Fewer young people are drinking, yet millions of adults still battle alcohol addiction. That is the blunt message from Dr George Koob, director of the US National Institute on Alcohol Abuse and Alcoholism. He shared the latest research on alcohol addiction in a recent episode of The State of Mental Wellbeing podcast, hosted by Mohini Venkatesh of the National Council. His account carries lessons for parents, health workers and policymakers.

Alcohol Addiction Trends: Good News and Bad News

“There’s good news and bad news,” Dr Koob said. Underage drinking has fallen for about 25 years. Generation Z is drinking less too. Peak drinking has moved from ages 18 to 24 to ages 26 to 34.

However, the scale of harm remains huge. About 28 million Americans live with alcohol use disorder, the clinical term for what many people call alcohol addiction or alcoholism. Alcohol claims around 178,000 lives a year. Those deaths come from many causes, including accidents and falls while intoxicated.

Some groups face extra risk. Dr Koob said women tend to suffer more harm per drink than men. They develop liver disease earlier, and they face more anxiety and depression alongside their drinking. Young women in their early 20s now binge drink more than young men for the first time. Meanwhile, drinking has climbed among baby boomers in their 60s and 70s, who may be more sensitive to alcohol as they age.

Treating Alcohol as a Vital Sign

Kaiser Permanente in Northern California has worked with Dr Koob’s institute on a programme called Alcohol as a Vital Sign. Primary care teams ask every patient how much they drink, just as they check blood pressure. Routine screening can flag alcohol addiction concerns earlier. This matters because alcohol affects “200 different conditions in the body”, from liver disease to heart arrhythmias.

A cardiologist once told Dr Koob that his first line treatment for hypertension is to ask patients about their drinking. Screening and brief intervention at Kaiser Permanente also lowered hypertension in some patients within a year. The effect was modest, but it was beneficial.

Still, a gap remains. “They ask someone how much they drink, but then what happens?” Dr Koob asked. He described referrals to treatment as “abysmal”. A brief intervention can be as simple as a friendly question, such as reminding a keen angler what a really good fishing rod would cost compared with a weekly drinking bill. Emergency rooms offer another opening, because Dr Koob estimates that half the people there on a weekend night arrive because of alcohol.

How Alcohol Addiction Changes the Brain

Heavy drinking over many years hits the brain hard. “It’s like your frontal cortex goes offline,” Dr Koob said. Decision making and impulse control suffer, so a person with alcohol use disorder cannot simply stop. Brain cells lost to heavy drinking do not grow back, although recovery can use a different pathway to rebuild thinking skills.

The stress system plays a part. Heavy drinking dulls the brain’s reward system and ramps up its stress system. People then drink to win back pleasure and switch off discomfort. Dr Koob describes a low level of irritability and unease that falls short of major depression, yet still drives drinking. Each drink feeds the same cycle. Loneliness adds fuel, because heavy drinking pushes friends and relatives away and deepens the isolation.

Some signs of alcohol addiction show up early. People who could drink everyone else under the table often develop problems later. Dr Koob calls this inherent tolerance and says it leaves them “halfway” to alcohol use disorder from a brain perspective. Scientists still do not know what causes it. The frontal cortex can take up to 25 years to fully develop, which is one reason his institute keeps a firm focus on underage drinking.

New Treatments and a Two Way Street

Treatment research for alcohol addiction is moving quickly. Early clinical studies of GLP1 agonists show lower craving and lower alcohol consumption in people with alcohol use disorder. Dr Koob called the results exciting, but he stressed that the findings are early and the unknowns are large. Researchers still need to learn who benefits most, how long the effects last and how the drugs work in the brain.

Integrated care is another focus. His institute is working with the liver society so that treatment for alcohol use disorder goes hand in hand with care for alcohol associated liver disease. For patients waiting on a liver transplant, he sees that as common sense.

Research also flows both ways. Doctors noticed that diabetes patients taking GLP1 drugs drank less, and the same held for patients taking spironolactone. Rodent tests of spironolactone then backed up the pattern. “Translational research goes two ways,” Dr Koob said.

Advice for Families and the Case for Hope

Stigma remains a major barrier. Many people still see alcohol addiction as a moral failing. Dr Koob rejects that view. “It really is a disorder that needs to be treated and can be treated, and from which you can recover,” he said.

For relatives worried about a loved one, he offered three principles. First, steer the person towards an informed primary care doctor. Second, avoid confrontation, because it backfires. Third, show concern without judgement or labels, and make clear that the problem is treatable. A respected figure in the community can also hold a gentle chat.

Awareness of alcohol addiction risks appears to be changing habits. Dr Koob pointed to the Surgeon General’s report linking alcohol to around 8% of cancers. He also noted the rise of mocktails, dry bars, Dry January and Sober October among younger people. His closing message is plain: “Recovery is possible.” For communities, the lesson is to ask early and to have help ready when someone answers honestly.

Source: dbrecoveryresources