The Science Behind AUD

How AUD Changes The Brain

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The Reward Pathway

Drinking leads to a spike in dopamine (a neurotransmitter responsible for mood, attention, motivation, and memory). At first, this feels good, but over time, the brain adjusts to the new elevated level by decreasing natural dopamine production. This means that over time, drinking is not about feeling good anymore, it's about avoiding feeling bad.

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Neuroplasticity

Neuroplasticity is the brain's ability to change and adapt over time. This is especially important for learning and memory. In active addiction, the brain rewires itself around drinking cues. This is why even after quitting drinking, relapses are common.

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Tolerance

Over time, as someone drinks more, the brain adapts, so it takes more alcohol to feel the same effect. This may seem like having "control" while drinking, but really it shows that the brain is adapting to alcohol, increasing the risk of dependence.

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Withdrawal

When someone with severe AUD quits drinking, the brain and body have trouble adjusting. This can lead to shaking, anxiety, nausea, and seizures. This is why it is so important to seek treatment instead of attempting to quit cold turkey in severe addiction.

Treatment Options

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Behavioral Therapy

Cognitive Behavioral Therapy: A method used to identify triggers and patterns that lead to drinking and reframe them to find a healthier solution. An example would be rethinking "I need a drink" as "I'm stressed, maybe going on a walk would help."

Motivational Interviewing: Counseling to find personal reasons to change, and finding personal motivation to get sober.

Contingency Management: Uses rewards to incentivize sobriety

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Peer Support

Support groups like Alcoholics Anonymous and SMART recovery offer a space for individuals with AUD to help each other recover by bonding over shared experience and providing mutual support and accountability. These support groups are free and available nationwide. There are also online options, increasing accessibility.

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Medication

Naltrexone: Blocks the rewarding response of alcohol, reducing cravings and relapse risk

Disulfiram: Causes negative side effects when alcohol is consumed to create a negative association mentally

Acamprosate: Helps to fix the chemical imbalance caused by long-term drinking, reducing the risk of relapse

Medications work best alongside some form of therapy (either behavioral therapy or peer support).

Current Research

Ozempic

Semaglutide (commonly known as Ozempic) was originally developed for weight loss and diabetes treatment, but current research is studying if it can also be an effective treatment for AUD. It alters reward pathways (which is why it's effective for weight loss), meaning it may be effective for reducing alcohol cravings. Research has shown that use of Ozempic as for AUD treatment can reduce the number of drinks consumed per day, BAC, and cravings.

Gabapentin

Gabapentin is currently used to treat seizures and nerve pain, but is currently being studied as a way to decrease withdrawal symptoms for AUD. It has been especially effective for individuals experiencing severe withdrawal.

Ibudilast

Ibudilast is an anti-inflammatory drug, currently being studied for how it can reduce neuroinflammation associated with AUD. This has been shown to decrease response to alcohol cues/triggers by restoring balance to the brains signaling pathways.

References

Anton, Raymond F., et al. “Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms.” Jama Intern Med, 2020. PubMed, https://pmc.ncbi.nlm.nih.gov/articles/PMC7063541/. Accessed 23 March 2025.

Burnette, Elizabeth M., et al. “Ibudilast attenuates alcohol cue-elicited frontostriatal functional connectivity in Alcohol Use Disorder.” 2022. PubMed, https://pmc.ncbi.nlm.nih.gov/articles/PMC8602728/#:~:text=Ibudilast%20is%20a%20selective%20phosphodiesterase,treatment%20of%20alcohol%20use%20disorder. Accessed 24 March 2025.

Hendershot, Christian S., et al. “Once-Weekly Semaglutide in Adults With Alcohol Use Disorder: A Randomized Clinical Trial.” JAMA Psychiatry, 2025. PubMed, https://pubmed.ncbi.nlm.nih.gov/39937469/#:~:text=Low%2Ddose%20semaglutide%20reduced%20the,to%20%2D0.06%3B%20P%20%3D%20. Accessed 23 March 2025.

Mar, Yoyina. “Treatment of Alcohol Use Disorder.” NCBI, 2 October 2023, https://www.ncbi.nlm.nih.gov/books/NBK561234/. Accessed 6 April 2025.

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