Alcohol Use Disorder: How rTMS Helps Treat It

Alcohol consumption is associated with many social and cultural occasions, such as celebrations and social events. In small to moderate amounts, alcohol can provide relaxation and pleasure. In addition, there are reports of health benefits, such as when wine is consumed with meals. However, excessive alcohol consumption can cause serious health problems and social difficulties. The line between moderate drinking and abuse can be fine, and excessive use can lead to addiction.

What is Alcohol Addiction?

Alcohol addiction, or alcohol use disorder (AUD), is a disease characterized by the inability to control alcohol consumption, despite negative consequences. According to the DSM-5, AUD is divided into three levels of severity (mild, moderate, severe) and includes a range of symptoms:

• Consuming larger amounts of alcohol or for a longer period of time than planned.
• Persistent desire or unsuccessful efforts to reduce or control alcohol consumption.
• Spending a lot of time obtaining, consuming, or recovering from the effects of alcohol.
• A craving or strong need to drink alcohol.
• Repeated drinking that leads to failure to fulfill important obligations at work, school, or home.
• Continued drinking despite persistent or recurring social or interpersonal problems caused or worsened by the effects of alcohol.
• Giving up or reducing important social, occupational, or recreational activities because of alcohol consumption.
• Repeated drinking in situations that are inherently dangerous.
• Continued drinking despite knowledge that there is a persistent or recurring physical or psychological problem that is likely to be caused or worsened by alcohol.

Tolerance, defined as:

• Need for significantly increased amounts of alcohol to achieve the desired effect.
• Significantly diminished effect with continued use of the same amount of alcohol.

Withdrawal, manifested by as:

• The characteristic withdrawal syndrome from alcohol.
• Use of alcohol (or a closely related substance, such as a benzodiazepine) to relieve or avoid withdrawal symptoms.

It is important to note that many people who are addicted are not in a state of inability to cope, as there is a percentage that remains relatively functional (high functioning alcoholics).

Research

According to a study, people who consume alcohol daily or at least weekly have a significantly higher chance of developing addiction compared to those who consume less frequently (NCBI, 2019).

Especially for Greece, alcohol abuse is a significant problem. Statistics show that alcohol consumption has increased in recent years, with 5% of men and 2% of women showing symptoms of addiction. Furthermore, alcohol consumption is associated with increased mortality and morbidity, with approximately 4,000 deaths annually due to alcohol-related causes (Michalis et al., 2019). Alcohol consumption is one of the leading causes of disease and death worldwide. In 2019, alcohol consumption caused 2.07 million male deaths and 374,000 female deaths worldwide. According to a 2022 survey, 16.4% of adults aged 18 to 25 met criteria for alcohol use disorder (AUD) in the previous year (National Institute on Alcohol Abuse and Alcoholism, 2022). Furthermore, alcohol use disorder is often accompanied by other psychiatric and physical disorders. In particular, comorbidity with psychiatric disorders, such as depression, anxiety, and personality disorders, is very common. These psychiatric disorders can exacerbate the state of alcohol addiction and make treatment more difficult (Grant et al., 2015, Michalis et al., 2019).

Consequences of alcohol abuse

Alcohol addiction has extensive consequences that affect the health, social life, and economic well-being of the individual. Specifically:

• Physical Consequences: Excessive alcohol consumption can lead to serious physical conditions, such as liver disease, cardiovascular problems, neurological disorders, and an increased risk of cancer. In addition, alcohol has a negative effect on the immune system, making the body more vulnerable to infections and other diseases.
• Psychological Consequences: Alcohol addiction is often associated with psychiatric disorders such as depression, anxiety, and sleep disorders. Continued alcohol consumption can worsen the symptoms of these disorders and reduce the quality of mental well-being.
• Interpersonal Relationships: Excessive alcohol consumption can cause conflicts and problems in relationships with family, friends, and colleagues. Often, alcohol abuse leads to domestic violence, alienation, and family breakdown. Personal relationships can be negatively affected by the person’s changing behavior and emotions.
• Professional Impacts: Reduced productivity, frequent absences from work, and increased likelihood of accidents in the workplace are common results of alcohol addiction. These impacts can lead to job loss and professional failure.
• Economic Impacts: The health care costs, lost productivity, and social service expenditures associated with alcohol addiction have a significant economic impact. According to studies, the total economic burden of alcohol consumption in the United States is estimated to be in the hundreds of billions of dollars annually.

