A Heart Medication May Also be Effective For Alcohol Use Disorder Treatment

Alcohol use disorder is an incredibly prevalent and serious medical condition affecting millions worldwide. Unfortunately, getting access to effective treatment is currently more difficult than it should be.

According to the Centers for Disease Control and Prevention (CDC), it is advised that adults should strive to drink alcohol in moderation to reduce their risk of developing health complications from overconsumption¹. But with moderate drinking levels being defined as one alcoholic drink a day for women and two alcoholic drinks per day for men, drinking more than the recommended amount is often not a difficult task¹.

As a powerful depressant drug, alcohol interferes with communication pathways in our brains. When consumed in excess, alcohol can impair a person’s ability to speak, keep their balance, and will alter their ability to make decisions². Over time, continually drinking large quantities can permanently impact the function and structure of a person’s brain, resulting in the development of alcohol use disorder, dependence, and powerful withdrawal symptoms².

With more and more people worldwide struggling with alcohol use disorder every year, it is clear that finding effective long-term treatment options for this condition is essential. But, with minimal pharmacological treatment options and current therapy options focused on helping people with alcohol use disorder through the initial short-term withdrawal period, there is still a gap in finding treatment that supports people during their recovery.

As a commonly researched topic, scientists are always looking for new medications that could be beneficial for treating alcohol use disorder. Excitingly, a recent 2022 study found that the commonly prescribed heart medication spironolactone may be a viable and effective option for treating alcohol use disorder — something that could help millions of people living with tempting alcohol cravings as they work to recover from alcohol use disorder.

What is alcohol use disorder?

Before we jump into the currently available treatment options for alcohol use disorder, we first need to understand the defining signs and symptoms of the condition.

Alcohol use disorder is diagnosed based on the presence of a repetitive pattern of higher-than-average amounts of alcohol consumption. For most people with this condition, it is common to experience difficulties controlling their drinking and may prioritize drinking over other responsibilities — even after these actions have caused problems in their lives.

According to the National Institute on Alcohol Abuse and Alcoholism, over 14 million Americans over 12 are living with symptoms of alcohol use disorder³.

When left untreated, mild to moderate alcohol use disorder can transition into alcoholism, a severe disorder with serious health complications like memory and personality changes, increased risk of heart disease and cancer, and death¹.

Some other interesting and eye-opening stats about alcohol use disorder worth knowing include:

• According to the CDC, over 140,000 people die due to excessive alcohol consumption every year⁴. Alcoholism and heavy drinking are among some of the top causes of preventable death worldwide.

• Men are more likely to consume large amounts of alcohol than women. In 2019, 9% of American men lived with an alcohol use disorder, compared to 4% of women⁵.

• On average, people with severe or end-stage alcoholism can lose up to 30 years of their lifespan due to alcohol consumption. While the average American lifespan currently sits at 77 years, the life expectancy of those with severe alcohol use disorder is shorter at 48 years old⁶.

Symptoms of alcohol use disorder can vary based on severity

As a diagnosable condition found in the latest version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the severity of a person’s disorder can be determined based on the number of symptoms they experience due to their drinking — mild (2–3 criteria), moderate (4–5 criteria), or severe (which is considered to be alcoholism, 6 or more criteria)⁷. Examples of some of the questions and criteria used to diagnose alcohol use disorder include:

Over the past year, have you:

• Drank more or longer than you wanted to?

• More than once, tried to cut back or stop drinking without success?

• Felt ill from the aftereffects of consuming large amounts of alcohol?

• Wanted to drink so badly you couldn’t think of other tasks?

• Found that drinking has impacted your relationships, job, or responsibilities?

• Cut back on activities you enjoy to make more time for drinking?

• Gotten into situations that increased your chances of being hurt while drinking?

• Had to drink more than those around you to achieve the same effect?

• Experienced alcohol withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure after a period of not drinking?

