Breaking the Chains

Rethinking Alcohol Addiction and the Path to Recovery

Written By: Dr. Rodney C. Brunson

Published on February 27, 2025

"About 20% of American adults in the U.S. have AUD (addicted to alcohol)—about 28 million people. Only about 7% of these people ever get treatment."

https://www.addictioncenter.com

"It is common knowledge that people who develop addiction are slow to recognize, at least openly, their enslavement. If we depend on something, there is a fear of what will happen if it is no longer available. And, as with all addictions, there remains that rush of pleasure, however short-lived, that is hard to give up." —Mathis Heydtmann, MD, PhD, 2017

Alcoholism can be treated successfully. But what does “treated successfully” really mean? Is "treated successfully" black and white? Cut and dry? Persons may not be treated to the point of 100% abstinence. Some will reach that 100% point, and some will not. The salient point, at least in my view, is that any improvement in the outcome of a patient's attempts to help themselves (and, by extension, their families and loved ones) can’t be bad. Reducing the harm one does to himself/herself has to be considered a good thing. The concept of harm reduction can be a goal (harm reduction is discussed later). Some persons may not want to or can’t be abstinent. Perhaps consumption reduction should be a goal for some. Total abstinence should be the ultimate goal, however, for some, someday, if possible. Reducing cravings for alcohol, the compulsion to use alcohol, control of alcohol use, and reduction of negative consequences can’t be bad (the 4C’s).

We need a new way of thinking about how we, as a society, are willing to accept our family members' (and all others') behavior when they are over-drinking. Perhaps we demand too much? Or perhaps we should not demand too much and accept what we can get.

In an article by Eduardo Cuevas in USA Today (1/2024), he discusses an article from the journal Addiction:

"That Nancy Reagan’s proclamation to ‘Just Say No’ is evolving into a better way of thinking about abstinence. Social scientists have learned in recent years that quitting something you’re addicted to is not a sudden process. If we shift our mindset about what it takes to quit, they say, we will see there are intermediate benefits to a gradual approach. People can live healthier lives if they wean themselves off drugs (and alcohol), studies show." —Cuevas

The intermediate process on one’s way to abstinence, as it turns out, just may be something to shoot for if not total abstinence.

Alcoholism is a use disorder or alcohol use disorder (AUD), aka alcoholism. A disorder, as described by behaviorists, is a condition that deviates from the expected or normal functioning of a system or organism. AUD persists for years, can be hereditary, and is a major cause of death and disability. The way it is thought of in contemporary thinking is that it is a moral failure or a weakness (as if the person made a decision to become and to remain addicted to alcohol). One would be hard-pressed to find an individual who is happy living in that state, however. Society must change its thinking about our fellow humans caught up in the world of alcohol addiction. If alcohol addiction were thought of as a disease by the general population, society might be more compassionate about the afflicted and perhaps would make more attempts to help instead of condemning.

Some persons do not have difficulty drinking a standard amount of drinks. This number is defined by the World Health Organization and considered moderate or excessive, as follows: one drink of about 14 grams of ethanol per day (a glass of wine or one beer) or 7 standard drinks a week (one drink per day) for a woman and 14 standard drinks a week (two drinks per day) for a man. Pregnant women should not drink alcohol.

But not every person can stop at one drink, thinking that maybe two, three, or even four standard drinks is not so bad—every day! That person does not see that there is now a control issue and is drinking excessively (WHO) and is on a path of life interruption. At some point, the body will not and cannot function normally after drinking heavily (heavy drinking occurs when one drinks 4 or more drinks per day or 8 or more drinks per week for women; for men, heavy drinking is 5 or more drinks per day or 15 drinks per week).

At this level of alcohol consumption, one notices changes in one’s physical appearance. Every part of the body is affected by alcohol (especially the brain, liver, lungs, kidneys, heart, and pancreas). It may taste good initially, be fun to drink, and seem enjoyable (sweetness, carbonation). What could be wrong with that? But consider the changes in the body caused by the toxicity of alcohol. Changes in the skin occur over time: since the skin needs fluids and nutrients, it may become dry and dull-looking or sallow, and more wrinkles may appear. One begins to look puffy/bloated from fluid retention in the tissues and body cavities after drinking excessively or heavily. There appears to be premature aging.

Alcoholic Nose (Rhinophyma): Redness, swelling, and prominent blood vessels occur.

The abdomen begins to protrude (from an enlarged liver with excess fluid from ascites), accumulated fluid around the waist and in the belly region. The skin may have a yellowish tone. The whites of the eyes may become yellow (these are usually signs of a poisoned liver—alcoholic hepatitis). The hair may become brittle and thin. Internally, every organ will become damaged and may not function well enough to sustain life. I can’t think of anything good that alcohol does to the body. How can something that makes one feel so good at first turn into something that makes one feel so bad?

People have been consuming alcohol excessively since ancient civilizations. If you read Genesis in the Bible, you will find that NOAH drank wine excessively to the point of inebriation.

Scientific American: The beverages of ancient societies may have contained far lower alcohol levels than their current versions, but people of the time were aware of the potentially deleterious behavioral effects of drinking. In fact, ancient societies cultivated grapes that would produce such effects.

Fast forward to early America, say the 1830s and 1840s, alcohol had become normalized to the point that men would mostly have an alcoholic beverage even with breakfast and certainly with dinner—all day long. Men would leave home at night to frequent drinking houses where they would become inebriated. Prostitutes were there to take advantage of the lack of morality standards. Men would return home in an intoxicated state and behave uncontrollably (causing great suffering to their families). The temperance movements against alcohol began around this time, condemning this behavior.

Then why haven’t we found a way to cure alcoholism? Not for lack of trying. Where is the pill? We have a pill for nearly everything else. Yet, we definitively have no specific cure for alcoholism at this time. We do have pills used to treat alcoholism, but they rarely cure it because the person usually, at some point, returns to drinking when the medication is stopped. But that person, hopefully, will return to drinking to a lesser degree.

But don’t be too discouraged, though, because some of the newer pills are very close to achieving an alcohol-free life—if that was the goal (this is discussed later in Harm Reduction). The way to solve a problem is to thoroughly understand it. We do understand the mechanisms of how alcohol works in the body. We know the centers in the brain that help maintain the alcoholic state. We can target these areas in the brain with medication to effect nearly a cure.

Alcohol Addiction

A discussion of the different methods of treating alcoholism is in order. What types of therapies are available? Talk therapy, behavioral therapy, medications, etc. Below is a list of medications:

Federally Approved (FDA) Medications to Treat Alcoholism:

• Disulfiram (Antabuse)

• Acamprosate (Campral)

• Naltrexone (pill or injection)

Non-Federally Approved Medications Used to Treat Alcoholism:

• Baclofen (Lioresal)

• Gabapentin

• GLP-1 inhibitors (Semaglutide)

• Ondansetron (Zofran)

• Topiramate

• Varenicline

• Zonisamide

Struggling with alcohol addiction?

Learn about recovery resources at WebMD’s Alcohol Use Disorder Guide

Or consult Dr. Rodney Brunson’s Verified Profile for expert medical insights.