover study with 1 week washout using normal adults, no benefit was found from taking the recommended three capsules of extract before and after drinking. Measures used included a hangover scale, sleep time, and cognitive functioning 1 hour before and 10 hours after drinking a standard sizeable amount.  U. Exeter, Effectiveness of artichoke extract in preventing alcohol-induced hangovers: a randomized controlled trial. Pittler MH, White AR, Stevinson C, Ernst E. CMAJ. 2003 Dec 9;169(12):1269-73