What do you think is the most common drug used by Canadians?
According to the Canadian Centre on Substance Abuse and Addiction – it’s alcohol.
Alcohol is a depressant drug that can affect the central nervous system by slowing down areas of the brain that impact behaviour, thinking, attitude, breathing, and heart rate. Excessive drinking can lead to serious health issues, including alcohol use disorder (AUD), or severe alcoholism, which occurs when a person cannot control how much alcohol they consume.
It is also accompanied by powerful cravings and withdrawal symptoms that perpetuate drinking. Withdrawals can be extremely severe – patients could experience seizures or require hospitalization.
It’s estimated AUD affects around nine to 14% of Canadians and is the leading risk factor for disease in Canadians who are 15 to 49 years old.
Alcohol use disorder signs and symptoms
“Alcohol addiction is a complex disease that can affect anyone,” says Dr. Peter Giacobbe, psychiatrist and clinical lead at Sunnybrook’s Harquail Centre for Neuromodulation.
Dr. Giacobbe is also a co-investigator in a North American first trial at Sunnybrook Health Sciences Centre that is examining brain surgery for treatment-resistant alcohol use disorder.
“Chronic alcohol use that is problematic can also lead to issues in an individual’s personal and professional lives, financial or legal issues, as well as health problems that may include changes in the structure of the brain, depression, liver damage, increased risk of heart disease, and other health risks including death.”
Some signs and symptoms of AUD include:
- Inability to limit the amount of alcohol consumed
- Strong cravings to drink alcohol
- Desire to cut down on drinking with unsuccessful attempts
- Continuing to drink alcohol despite problems it is causing you physically, socially or in your relationships
Chronic alcohol use that is problematic can also lead to issues in an individual’s personal and professional lives, financial or legal issues, as well as health problems that may include brain damage, depression, liver damage, increased risk of heart disease, and other health risks such as death.
How is AUD treated?
“Currently, the standard of care is receiving pharmacotherapy with an evidence-based intensive psychosocial therapy,” says Dr. Ilan Nachim, co-investigator in an AUD study at Sunnybrook, and medical director at Bellwood Health Services. “For patients that have a mild to moderate condition, outpatient treatments can often suffice. For more severe conditions, inpatient treatment is sometimes recommended.”
Conventional treatments for AUD include:
Detox and withdrawal program – this treatment is typically medically supervised in a hospital or treatment centre-setting and involves a program of detoxification where alcohol withdrawal symptoms are managed with medication over a period of several days.
Psychotherapy and support groups – individual or family counselling: Other mental health disorders, such as depression, can occur alongside AUD. Continued talk therapy (psychotherapy), medications and other treatments may help
Medication – some medications help to decrease cravings for alcohol, or minimize the amount of alcohol that someone consumes. Other medications work by causing uncomfortable issues such as nausea, vomiting and headaches.
Addictions treatment can include a combination of psychotherapy and medication. While Conventional treatments can help, they are successful for less than 50% of patients. The rate of relapse is estimated at 75%.
Deep brain stimulation: trial investigating possible future treatment of alcohol use disorder
There are also patients, who have tried various treatment options without success and who have been diagnosed with treatment-resistant AUD.
Researchers at Sunnybrook Health Sciences Centre are leading the way with the first clinical trial in North America investigating deep brain stimulation (DBS) to treat alcohol use disorder.
“Our study is investigating the safety of DBS for treatment-resistant chronic alcohol use disorder,” says Dr. Nir Lipsman, principal investigator in the study and director of Sunnybrook’s Harquail Centre for Neuromodulation.
“There are currently, no brain-based, targeted therapies for treatment-resistant AUD,” says Dr. Benjamin Davidson, a study co-investigator and surgical resident at Sunnybrook. “This study will help us learn more about what could one day be a possible new treatment option for treatment-resistant AUD.”
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DBS is a neurosurgical procedure that involves inserting thin electrodes into specific areas of the brain to disrupt abnormal activity that is occurring in the targeted pathways. In this trial, they’re focused on the nucleus accumbens, an area of the brain which plays a role in addiction, managing cravings, and mood and anxiety.
“With advancements in neuroimaging and as we develop a greater understanding about the pathways and mechanisms of addiction, we are a moving towards the direction of being able to improve the lives of people that are most harmed by substances,” explains Dr. Ilan Nachim, a co-investigator in the study.
This direct-to-brain approach can potentially help patients in their recovery.
“It’s not a light switch, it’s more like a dimmer,” explains Dr. Lipsman. “It happens over time. Weeks and months, really, to start detecting changes. Although promising, DBS for AUD is still in the early days, and is an experimental treatment.”
“Research has indicated that DBS may work for treatment-resistant AUD because it’s not just influencing neurocircuitry that is related to addiction, these brain pathways are also involved in mood and anxiety. Depression often accompanies alcohol use disorder,” says Dr. Davidson.
For over 25 years, DBS has been used around the world, to help treat symptoms of Parkinson’s disease. It is currently approved for the treatment of obsessive-compulsive disorder and essential tremor. Sunnybrook is also pioneering research in the Canadian first trial using DBS in post-traumatic stress disorder.
“Alcohol use disorder is a chronic disease, similar to diabetes, that can improve or worsen over time,” adds Dr. Nachim. “For those that do not respond well to medications and therapies, there is a huge toll to themselves, their families and friends, and society. This is why it’s important to explore new treatment options for patients that have not responded to conventional treatment.”
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