Alcohol Use Disorder Treatment: Problems and Solutions
Abstract
Alcohol use disorder (AUD) imposes a significant burden on society that inflicts significant medical and social costs. In the United States, most afflicted individuals do not receive treatment, and closing this treatment gap is an ongoing challenge. Effective behavioral health treatments and FDA-approved medications are available but greatly underutilized, contributing to a major treatment gap.
Given the diverse biological processes that contribute to AUD, new medications are needed to provide a broader spectrum of treatment options. A starting point for exploring the heterogeneity of AUD with regard to treatment includes engaging a heuristic framework for AUD that includes a three-stage cycle—binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation—with three domains of dysfunction that parallel each stage and have been validated and replicated.
This review outlines challenges that face the alcohol field in closing the treatment gap, and it offers solutions, including broadening end points for the approval of medications for the treatment of AUD; increasing the uptake of screening, brief intervention, and referral to treatment; addressing stigma; implementing a heuristic definition of recovery; engaging the concept of early treatment; and educating health-care professionals and the public about challenges that are associated with alcohol misuse. Additionally, broadening potential targets for the development of medications for AUD, based on the three-stage heuristic model, will provide a neuroscience- and neurocircuit-based rationale for reestablishing homoeostatic function in reward, stress, and executive function domains, now known to be the root cause that perpetuates AUD. Such a neuroscientific approach will require a scaling up of the current reductionistic molecular-microcircuit targets under intense investigation in addiction research today but, ultimately, will allow individualized medicinal treatments for AUD that account for diversity in all domains, from gender to culture to individual makeup.