Mainstream medicine has done little to really figure out how to help the 9 percent of drinkers who abuse alcohol. Essentially, they just preach total abstention for everyone and anyone. (Even the 91 percent of drinkers who consume alcohol safely and in moderation.)
The problem is, going “cold turkey” just doesn’t work well for many problem drinkers. And can even pose a danger for some.
Fortunately, researchers with University College in London recently pioneered a novel, practical approach that helps problem drinkers significantly cut back on their alcohol consumption. And it’s surprisingly simple…
Setting heavy drinkers up to expect a reward
For this new study, researchers with University College in London recruited 90 people with a history of excessive drinking. None of the participants had been diagnosed with alcoholism. Yet, on average, they consumed about 30 pints of beer a week, which is five times the recommended amount. (Granted, their average age was 27.5 years old, so they probably hadn’t yet been into the medical system long enough to get labeled with a diagnosis of alcohol disorder.)
The researchers thought giving the participants just a single dose of ketamine might disrupt the participants’ pleasant memories of drinking, particularly if they triggered the participants’ memories just before administering the drug.
(Ketamine is a very powerful, even addictive drug that can produce hallucinations. But it’s also been used as a fast-acting treatment for depression. It’s thought to block certain receptors in the brain that help “stabilize” memories.)
On the first day of the experiment, the researchers showed the participants pictures of beer and other alcoholic drinks—to stimulate their memories—and asked them to rate the strength of their urges to drink. Then, they allowed all of the participants to drink a beer.
On the third day, researchers brought the participants back into the lab and repeated the process. Except this time, they divided the participants into three groups:
- The first group saw pictures of beer and other alcoholic drinks—again, to stimulate their memories and urges to drink—and then they received a single intravenous infusion of ketamine.
- The second group did not see stimulating pictures, but they did receive an intravenous infusion of ketamine.
- The third group saw the stimulating pictures of the drinks, but then received a placebo infusion of saline solution.
And here’s what the researchers found…
Disrupting the brain’s reward center
As you may note, all the participants were unexpectedly denied the anticipated beer on the third day when they repeated the process. This unexpected bait-and-switch maneuver was the key to this study, as it disrupted and destabilized the participants’ “maladaptive reward memories” (or MRMs).
MRMs produce an exaggerated desire to drink or take a drug. And unfortunately, once they’re are established, they’re very hard to break.
This line of research actually reminds me a lot of Russian scientist Ivan Pavlov’s work in the 1890s on conditioned responses in dogs. As you may recall, he set up an experiment to ring a bell before feeding dogs. Then, he found that the dogs began to salivate whenever they heard the bell, in anticipation of a meal, even when food wasn’t presented.
I’ve always thought that substance abuse and addiction in humans works in much the same way as Pavlov’s dogs. That is, unless we can disrupt the MRMs.
And that’s exactly what the researchers seemed to accomplish with this experiment. They set up the participants to expect a reward, but then they did NOT fulfill it. Which seems effective enough to destabilize the MRMs…
In fact, 10 days after the experiment, the first group of heavy drinkers (which had their memories triggered with pictures of alcoholic drinks and received ketamine) reported a significant decrease in their alcohol intake. Plus, nine months after the experiment, they reported a 50 percent reduction in their alcohol consumption!
Even the second group (which didn’t have their memories triggered, but were still denied the beer and received ketamine) saw a smaller but still significant reduction in drinking, both at the 10-day mark and nine months later. And the third group (which had their memories triggered, were denied the beer, and received a placebo infusion) also reported a decrease, albeit a more modest one.
Finally, some real scientific progress on alcohol abuse
In my view, disrupting the MRMs works a lot like disulfiram, a prescription drug that literally makes people sick after they take a drink. It was approved in the 1950s to help treat alcoholism.
But there are two important differences between that toxic drug and the novel behavioral approach of disrupting an MRM…
First, disrupting MRMs creates an aversive reaction before—not after—taking a drink. Second, disrupting MRMs doesn’t require you to take a toxic prescription drug!
The government has spent decades—not to mention, billions of dollars—studying alcohol abuse. It even created an entire new institute called that National Institute of Alcoholism and Alcohol Abuse (NIAAA).
The building must sit next to the National Redundancy Institute of Redundancy! But it’s filled with science bureaucrats who couldn’t quite cut the mustard at the real National Institutes of Health. In fact, during my tenure as a government researcher, I saw more than one science bureaucrat get shipped off to the “Never Never Land” of NIAAA. (They’d failed to accomplish anything at real jobs, but could never get fired from the federal gravy train.)
At the end of the day, we’ve done very little to significantly advance the science into the study of alcohol abuse over the last 50 years.
In fact, I’ll never forget Dr. Sidney Schnoll, one of my professors in college at the University of Pennsylvania, presented a lecture on the science of substance abuse and addiction. He was a gem of a doctor—a totally cool guy, before it was cool to “be cool,” and he needed to be in his line of work. He readily admitted that we just didn’t really understand it or know how to treat it. Dr. Schnoll said the best he could do was to play us Billy Joel’s two brilliant (then new) songs, “Captain Jack” (Captain Jack will get you high tonight/And take you to your special island/ Captain Jack will get you by tonight/Just a little push, and you’ll be smiling’…) and “Piano Man” (It’s nine o’clock on a Saturday/The regular crowd shuffles in/There’s an old man sitting next to me/Makin’ love to his tonic and gin”).
Thankfully, with this new line of promising research, the NIAAA’s song and dance may be coming to an end. And we may finally have an effective approach to help our problem drinkers.
P.S. Of course, for the vast majority of people, alcohol consumption does not pose a problem. In fact, I often report on the many benefits of moderate alcohol consumption. I just devoted an entire article to more new science on the benefits of beer in this month’s Insiders’ Cures newsletter (“Six surprising reasons to consider trading in your wine glass for a beer stein”). Subscribers have access to this and much more in the archives. So if you haven’t already, consider signing up today!
“Ketamine can reduce harmful drinking by pharmacologically rewriting drinking memories.” Nature Communications, 2019; 10(5187). doi.org/10.1038/s41467-019-13162-w