“Telling the patient ‘stop drinking’ – says prof. Sorrowful – unfortunately it leads nowhere. He doesn’t drink by choice at certain levels; the order starts from the brain, from the oldest part of our nervous system (the cortical meso-limbic system) which also regulates the mood and most of the behaviors necessary for all animals to make the species last (sleep, food, reproduction).
- The system responds to these stimuli by releasing the neurotransmitters of gratification (serotonin, dopamine and GABA).
- Unfortunately, however, this system, when it becomes unregulated, responds in the same way to psychotropic substances (heroin, cocaine, benzodiazepines, alcohol).
And when you lose control over the intake of these substances, stopping drinking or taking drugs is no longer a choice, because order, once one is deprived, starts from that part of the nervous system that is free from the our control.
It is as if I wanted to order my heart not to beat. Just to clarify things immediately, therefore, alcohol abuse is neither a vice nor a bad habit, but a real disease and already codified for at least 50 years with the criteria of the DSM “.
According to the latest edition (the fifth) of the DSM
The diagnosis is made through two main criteria: 1) the patient has continued to use a substance, despite the awareness of having a physical, psychological or social problem that contraindicates its use ; 2) the patient drinks not to enjoy a glass of wine, but to seek the psychotropic effects of alcohol (the so-called craving, distinguished in relief carving – I drink to reduce tension levels – or the reward craving – I drink to seek an increase mood).
How it comes out
“As for all diseases – explains prof. Sorrowful – it is essential to take charge of the patient based on three cornerstones to be used together: drug therapy, individual and group psychological support treatment. We have several so-called anti-craving drugs available, two of which have been identified by our research group.
- Unfortunately, almost none can be used in patients with advanced liver disease, because they are metabolized by the liver.
- A few years ago we therefore began to study baclofen (a drug that is not metabolized by the liver, but is eliminated unchanged by the kidney), demonstrating its efficacy and safety even in cirrhotic patients (the study was published by Lancet in 2007).
Having an effective, manageable and side-effect-free drug
“Here at Gemelli we have integrated the alcohol center within the hepatological center and we all work together – continues Addolorato – And the fact that the hepatic patient with alcohol abuse disorders must be treated with the integrated model is also explained in the guidelines of the ‘AISF (Italian Association for the Study of the Liver).
In light of the results of the many clinical studies carried out on the subject that have shown the superiority of this approach (even in patients who are candidates for liver transplantation), it is no longer acceptable that a liver disease center does not have an internal team with expertise in the field of alcohol-induced liver disorders (which are currently responsible for most chronic liver diseases).
Unfortunately in Italy the situation is still patchy and not all the hepatological centers have integrated within them the specific figures for the management of alcohol-related diseases ”.