Your Brain on Alcohol
A new understanding of how alcohol alters brain chemistry may transform treatment of the disease
Another substance, acamprosate, has shown promising results in Europe. And ondansetron was found to reduce drinking and increase days of abstinence in clinical trials. Yet for now, alcoholism treatment centers are reluctant to prescribe drugs. At the Betty Ford Center, for example, counselors might sometimes suggest naltrexone to fight cravings if follow-up contact shows that a patient has repeatedly relapsed. But the drug is not used during the stay there. Helping heavy drinkers cut back may not be enough to treat actual alcoholics, say counselors. Most experts think moderate drinking is not an option for a true alcoholic
Talk therapies. Experts are betting that new generations of drugs will work best when combined with counseling and group therapy. These talking therapies, researchers believe, help the brain learn to compensate for the damage done, just as rehabilitation helps a stroke victim's brain relearn speech or movement. Many alcoholics must relearn how to accept responsibility for themselves and how to behave toward others. Almost all group programs incorporate the 12 steps of AA, which help people just starting their recovery get support from veterans of the struggle.
A large-scale study in 1997 that tested three kinds of treatments--cognitive therapy, motivational therapy, and group AA meetings--found that roughly half the patients in each group reduced their drinking or avoided heavy drinking. (Some centers, such as Betty Ford, have success rates of more than 60 percent.) Other chronic diseases, such as diabetes and asthma, have similar relapse rates after medical treatment, according to a study published last fall in the Journal of the American Medical Association. A setback isn't cause to give up. "There is no, I repeat no, treatment [for alcoholism] that is finished at the end of a residential stay," says A. Thomas McLellan, author of the JAMA study. "There aren't cures here."
Treatment experts say patients and families should be skeptical of programs that promise much higher success rates--say 80 percent or more. Experts also caution against programs that forbid drugs of any sort, even such nonaddictive medications as some antidepressants, which can help some alcoholics.
No matter how much scientists learn about the brain changes behind alcoholism, much of the work of recovery still will fall to patients. And so will the rewards. "When I was drinking, my life was a roller coaster, and when I was first sober, I thought sobriety would be a dull, flat line," says Clarke. Yet since she stopped drinking, she has lived in Hawaii for a year, traveled to sunny climes with friends, and painted desert scenes in California and cherry blossoms in Virginia. "Now, instead of just daydreaming, drunk on the couch, about wonderful things I would do, I do wonderful things."
Alcohol: How it affects the brain
For the first time, sophisticated brain imaging techniques can present stark, real-time pictures (shown below) that provide insight into how chronic alcohol use may change the brain. Initially, it tickles the pleasure center. But long-term, heavy drinking cuts new pathways to the areas of the brain involving attention and judgment. Some researchers believe it moves into areas that turn drinking into a compulsion.
advertisement
