Addiction is a social term that is medically called Substance use disorder, which is considered to be a mental health condition. Alcohol dependence is one of the leading causes of preventable deaths in the world and seen as a major public health hazard. It is a serious condition with far-reaching personal, societal and public health implications. While there are advances in the understanding of it as a disease process, there has been progress in its management as well.
There have been significant advances in the space of alcohol use disorder management – one of them is the introduction of motor rehabilitation (as opposed to the usual cognitive control to reduce impulsive choices) in the rehabilitation program. Another is using positive environmental conditions, such as environmental enrichment to reduce the intense and urgent desire for alcohol (anti-craving techniques). Counseling techniques that increase the insight into the disease are also being introduced. Yet another is Deep Brain Stimulation (DBS) in severe, refractory cases of alcoholism. Let’s look into them individually.
Motor rehabilitation: The stop-signal reaction time (SSRT) is used as a clinical index for impulsivity. Subjects who are more impulsive are slower to respond to a stop signal. It is for that reason that a cocaine user will display significantly poorer ability to inhibit their responses. This suggests that there is a neurobiological phenotype for stimulant drug addiction and indicate that there might be some brain abnormalities that predispose one to self-control and inhibition issues which then lead to use disorders.
Environmental enrichment: It is well-known that environmental conditions can dramatically influence the behavioral and neurochemical effects of drugs of abuse, which is why it is being postulated that environmental enrichment can reduce the reinforcing effects of drugs and may provide protection against the development of drug addiction. An enriched environment means one where there are stimulating social interactions, higher motor activity, and larger cognitive stimulations.
Anti-craving: This simply means actions taken to reduce harmful alcohol consumption. Group therapies (AA) and medications that reduce craving help patients to develop better insight and high motivation to achieve abstinence, rather than the other way around.
Deep Brain Stimulation (DBS): This is a surgical treatment involving the implantation of a medical device in the brain and may be considered only in severe cases of alcoholism. DBS sends electrical impulses to specific parts of the brain and inhibits centers involved in craving and dependence. Especially in alcoholics who have an underlying condition of Obsessive Compulsive Disorder (OCD) might be the best candidates for this intervention.
Overall, alcohol use disorder manifests clinically with a wide spectrum and one size does not fit all. As the understanding of the disease process improves, newer interventions are being introduced to capitalize on that, with a goal to lower the substantial mortality and morbidity rates associated with alcoholism.
