Your Brain on Alcohol
A new understanding of how alcohol alters brain chemistry may transform treatment of the disease
Some people summon the will to stop from within. "What shocks people is that the vast majority of people who recover from alcoholism never sought any treatment at all," says Stanford's Humphreys. But a lot of people can't quit on their own. The ability to stop is as individual as each person's internal motivation. Ehrlich, for instance, had spent much of his adulthood drinking and using drugs while he lived the high life of a rock-and-roll promoter. He tried quitting on his own, tossing pills and bottles into a casket at an elaborate "wake" for his addictions. Finally, he went to the Betty Ford Center for treatment.
Banishing the pink elephant. About half a million people each year make a similar decision, seeking a treatment slot at Betty Ford, the Hazelden Foundation, Par Village, Delancey Street in San Francisco, and a host of other inpatient and outpatient treatment centers. Up to a million more get in touch with Alcoholics Anonymous. For the most impaired, the first step is to get weaned from alcohol. This is the time when patients can become leg-jiggling, arm-scratching, face-touching, whirling dervishes of inattention, seeing the "pink elephants" of lore. They can have tremors, hallucinations--even seizures. The brain has grown accustomed to an artificial balance between chemicals that cause excitation and those that cause inhibition. Sudden withdrawal of alcohol alters the balance in favor of excitation. Valium can help, but it, too, is addictive. Some nonaddictive anticonvulsants, like carbamazepine, divalproex, and gabapentin, can also ease the passage.
Withdrawal is the relatively easy part, generally lasting three days or less. Dealing with the ongoing verbal dual between the devil on one shoulder and the angel on the other is the hard part. The brain has been reprogrammed to compulsively want a drink, and hundreds of individual thoughts or actions can trigger the craving--a walk past the neighborhood tavern or even seeing a beer commercial.
Subconscious desires. Craving can haunt recovering alcoholics even in sleep. "I had a dream last night that my friend met me at the airport with a huge glass of champagne," says Monica, 40-ish, tall, slim, and regal, who is checking out after 28 days at the Betty Ford Center. Such dreams are an indication that craving never rests. "Dreams are drives that call out for satisfaction," says Brian Johnson, a Boston psychoanalyst who specializes in addiction treatment.
Mark George, along with Anton, at the Medical University of South Carolina has done some of the first brain imaging showing the power that the mere thought of a drink can have on a recovering alcoholic's brain. He put alcoholics and nonalcoholics inside an MRI, then showed them photographs of martinis, beer bottles, or glasses of wine. They were also shown pictures of soft drinks and coffee, and a third set of neutral images. In alcoholics, the frontal cortex lights up with desire at the alcohol images.
Drugs can help dampen that desire, although no one knows exactly how. An early drug called Antabuse, now little used, made patients sick when they took a drink but didn't kill the craving. Naltrexone appears to. Originally used to counteract opiates like heroin, it might work by blocking a pleasurable surge of natural opiates released in the brain by an image or thought of alcohol. The drug may have worked for Scott Campagna, 23, of Atlanta, who participated in an ongoing trial. Campagna says he binges about twice a week--seven or eight beers and two or three hard drinks. "I feel I could quit or cut back if I wanted to," he says. He believes he got the drug, not a placebo, because he thought less about drinking the week he took it.
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