23 ms·

A drug that cures alcoholism may be the next anti-anxiety medication

197 points by rustoo 5y ago

MissionInfl 5y ago
As I comment on many HN posts, I cannot exaggerate the impact that alcoholism medication has had on my life. It is only tangentially related here, as this comment is not about disulfiram but rather naltrexone, a drug with similar goals but a very different mechanism of action This is all to say, if you or a loved one is struggling with alcoholism, I highly recommend looking into The Sinclair Method. Check out /r/alcoholism_medication or this accounts recent comment history. That community supports those that use disulfiram as well, but I cannot comment on that medication myself
- locusofself 5y ago
  Good to hear it .. I've been sober 12 years (cold turkey after years of attempts) and when I was struggling I tried to get a prescription for Antabuse and doc said no. I see no reason not to try whatever tools are available to save someone from a terrible life (or death).
  - tom899 5y ago
    Antabuse can lead to death or dangerous healh problems. The doctor is and will be responsible for that, so he wont take the risk.
    - Broken_Hippo 5y ago
      "Antabuse can lead to death or dangerous health problems." So can a slew of other drugs. You should see the drug risks for stuff folks take for autoimmune disorders. It isn't just up to the doctor to mitigate the risks: Patients must do their part as well (blood tests and so on). And most importantly: So can alcoholism. Alcoholism kills slowly. Withdrawal can kill not-so-slowly. Somehow, do you think the doctor is not responsible for refusing help when the alternative risks include death as well? That said, I'm not a doctor and there are generally (but not always) good reasons to avoid a drug or another. The risk of drugs by itself usually isn't it, though, as it depends on effectiveness compared to other drugs/methods and comparing the risk of cure to the risk of continued disease.
      - aaaaaaaaata 5y ago
        > So can a slew of other drugs Dr isn't legally liable for drugs you find on your own.
        Broken_Hippo 5y ago
        I was speaking of prescription drugs here, the very ones you have to visit the doctor to get. I thought with the context that would have been clear.
        dragonwriter 5y ago
        Dr. isn't legally liable if they act within the norms of the profession with with informed consent. Almost any drug can cause death or dangerous health problems.
      - MissionInfl 5y ago
        Sorry if you already know this, but the difference with disulfiram/Antabuse is that these side effects are intentional and are supposed to act as a deterrent to consuming alcohol. The fact that it can kill you if you mix it with booze is why people take it, as far as I understand it
- hn_user82179 5y ago
  I'm currently on a naltrexone/wellbutrin combo. I started it to try to finally end an infinite binge/purge cycle I find myself stuck in (an eating disorder). I also have depression/insomnia and had been self-medicating with alcohol (really, I just drank to relax -> drank to fall asleep -> didn't fall asleep -> drank more). I wouldn't say it was a lot compared to what you think of when you think of an alcoholic but it definitely fell under the category of binge drinking nightly (~3 beers a night). I had reached a point where I figured it'd be good to stop (after reading about how easily one can develop a Thiamine deficiency) but found it... not easy. I could go a few days but living alone, wfh, etc made me really enjoy my post-work/before-bed beer ritual - it felt like the only thing distinguishing night and day. The medication has helped all 3 issues, a lot. How much it's worked is incredible. I don't know how hard it would've been to stop alcohol without it, but I'm sure I would've failed more before succeeding. Honestly, I'm more impressed by how it's helped me manage my relationship with food. I've spent the last 15+ years obsessing over food. I still think about it far more than people without eating disorders, but my self-worth is not tied to whether or not I eat. I think my mood was better managed on my old antidepressant but things now feel... how I think "normal" is? That said, I do need to get a medical bracelet of some sort. My doctor didn't mention exactly how naltrexone worked and it wasn't until I stumbled across /r/alcholism_medication that I realized that if I got hit by a car or had some other accident, was unconscious and administered opiates - they wouldn't work, and being on naltrexone could have harmful effects if I underwent emergency surgery if the medical personnel were unaware of my prescription.
  - refurb 5y ago
    Probably good to have an alert bracelet, but if you were undergoing emergency surgery, the anesthetist would monitor close enough to know something is off and respond appropriately.
    - aaaaaaaaata 5y ago
      How? By upping the pain medication?
