Alcohol use disorders are a growing problem in the United States that experts say has been exacerbated by the pandemic, especially among women. But as Lisa Ling reports in a new episode of This Is Life, scientists are researching new treatment options.
Brook was 34 when her drinking escalated to cope with a breast cancer diagnosis.
“I just decided I’m not going to get through this right now,” she told Lisa Lang on an episode of This Is Life With Lisa Ling, which airs Sunday at 9 p.m. ET on CNN.
“I would drink before going to my chemo sessions. It became more and more of a coping mechanism,” said Brook, who declined to use her last name.
Brook survived her battle with cancer but says she became addicted to alcohol – and the pandemic has only made it worse.
“When Covid started and I was home, I started drinking more and more and more,” said Brook, now 42. “I started not being able to eat, I started throwing up more often, and then I started vomiting blood.”
She recently ended up in hospital, where she was diagnosed with cirrhosis of the liver and bleeding from ulcers that could kill her if not treated quickly.
“Afterward, when they spoke to me, they said, ‘If you keep this up, you’ll be dead in a year,'” Brook told Ling.
It’s an illness
Alcohol use disorder is defined as compulsive use of alcohol despite negative consequences for relationships and one’s ability to function at work, school, or in the community. Over time, excessive drinking can even rewire the brain, making alcohol just as desirable as natural rewards like food or sex, experts say.
Researchers at the University of California, Los Angeles showed images of alcoholic beverages to people who are addicted and non-addicted while they scanned their brains. Regions of the brain associated with desire, pleasure, and reward lit up significantly more in people with an alcohol use disorder.
“It’s a lot more of a medical and brain disease than we initially thought,” Lara Ray, a clinical psychologist who leads the UCLA Addictions Lab, told Ling.
In addition, as little as a pint of beer or an average glass of wine per day can begin to shrink the overall volume of the brain. According to a study published in March, non-drinkers who started drinking an average of one unit of alcohol a day aged their brains by half a year.
The damage worsens as the number of daily drinks increases, the study found — drinking four units of alcohol a day ages a person’s brain by more than 10 years.
effects of the pandemic
Alcohol use disorders are a growing problem in the United States that experts say has been exacerbated by the pandemic, especially among women.
“Last year I cared for two women in their early 20s who had cirrhosis and needed liver transplants, and I’ve never had that in my entire career,” said Dr. James Burton, medical director for liver transplants at the University of Colorado School of Medicine at Aurora, said Ling.
A recent study found a significant increase in alcohol-related liver disease between 2020 and 2021, and a 15% higher rate of waitlists and subsequent liver transplants — the largest increases occurred in young adults.
Since the pandemic began, statistics show an overall 14% increase in the number of drinking days per month, but a “41% increase in heavy drinking days among women,” according to Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital, told CNN in January.
Why? Pre-pandemic mother wine culture, which “normalized and even glorified” drinking, is partly to blame, Dr. Leena Mittal, director of women’s mental health in the Department of Psychiatry at Brigham and Women’s Hospital in Boston.
In addition, “Studies have shown that the complexity of balancing household, work and care responsibilities during the pandemic weighs disproportionately on women,” Mittal said previously.
Women are at high risk
According to the National Institute on Alcohol Abuse and Alcoholism, women are particularly sensitive to the effects of alcohol. Alcohol-related problems occur earlier and with smaller amounts than in men, said the institute, which is part of the US National Institutes of Health.
Women are more prone to alcohol-related brain damage and heart disease than men, and studies show that women who drink one drink a day increase their risk of breast cancer by 5% to 9% compared to those who don’t.
Pandemic lockdowns have also forced many people to live and work from home — sometimes alone. A July study found that drinking alone during adolescence and young adulthood can greatly increase your risk of alcohol abuse later in life, especially if you’re a woman.
Victoria, who also declined to use her last name, told Ling she started drinking when she was a teenager. The 55-year-old “still can’t control it. It’s like a tension building. And then when I drink it’s like, ‘Ah! I’m drinking, you know, so it’s way too much, way too fast.”
Binge drinking — defined as having more than four drinks for women and five for men in a few hours — is on the rise. According to a study published in June, even older people who describe themselves as moderate drinkers have multiple drinks in one sitting.
The study found that people who binge eat were about five times more likely to have a variety of alcohol problems, including injuries, emotional or psychological problems, and alcohol addiction at work, school, or when caring for children.
“This means that a person whose total consumption on Saturday night is seven drinks has a greater risk profile than someone whose total consumption is one daily drink with dinner, even though their average drinking level is the same,” study co-author Charles Holahan, professor in psychology from the University of Texas at Austin, CNN previously said.
The hunt for answers
The US Food and Drug Administration has approved only three drugs intended to reduce alcohol consumption since 1951: disulfiram, which causes headaches, nausea, and vomiting when mixed with alcohol; acamprosate, which acts on the brain’s reward centers to reduce cravings for alcohol; and naltrexone, which reduces cravings and appears to help with heavy drinking.
All three have significant side effects that can discourage people from using them consistently.
Researchers continue to experiment with different drugs to see if they can help cure cravings without major side effects. The anticonvulsant drug topiramate, while not FDA approved, has shown promise in some clinical trials but may impair cognition and memory. Other antiseizure drugs, such as zonisamide and gabapentin, and a smoking cessation drug called varenicline, have shown mixed results.
In Ray’s lab at UCLA, small clinical trials have found promising results with the neuromodulator ibudilast, which inhibits cravings and reduces the likelihood of heavy drinking by 45% in some people.
For Billy Flores, 45, the change was quick.
“The first two days I was upset in the stomach, but by the third day I was out of alcohol, which I think is pretty amazing,” he told Ling of using ibudilast.
Additional studies are needed to determine if the benefits apply to larger populations.
There are now gold standard treatments for alcohol use disorder that don’t involve medication. These include 12-step Alcoholics Anonymous programs and self-management and recovery training, cognitive-behavioral treatments, and mindfulness-based approaches.
A large 2006 clinical study found that behavioral interventions can be just as effective as medication—in fact, most of the clinical trials of medication conducted to date have also included some form of social or behavioral treatment in combination with medication.
Having support is crucial to maintaining a positive attitude that will ultimately win the battle against alcohol, experts say.
“When I was doing my intake for rehab, one of the questions was, ‘What made you do this?’ And I said, ‘I’m better than that,'” she told Ling.
“I still like to think that despite the relapses, I’ll still be the person to get right back up and try again.”