[PBS NewsHour]

Why medication to treat alcohol-use disorder is ‘vastly underutilized’

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WASHINGTON (NewsHour) — Nearly 30 million Americans struggle with alcohol-use disorder.

Medication used to treat alcohol-use disorder have been on the market for decades, but is rarely prescribed.

Dr. Sarah Wakeman, medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital Brigham, joins NewsHour’s Ali Rogin to discuss medication’s potential for treating this disease and why it’s underused.

Read the full transcript

JOHN YANG: If you have diabetes or depression medication might be part of your treatment.

But for people suffering from alcohol-use disorder, medication is rarely prescribed.

Ali Rogin reports on the potential that medication holds for treating this disease and why it’s underused.

ALI ROGIN: Nearly 30 million Americans struggle with alcohol addiction and the problem has steadily gotten worse, accelerating since the pandemic began.

Yet less than 5 percent of people reported getting treatment of any.

But drugs used to treat alcohol use disorder have been on the market for decades and more are currently being studied.

Dr. Sarah Wakeman runs the Substance Use Disorder Initiative at Massachusetts General Hospital Brigham.

Thank you so much, Dr. Wakeman for joining us.

First of all, let’s talk about how the medical community defines alcohol use disorder.

And also what if the trend line has been has the problem gotten more prevalent since the pandemic began?

DR. SARAH WAKEMAN, Mass General Brigham: The definition of alcohol use disorders compulsively using alcohol despite problems.

And so those can be problems in your life, like in your relationships, or your ability to work or carry out your functions, or in your house.

So continuing to use alcohol despite known health, either mental or physical health problems that are exacerbated by use.

So like many health conditions, and many areas of substance use disorder, we’ve seen worsening trends and fawns have of the pandemic.

And this is true both for heavy drinking and also alcohol use disorder and health conditions related to alcohol use.

One of the most scary trends we’ve seen, actually, soon after the pandemic hit, we saw an increase in alcohol related mortality, which is largely driven by liver disease or liver failure from heavy alcohol use.

ALI ROGIN: And people might not be so aware that medication is available to address alcohol use disorder, how has medication been used historically in the United States?

SARAH WAKEMAN: It’s vastly underutilized.

So you talked about your opening, we have millions of people who meet criteria for alcohol use disorder.

Fewer than 8 percent really access treatment in a given year.

And of those less than 2 percent of people access treatment with medications.

And there’s lots of reasons for that.

But it is one area of medicine that really doesn’t make its way to people who need it most.

ALI ROGIN: Can you tell us about the drugs that are already available to treat alcohol use disorder?

And why aren’t they prescribed more readily here.

SARAH WAKEMAN: So there are three FDA approved medications available in the U.S. for treatment of alcohol use disorder.

There’s also other medications that are off label are not officially approved for that indication, but are very effective.

And these medicines, for the most part, work by reducing the urge to want to drink and the pleasurable feedback that you get from drinking.

And so they can be really powerful.

And it’s been shown to help reduce heavy drinking days, and also to improve the likelihood that someone can achieve abstinence meaning not drinking at all.

I think many people aren’t even aware that there are medications they could ask their doctor for, or that could be a part of their treatment.

And we have to remember, as a society, for more than 100 years, we’ve really carved addiction out as something separate from the rest of our healthcare system are somehow different than the rest of medical care or medical conditions that we treat.

And so there’s been this idea that addiction, although we sometimes say it’s an illness, many of our policies and our clinical procedures really approach it like it’s an issue of morality or willpower.

And so really undoing that ideology.

Those general stigmatizing notions is really important to bring addiction back into the medical system back into medical training, so that doctors and nurses and other health care professionals feel comfortable addressing this and offer medication treatment just like they would for depression, or diabetes or heart disease.

ALI ROGIN: What about elsewhere in the developed world, how is medication used in other parts of the world?

SARAH WAKEMAN: Medications used much more commonly, for example, in Europe, where there’s even a method of using medication as needed to reduce heavy drinking.

So if you know that when you go to a cocktail party or around holidays, or during times of stress, you’re more likely to drink heavily or at a level above what you want to be drinking for your health or life goals.

You can actually take a medicine before that, and it’s been shown to help reduce heavy drinking.

ALI ROGIN: There’s been increased attention on diabetes drugs like Ozempic, that they have been shown to reduce symptoms of alcohol-use disorder.

Two Ozempic Insulin injection pens next to an Ozempic box.
Ozempic has been shown to reduce symptoms of alcohol-use disorder. [Natalia Varlei |]
What is the potential there and also what are some concerns around the use of these drugs for that purpose?

SARAH WAKEMAN: And it’s really exciting.

We obviously need to utilize medications, we have an existence, but we always need more innovation and better medication and more options for patients.

The early studies both serve anecdotes about people who’ve taken these medications and found that they’re craving or urge to want to drink have diminished are really promising.

There’s also some animal studies in mice showing reduction in alcohol use and alcohol seeking behaviors.

Obviously, there needs to be clinical trials that show that this is effective, and that it gets to the right clinical endpoints.

And that would require funding and research.

And so usually that takes on the order of years for those kinds of approvals to happen.

I think that can sound like a long time.

But in the meantime, we have effective medications that exist, that are easy to prescribe that any doctor can prescribe.

And so really encouraging people who are listening, if you’re struggling, if a family member is struggling, you could talk to your doctor, this could be one component of lots of different types of treatments that are available for alcohol use disorder.

ALI ROGIN: And lastly, let’s talk about when should someone reach out for help seeking treatment or otherwise addressing an alcohol use disorder.

SARAH WAKEMAN: Think of you’re worried about your alcohol use if someone in your life is worried about it.

Those are probably the two best predictors.

If you’re having health related consequences from alcohol use, like liver problems, even feeling hungover having any times like a blackout.

You don’t remember what happened.

Those are all really worrisome symptoms and alcohol was playing a role in your life that could begin causing problems.

I think many people don’t know about the lower level drinking limits that we think of when we talk about lower risk drinking.

It’s really no more than seven drinks a week for a woman or anyone over 65.

And no more than 14 drinks a week for a man who’s under 65.

I think if you try to make changes to your alcohol use to get it to a healthier level and you find it’s hard to cut back or hard to make changes, that sometimes can be an indication that things may have gotten out of your control.

And it’s never a wrong thing to talk to someone or ask for help because the earlier we can provide support, the earlier we can intervene, the better someone will do.

ALI ROGIN: Dr. Sarah Wakeman with Massachusetts General Hospital Brigham, thank you so much for talking about this important issue.

SARAH WAKEMAN: Thanks for having me.