      - 5y ago
- beeboop 5y ago
  I just wanted to say thanks for you mentioning this. I had never heard of naltrexone before and it's something I'm going to talk to my doctor about next week. I've been drinking way more than I want to and I'm finding it difficult to tone it down.
noelwelsh 5y ago
The people I know who like to drink the most are also people I would say are highly anxious, which makes me wonder if they're using alcohol as self medication. Just an informal observation---not claiming a universal truth here.
- dclusin 5y ago
  Addiction is very commonly diagnosed with other mental health disorders.
- rootw0rm 5y ago
  as a person new to recovery, i can definitely say that alcoholism was the direct result of my social anxiety.
- brohoolio 5y ago
  100% that the folks I know who are alcoholics have high anxiety. It’s not the same exact kind of anxiety in all of them, but I believe it’s at the root of their problem with alcohol. Part of my understanding is that for at least some of these folks they never learned to deal with emotions. They never learned how to feel and accept that feelings exist. Alcohol is the agent that they utilize to help keep those feelings at a level they can manage. It’s a numbing agent. The social chaos that these individuals because of their alcoholism is so enormous. And I’m at a point where I can see how it influences their adult children and it’s depressing. You can see how the disease is transmitted from generation to generation. Someone might be disposed towards alcoholism, but coming from an alcoholic family and the chaos that comes from that makes it even more likely that the kids will become alcoholics.
  - tom899 5y ago
    You are right with your observations. The root cause are mental health disorders like depression. There is no fast working anti-depressant like alcohol. People try to solve their problems in the short path with it, it works, but in the long run, the problems coming back even more severe. Untreated disorders will be amplified like abuse, depression etc. But its understandable people try alcohol first, until therapy and medication works, its a hard time.
Quequau 5y ago
Given the extremely strong negative reaction to alcohol that patients who are taking Disulfiram experience and given that this is apparently the sole effect that alcohol abuse cessation treatment using it relies on, it is my belief that the treatment is unconscionable and inhumane. I quit drinking after more than 25 years of problematic drinking using naltrexone (The Sinclair Method) and, given my experience with alcohol, it was the easiest thing I've ever done. I urge people who have a problem with drinking and wish to quit, who for whatever reason do not feel that 12 step programs like Alcoholics Anonymous are right for them to find a doctor who is willing and able to prescribe naltrexone and have a serious discussion with them. Had I known it was effective as it is I probably would have been able to stop drinking 20 years sooner than I did.
- okareaman 5y ago
  Antabuse is a way to stop drinking for a period for whatever reason, maybe you have surgery in two weeks and the doctor says you must stop but you can't. No one in danger of having seizures from withdrawels should suddenly stop. I took Antabuse when I wasn't a very bad alcoholic and I stopped for two weeks. Later, when I was much worse, I would shake in the morning until I got a drink. At that point cessation therapy would be dangerous. I did a medical detox.
  - raptorraver 5y ago
    Antabuse helped me quiting few years a go. It wasn't THE solution but one of the components in my success. It felt liberating that I didn't have to think that could/should I have a drink. That door was closed.
- heavyset_go 5y ago
  As long as it's voluntary, it should remain a tool for those who choose to use it. I don't like the idea of court compelled psychiatric or addiction treatment possibly putting people in situations where they might have to take it or otherwise be considered non-compliant to the courts. The Marchman Act in Florida is particularly worrying in that aspect, as it doesn't require someone to have committed a crime at all to be involuntarily ordered into rehab, and non-compliance can mean being in contempt of court. It's cliche, but it reminds me a little too much of the Ludovico technique.
okareaman 5y ago
Antabuse (Disulfiram) does not cure alcoholism. I think there's been a translation error from Japanese to English, because I don't believe the Japanese think they have a cure for alcoholism.
- loeg 5y ago
  Could it just be a case of an over-enthusiastic headline writer? The article body says "treat" repeatedly; never "cure."
