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Substance Abuse in the 21st Century

Communities Have Many Tools Already Available


Updated June 15, 2003

Although medical science hopes to develop more tests and medications for the prevention and treatment of alcoholism, communities already have available many tools to help address the growing problem.

This was the conclusion of former NIAAA Director Enoch Gordis, M.D. in his remarks at "Substance Abuse in the Twenty-First Century: Positioning the Nation for Progress" a conference of The National Center on Addiction and Substance Abuse at Columbia University and The Ronald Reagan Presidential Foundation.

The development of a "magic pill" to treat alcoholism or prevent cravings for alcohol is a goal for the future, but society already has in place many proven intervention and treatment resources, if communities are willing to activate those options.

New Medications Expected

Neuroscience research, including studies of alcohol actions on the brain, biological and behavioral mechanisms of chronic drinking, mechanisms of brain damage and cognitive dysfunction, and animal and human genetic studies on the role of genes in mediating behavioral responses to alcohol, is a key to optimal treatments and targeted prevention among persons at risk for alcoholism (alcohol dependence).

Neuroscience led to the identification in 1995 of naltrexone and in 1999 of nalmefene, medications that help to prevent relapse in treated alcoholics, and to another promising medication--acamprosate--now under study.

Additional new medications are expected as researchers home in on the intrinsic genetic and constitutional factors that affect a drinker’s responses to alcohol, including the development of alcoholism and its hallmark features: impaired control over drinking, tolerance, physical dependence, and craving.

A Different Drug

Alcohol differs from illicit drugs in the complexity of its actions on the brain and other organs. While most illicit drugs work on one or several brain neurotransmitters, alcohol influences multiple neurotransmitter systems and brain circuits in ways that may differ from one drinker to the next.

Also unlike illicit drugs, alcohol is toxic to most body organs. Chronic, heavy drinking is implicated in brain, liver, heart, and bone disease, hypertension, stroke, immune system dysfunction, and certain cancers. At the same time, epidemiologic research indicates an association between light or moderate drinking and beneficial effects on the cardiovascular system.

Unlike other drugs, alcohol is a legal beverage that most drinkers use without problems. But for persons with the clinical disorders alcohol abuse and alcoholism -- and even for some who misuse alcohol on a single occasion -- drinking can lead to profound health, social, or economic consequences that affect not only the drinker but other persons and all society. For example, all of us share the $185 billion annual economic cost of lost productivity, medical, legal, and property damage due to alcohol misuse.

Proven Treatment, Interventions

To reduce alcohol consequences to individuals and society, NIAAA supports, in addition to basic biomedical research, studies on screening for alcohol problems and brief intervention, the effectiveness of available behavioral and pharmacologic treatments, health services (including the influence of managed care on treatment access), and prevention (including community-based approaches, alcohol advertising, alcohol-impaired driving, and social regulatory policies such as those governing alcohol availability, beverage pricing, and taxation).

In the past decade, NIAAA researchers have tested and proven effective interventions in each major study area.

Thus, while optimal interventions for alcoholism are a goal of ongoing neuroscience and genetics research, proven treatment and preventive interventions for alcohol abuse, alcoholism, and societal alcohol problems are available now to individuals and communities willing to face alcohol problems head on.

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