The stages of alcohol misuse

Because alcohol use disorder is a pattern-based health condition, many people who get diagnosed with the condition often start off displaying similar behaviors. While this may not be the exact same experience for everyone, generally speaking, many people who develop alcohol use disorder move through the following five stages⁸:

• Experimentation — As the first stage of an alcohol use disorder, this stage is commonly experienced earlier in life when a person is experimenting with substances and partying. A person may start drinking out of curiosity, peer pressure, or for fun, but it is common for people in this stage to binge drink (consume many alcoholic drinks in a short period to elicit a drunk feeling).

• Increased tolerance — Like other addictive substances, repetitive exposure to alcohol will increase tolerance (meaning you need to drink more to get the same feeling as you used to from less alcohol). During this time, cravings for alcohol may develop, and the number of drinks a person consumes casually will increase.

• Adverse outcomes — After prolonged periods of increased alcohol intake, symptoms of alcohol use disorder will begin to emerge. It is common for family and friends to notice mild or significant changes in a person’s behavior, mood, and personality at this stage of the disorder. A person in this stage of the disorder may also begin to display difficulties maintaining responsibilities due to alcohol consumption. 

• Dependence — At this stage of an alcohol use disorder, drinking alcohol has become integrated into the person’s daily life, regardless of the consequences. It is common for people who are dependent on alcohol to display physical and mental symptoms due to alcohol consumption, such as tremors, severe irritability, nausea, and insomnia.

• Addiction — People in this stage of alcohol use disorder are considered to be living with end-stage alcoholism. For some, the intense withdrawal symptoms from attempting to stop drinking in this stage can be dangerous or even life-threatening if done without medical support. Cravings, guilt, compulsive behavior, and impaired coordination are all other commonly experienced symptoms of this stage of alcohol use disorder.

Drinking too much can cause health complications

In addition to impacting a person’s behavior and mental state, consuming larger amounts of alcohol for a prolonged period can also lead to significant physical health challenges. As a powerful irritant that causes damage to the gastrointestinal tract, liver, kidneys, blood vessels, and brain, some of the most common physical health complications of alcohol use disorder can include⁹:

• Increased risk of experiencing a stroke

• The development of heart arrhythmias, high blood pressure, and cardiac disease

• Increased risk of developing pneumonia and acute respiratory infections

• Weakening of the muscles

• Increased risk of bone density loss and bone fractures

• The development of acute or chronic pancreatitis

• Increased risk of developing oral or esophageal cancers

• The development of gastrointestinal bleeding and leaky gut syndrome

• Eventual scarring, fibrosis, and cirrhosis of the liver

Spironolactone may help in the treatment of alcohol use disorder

Despite the increase in demand for treatment options for treating alcohol use disorder, there are currently only three medications approved by the National Institute on Alcohol Abuse and Alcoholism for this purpose¹⁰:

• Naltrexone — This medication blocks receptors in the brain responsible for creating alcohol cravings. It can be taken as a daily pill or as a monthly injection.

• Acamprosate — Commonly taken as a pill three times a day, this medication helps to relieve some of the common negative side effects of staying abstinent from alcohol after periods of prolonged alcohol use.

• Disulfiram — Different from the other two medications, this medication causes unpleasant side effects like nausea and body flushing if taken with alcohol. It can be used to reduce a person’s interest in drinking alcohol.

With the demand for effective treatment options for alcohol use disorder on the rise, new research has found a new medication that may benefit those in recovery — a cheap, commonly prescribed heart medication called spironolactone.

Spironolactone is most commonly prescribed for those with heart failure and hypertension by encouraging the kidneys to remove excess water from the body¹¹. Interestingly, this medication encourages increased water excretion by blocking proteins known as mineralocorticoid receptors. The latest research into alcohol use disorders suggests that people with higher than average mineralocorticoid receptors may be at an increased risk of experiencing alcohol cravings.

In a 2022 study about the effects of spironolactone on alcohol cravings, it was found that both the rodent and human populations who were given spironolactone drank significantly less alcohol once they started the medication¹². While more research is needed to fully understand the benefits and risks of this therapy for treating alcohol use disorder, it is a huge step forward in finding more sustainable and effective treatments for those in recovery.