  - okareaman 5y ago
    You're right, misleading headline
tom899 5y ago
I am an alcoholic myself, sober for five months now after a long-term therapy. I am sceptical about taking meds for this desease. The change of life and coping with stress is the best way to avoid getting in relapse of use. The therapists said meds might be a help, but are not the solution. Its a trap for the dependant who might think now hes cured and does not find himself changing his life and solving problems which have caused the desease. I was working in IT and have now time to change, i will be working in a less stressful job and will undergo further treatment of depression and narcicisstic personalty disorder i suffer. In the long run, alcoholism can be avoided by selling it only in special stores, people need more knowledge about it and society itself must be more aware how dangerous alcohol is. I live in bavaria,germany. I can purchase hard liqour around the clock and in amounts with no limit. Its cheap and i have no problem with the people around me. The drinking culture makes it possible to be offerd a beer to almost every occasion. Sure the openly and public drinking in broad daylight is some kind of awkward, but people dont take it too serious. We have no laws exept driving cars or being drunk at the workplace. But well, meds can help a bit to get someone stable enough be treatabel for a long term therapy, but a cure, they are not. The nucleus accumbens has stored the associative information that drinking can help with insomnia, depression and makes live a bit easier. To get rid of this is a long and hard way, the most is done by undergo treatment, self help groups and finding new hobbies or something replacing the habits that led before to the addiction.
- blenderdt 5y ago
  Multiple studies have shown that alcohol sits in the top two of most destructive harddrugs for both the user and the user's surrounding. And still we can buy it everywhere. Like you say: the drinking culture must change.
  - alar44 5y ago
    > the drinking culture must change. Why? Because a small fraction of people can't handle alcohol? If you don't want to drink, don't. But don't tell me how to live.
    - 5y ago
russellbeattie 5y ago
Crap. This topic just reminded me that I haven't done my taxes yet. I wish I was kidding.
toxicFork 5y ago
https://pubmed.ncbi.nlm.nih.gov/25586396/ https://pubmed.ncbi.nlm.nih.gov/25586396/ > Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study Mushrooms will help us.
- taneq 5y ago
  Are you sure? One time in a Amsterdam I tried mushrooms and I’m pretty sure I drank the same pint of Heineken four times.
shisisms 5y ago
The madness of assuming that by treating the symptoms you remove the cause. Isn’t one of the most dangerous aspects of our current industrial medical complex the risk that by avoiding the underlying causes the anxiety manifests elsewhere, thereby not actually solving anything. Small bandaid. It’s where mindfulness and accelerated capitalism became such a potent and dangerous game. One of the upshots of the current trends in psilocybin treatment is that it at least places an equal emphasis on a therapeutic environment.
magicconch 5y ago
Another alternative drug is emoxypine [1], sold under the brand name Mexidol. It also possesses anti-anxiety effects. Rather than make the user feel terrible when they drink (as in the case of disulfiram), it has effects more similar to naltrexone: reducing the effects of alcohol so the user does not experience the feelings they usually would. I think this is a lot more humane than disulfiram. [1] https://en.wikipedia.org/wiki/Emoxypine https://en.wikipedia.org/wiki/Emoxypine
- kraussvonespy 5y ago
  I was just looking to see if someone had posted emoxypine. I have some experience with this med and it does work as intended for alcoholism. Plus it does the job a lot more gently than what I imagine disulfiram does.
braingenious 5y ago
Oh thank goodness that there’s a CURE for alcoholism! This must be new, because the last time I heard an outlandish claim like that was from some complete moron pastor trying to pitch somebody on taking Antabuse after having read a sales pamphlet that said something to that effect. I’ve seen people take obscure research benzos that led to weeks long blackouts, belladonna alkaloids that led to assaulting firefighters, bath salts that led to arson charges… and I’d suggest any one of those over the absolute abject misery that I’ve seen disulfiram cause. Anybody that calls a drug that’s essentially a form of torture a “cure” for something as complex as alcoholism is at the very best dangerously stupid, at the very worst a liar with a conscious fetish for abusing strangers, and on average somewhere in between. No matter what, they aren’t real scientists by any stretch of the imagination.
