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December 2, 2011

Alcoholism: Can it be Cured?

Alcoholism to this day is one of the most deadly and chronic diseases, that is interestingly controversial with regards to symptoms, treatment, diagnosis, and even heritability. How can a disease be so dangerous and historical and yet not even be remotely understood? As medicine, science, and technology move forward we are rapidly moving towards this inconceivable goal, but treatment is still only moderately successful along with progressive pharmacotherapies for all addictions.

A huge part of this lack of understanding of this disease is the fact that alcoholics are all different in a variety of ways; including their symptoms. There are numerous biological mechanisms as a result of alcohol addiction, all of them varying in their manners and withdraw. So recent studies show that these different mechanisms represent different stages of alcoholism, which could be relieved by different treatments. Regardless, these treatments have to block motivation to seek and consume alcohol.

Researchers have determined two categories: relief and reward drinkers. Reward drinkers drink to reward themselves the same way many drugs work, by activating brain reward pathways. Relief drinkers drink to relieve negative emotions, such as anxiety and feelings of withdrawal. Obviously these two varying types of alcoholics require different treatments.

It has also been discovered that alcoholism is marginally heritable. Genetic susceptibility is an alcoholic trait that can be passed down from generation to generation, however these varying types of alcoholism are largely based on environmental factors. These would include things such as how often the individual is exposed to stress or put in a circumstance of reward.

So now, is it possible to treat either one or both of these forms of alcoholism? Studies show that the reward system of alcoholism is mediated by a collaboration of endogenous opioids and dopamine release. Activation of dopamine in the mesolimbic pathway has been correlated to many other sorts of drug addictions. Dopamine is regulated in the corticomesolimbic system by a receptor known as MOR (mu-opioid receptor), which if blocked, prevents dopamine release caused by alcohol consumption. A drug known as naltrexone is an antagonist of opioid receptors, and is currently being researched as treatment for reward alcoholics.

Next is relief drinking. Relief drinkers drink to suppress stress, anxiety, discomfort, pain, and dysphoria. These alcoholics generally end up setting the stage for routine and frequent alcohol consumption to escape negative emotions. Recently, it has been discovered that release of CRF is central to this behavior. CRF (Corticotropin-releasing factor) is a peptide that is released into the anterior pituitary by alcohol consumption in relief drinkers, which in turn releases ACTH and stimulates cortisol release, reducing stress. CRF regulation and function is somewhat genetically determined, which makes a pharmacological cure more difficult and less likely to be successful. However, studies have shown that in individuals with naturally decent regulation of CRF could likely be treated for relief alcoholism; via CRF1 antagonism. Research is still ongoing as to whether this would be a sufficient method to treat alcoholics.

Alcoholism is a very complex disease, by which human understanding is challenged and pushed to therapeutic limits. This blog marks a tremendous step in the right direction towards understanding alcoholism and possibly curing the disease one day, but until that day comes there is plenty more to learn and to gain.

Heilig, Markus, David Goldman, Wade Berrettini, and Charles P. O'Brien. "Pharmacogenetic Approaches to the Treatment of Alcohol Addiction : Article : Nature Reviews Neuroscience." Nature Publishing Group : Science Journals, Jobs, and Information. 20 Oct. 2011. Web. 02 Dec. 2011. .
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