Non-pharmacological treatment options vary based on individual needs

Aside from pharmacological treatment options, it is often recommended that a person recovering from alcohol use disorder also explore alternative therapies to provide support as they heal. 

In most cases, the treatment of alcohol use disorder is broken into two primary categories: detoxification and long-term support.

During the first stage of treatment, a person who has been drinking alcohol regularly will commonly experience withdrawal symptoms after they attempt to quit drinking. Commonly done in a controlled treatment setting, the goal of alcohol detoxification is to allow the person’s body to expel and remove the toxins and waste that have built up as a result of prolonged alcohol use¹³. During this stage of treatment, it is common for people with alcohol use disorder to be offered support through medications and therapy. However, every person’s treatment plan will be different to meet their needs.

After the initial detoxification period, alcohol use disorder treatment aims to give the person new and effective coping mechanisms and resources to reduce their risk of relapsing. Some common examples of long-term treatment options include:

• Behavioral therapy — Depending on the person’s needs, there are a variety of different behavior-based therapies that can be done to support their recovery journey. Examples of common therapy types used for the treatment of alcohol use disorder include talk therapy, cognitive behavioral therapy (CBT), and dialect behavioral therapy (DBT)¹⁴.

• Joining support groups like Alcoholics Anonymous (AA) — Building a strong support group is one effective resource for people working through their recovery journey. Groups such as Alcoholic Anonymous, Women for Sobriety, and Secular Organizations for Sobriety (SOS) offer emotional support through mentorship and weekly or daily check-in programs.

• Calling support hotlines — During an episode of crisis or potential relapse, calling support hotlines can be a valuable resource. The Substance Abuse and Mental Health Services Administration (SAMSA, which can be reached at 800-662-HELP (4357), is an example of a nationwide service across America. 

Social stigma and judgment get in the way of care

Similar to other mental health and substance use conditions, people with alcohol use disorder can experience a large amount of stigma and discrimination from their families, friends, coworkers, and even medical staff. As a result, receiving the quality of care that they need to begin their recovery journey can often be more difficult than it needs to be.

As we continue to research treatment options for alcohol use disorders, there are things that we can do to help people struggling with alcohol today. If you notice that someone you love is struggling with alcohol misuse, we recommend offering support in the following ways:

• Being a person they can trust — Make it clear to the person you care about that you are there for them in a supportive way. If they disclose anything to you, do your best to reassure them while offering a judgment-free space to talk.

• Offering to listen — Instead of jumping right to options to “solve” their issues, offer an ear to listen. Allowing people to talk about their problems and get things off their chest can be very helpful and cathartic.

• Providing helpful resources — When appropriate, offering your loved one resources to begin their journey to sobriety can be incredibly helpful. Hotlines, support groups, and rehabilitation centers are all available resources that can be used as steps toward healing when they are ready.

Sources:

1. Dietary guidelines for alcohol | Centers for Disease Control and Prevention (CDC)

2. Alcohol and the brain: An overview | NIH: National Institute of Alcohol Abuse and Alcoholism

3. Alcohol facts and statistics | NIH: National Institute of Alcohol Abuse and Alcoholism

4. Deaths from excessive alcohol use in the United States | Centers for Disease Control and Prevention (CDC)

5. Excessive alcohol use is a risk to men’s health | Centers for Disease Control and Prevention (CDC)

6. End stage alcoholism and the steps leading to it | FHE Health

7. Understanding alcohol use disorder | NIH: National Institute of Alcohol Abuse and Alcoholism

8. Alcoholism stages: How do abuse and dependence occur? | Addiction Resource

9. Alcohol's effects on the body | NIH: National Institute of Alcohol Abuse and Alcoholism

10. Frequently asked questions: Searching for alcohol treatment | NIH: National Institute of Alcohol Abuse and Alcoholism

11. Spironolactone | MedlinePlus

12. Spironolactone as a potential new pharmacotherapy for alcohol use disorder: convergent evidence from rodent and human studies (2022)

13. Alcohol detox | Addiction Center

14. Types of therapy for alcoholism | Alcohol Rehab

Claire Bonneau is a medical writer and certified trauma operating room nurse.