jrapdx3 5y ago
Disulfiram is a very familiar and very old line drug. It doesn't (directly) stop people from drinking alcohol, but just makes it very unpleasant. Disulfiram interferes with the breakdown of the normal metabolic products of alcohol, which cause nausea, headache, flushing, sweating and other autonomic symptoms. With large amounts of alcohol the interaction can be dangerous, rarely even fatal. But the article is reporting a different effect altogether. Disulfiram indirectly inhibits glutamate signaling, which produces a putative "antianxiety" effect in an animal model of anxiety. It makes sense in that glutamate is the primary activating neurotransmitter in the brain. After all existing antianxiety agents like benzodiazepine drugs work by binding to GABA receptors. GABA is the primary inhibitory neurotransmitter. The logic is increase inhibitory effect == reduce activating effect. BTW it's not coincidence that alcohol also binds to GABA receptors, the reason people reach for a drink when they're feeling nervous. But the problem remains that taking disulfiram for anxiety means using NO alcohol at all. Maybe a few people are OK with this but I bet most will be unwilling to give up having a drink now and again. So it creates a problem since people will forget and with both on board it can be a big headache, in more ways than one.
- trompetenaccoun 5y ago
  Being unable to tolerate drinking alcohol is the norm, not the other way around. There are a lot of people around the world who have an alcohol intolerance or "allergy", interestingly the exact same effect you experience when taking this drug. Trust me, from personal experience you're not going to forget. There's a reason they treat addicts with this.
  - deleted 5y ago
    [deleted]
  - jrapdx3 5y ago
    Yes, it's true that a significant fraction of certain populations have an intrinsic disulfiram-like reaction to alcohol. (Affected individuals don't produce the enzyme that disulfiram interferes with.) For sure these people have a good reason to avoid alcohol. Whether this inherited intolerance of alcohol is the norm depends on which populations we're talking about. For example among people with European ancestry this genetic variation is uncommon. And indeed alcohol dependence is a huge issue in many parts of the world. In my experience disulfiram is only useful with people who are motivated to quit drinking. Forcing alcoholics to take disulfiram is asking for catastrophe. (Courts used to impose this condition on people charged with driving while intoxicated.) I've known individuals who drank anyway and wound up in the Emergency Department. Fortunately none died but it can happen. Anyway it's an issue because having an anxiety disorder often leads to abusing alcohol. But the article's real story is not only the potential antianxiety benefit of disulfiram, but the intriguing finding regarding novel mechanisms of action, and that is worthwhile exploring further whether the drug ever gets approved for this new use, or not. Not at all contradicting your point. It just goes to show we have to take things in context, the context itself being subject to infinite variation.
02020202 5y ago
fitba72 5y ago
Need to point out that the disease theory of addiction is hotly debated in the US. Not so much in developed countries where socialized medicine is available, where the theory is widely discounted. Those interested should take a look at the work of Stanton Peele.
- emerged 5y ago
  I’d imagine most addiction occurs when the body has a natural imbalance in certain neurotransmitters (GABA), so it seeks a way to adjust the balance (alcohol). Seems fair to call that natural imbalance a disease.
  - netizen-936824 5y ago
    You're onto something there. These imbalances (rather, deviation from the average in terms of various regulatory pathways) are absolutely key to differences not only in personality but perspective, cognitive abilities, and as you mention propensity to use psychoactive substances. I've been thinking something similar for a while now, that most people with addictions to psychoactive are likely attempting to correct for something. Not to mention, most of the illegal compounds have pharmacological activity that would be nearly impossible to get from a prescription for most people.
  - fitba72 5y ago
    Your US medical insurance will cover an illness or disease (why 12 step for profit rehabs continue to lobby this idea). Less likely to cover you for a lifestyle choice that became a learned behavior.
xanaxagoras 5y ago
There is absolutely no sense in which antabuse "cures alcoholism", I really can't think of a worse way to put that. All it does is cause a violent physical reaction when alcohol is consumed. Alcoholism is an umbrella term for 2 co-occurring disorders, one physical and one mental. On the physical side, alcohol produces an allergy which manifests as an intense physical craving for more alcohol - craving in the sense of a physiological need, which the alcoholic experiences on equal footing as a need for food, water or oxygen. The mental side of things (often referred to in AA as a spiritual ailment) is a sort of compulsive disorder in which the alcoholic becomes absolutely obsessed with proving to himself and others that he can "drink normally". The obsession is why the first drink is taken and the allergy is why it will never be enough. Now, the allergy is relieved immediately by removing the allergen, say by going to rehab or drying out at home, but as anyone who has spent any time at all around one of us knows, this purely physical "sobriety" is usually short lived if the mental obsession is left untreated. The proposition of antabuse is basically identical. Everyone I've ever known who took antabuse simply stopped X days ahead of a relapse. It is completely useless. As for whether or not it alleviates anxiety in rodents, I will leave that to the people who are studying it.