Treatment Approaches for Alcohol Addiction

There are several treatment approaches to managing alcohol use disorder.

Pharmacological treatments: Usually aim to reduce cravings for alcohol, improve the balance of neurotransmitters in the brain, and prevent drinking through unpleasant reactions. These treatments help modify the body’s response to alcohol and reduce the need to drink.

Psychological treatments: Psychotherapeutic methods, such as cognitive-behavioral therapy (CBT), focus on changing negative thoughts and behaviors related to drinking. Others, such as motivational interviewing, help people find internal motivation to change their behavior. Group therapy and support groups provide additional support and guidance from people experiencing similar problems.

Repetitive transcranial magnetic stimulation (rTMS)

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive therapeutic method that uses magnetic fields to stimulate specific areas of the brain. rTMS has been identified as a promising treatment for several psychiatric disorders, including alcohol addiction.

rTMS targets the prefrontal cortex of the brain, an area involved in decision-making, self-control, and desire. By stimulating this area, rTMS can reduce cravings for alcohol and improve self-control. Research has shown that rTMS can affect neural pathways associated with addiction, helping to reduce alcohol consumption and improve treatment outcomes. Several studies have shown the positive effects of rTMS in the treatment of alcohol addiction. One study found that rTMS can significantly reduce cravings for alcohol and improve patients’ quality of life. Furthermore, it is reported that rTMS reduced relapses and improved long-term abstinence from alcohol​ (NIAAA)​.

According to recent research, rTMS may affect neurotransmitter pathways related to reward and desire, thereby reducing alcohol consumption and relapse frequency. The study highlights that rTMS offers a promising alternative approach to the treatment of AUD, contributing to improving self-regulation and reducing dependence (Mehta et al, 2023).

Advantages of rTMS

• Non-invasive method: Unlike other treatments, rTMS does not require surgery or medication.
• Minimal side effects: The most common side effects are mild and may include headache and discomfort at the site of stimulation. However, these symptoms are temporary.
• The treatment does not require anesthesia and individuals can return to their daily lives immediately after the sessions.

rTMS has shown promising results in other forms of addiction, such as substance addiction and gambling. Each form of addiction requires a specialized approach and treatment. rTMS may offer a new treatment option for many patients.

Alcohol addiction is a serious and complex disorder that affects millions of people worldwide. Understanding the causes and consequences of the disorder is crucial for the development of effective treatments. Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment option that can help patients reduce alcohol consumption and improve their quality of life.

 

Bibliography

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.Diagnostic and Statistical Manual of Mental Disorders, [online] 5(5). doi:https://doi.org/10.1176/appi.books.9780890425596.

Belgers, M., Van Eijndhoven, P., Markus, W., Schene, A. and Schellekens, A. (2022). rTMS Reduces Craving and Alcohol Use in Patients with Alcohol Use Disorder: Results of a Randomized, Sham-Controlled Clinical Trial.Journal of Clinical Medicine, 11(4), p.951. doi:https://doi.org/10.3390/jcm11040951.

Michalis, G., Bellos, S., Politis, S., Magklara, K., Petrikis, P. and Skapinakis, P. (2019). Epidemiology of Alcohol Use in Late Adolescence in Greece and Comorbidity with Depression and Other Common Mental Disorders.Depression Research and Treatment, 2019, pp.1–9. doi:https://doi.org/10.1155/2019/5871857.

National Institute on Alcohol Abuse and Alcoholism (2022).Alcohol Facts and Statistics. [online] National Institute of Alcohol Abuse and Alcoholism. Available at: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics.

NCDAS. (2023).NCDAS: Substance Abuse and Addiction Statistics [2023]. [online] Available at: https://drugabusestatistics.org/#:~:text=Substance%20Abuse%20Statistics&text=138.543%20million%20or%2050.0%25%20of

NIAAA (2023). Alcohol and the Human Body | National Institute on Alcohol Abuse and Alcoholism (NIAAA). [online] www.niaaa.nih.gov. Available at:https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-and-human-body.

.