- bee_rider 5y ago
  Is there any medically backed information on the idea that alcoholism is an allergic reaction to alcohol? I mean -- it doesn't seem like a great analogy, but I don't generally have an uncontrollable desire to overindulge in cat dander and pollen, personally.
  - gitfan86 5y ago
    No. Allergic reactions are the immune system responding to a substance in a hypersensitive way[1]. There is however a genetic component to how people respond to alcohol. Some people after having 1 drink have a strong desire to continue drinking to blackout levels. Others are more likely to feel sick or sleepy after 2 drinks and have a desire to stop. It isn't an immune system reaction, but it is a reaction. The AA community generally considers this a disease that has no cure. Once an alcoholic you are permanently an alcoholic. So that is why you'll see people pushing the idea that it is similar to an allergy. They are correct that genetic differences exist, but in the real world, many people have substance abuse problems due to stress or anxiety or childhood trauma. Meaning the biological components are far less of an issue than the psychological and mental health component in most cases of substance abuse. A well documented point of evidence of this is heroin use in Vietnam [2] [1] https://en.wikipedia.org/wiki/Type_I_hypersensitivity https://en.wikipedia.org/wiki/Type_I_hypersensitivity [2] https://jamanetwork.com/journals/jamapsychiatry/article-abstract/490667 https://jamanetwork.com/journals/jamapsychiatry/article-abst...
yread 5y ago
take this with a large amount of salt. Disulfiram reacts with a lot of stuff so it pops up on all kinds of screenings. Some people saw its activity against cancer, even covid but it never pans out
TedShiller 5y ago
There are plenty of drugs that will stop you from drinking. They will also stop you from doing anything else.
throawayAlcohol 5y ago
I logged out and made a throwaway because I'm somewhat sad to see the responses here. While it isn't helpful to every alcoholic, and should never be forced upon any alcoholic at all, it is to some. It's the alcohol equivalent of suboxone, for better and worse. You cannot force an addict of either sort to recover until the person wants to, for sure, I've been there. I chose to seek Antabuse of my own volition some years ago after failing repeatedly with every other method including naltrexone and rehab. It worked for me brilliantly to stop my brain from sabotaging my life. Humans are not immune to the biological and evolutionary mechanisms that every other animal also suffers from, and there's just as much no reason to ignore things that can work. I know this'll just get labeled as shill post since it's anon throwaway, but I promise I'm not. It does work for some people and gave me my life back. Maybe not that many, but more than zero.
- adwi 5y ago
  Congratulations on finding a method and making it work, that’s all that matters.
Rainymood 5y ago
I'm half asian and I get the "Asian flush" [0] which for all intents and purposes induces the same effect as this drug (DSF) >Individuals who experience the alcohol flushing reaction may be less prone to alcoholism. Disulfiram, a drug sometimes given as treatment for alcoholism, works by inhibiting acetaldehyde dehydrogenase, causing a five to tenfold increase in the concentration of acetaldehyde in the body. The resulting irritating flushing reaction tends to discourage affected individuals from drinking.[9][10] I literally have a negative feedback loop from drinking alcohol, it makes me feel really bad, my skin flushes, I feel my heartbeat in my chest/neck/head, and I literally feel miserable. Honestly, it kind of sucks, because when you can't drink you notice how much socialising is based around alcohol. I've found ways to cope with this and am on good terms with myself now but it really took me a long time. Especially to get around the social/peer pressure of having to drink. On the bright side, I'll likely never become an alcoholic.
- darkerside 5y ago
  You might enjoy this https://dynomight.net/alcohol/ https://dynomight.net/alcohol/
  - cypherpunks01 5y ago
    Interesting article, thanks!
- zbentley 5y ago
  The effect you describe is only one of the effects of antabuse. The others are substantially worse (in that they are extremely painful and in that they can be medically quite severe). The mechanism is similar, you're right, but not quite the same.
ohiovr 5y ago
The only thing that cures alcoholism is a desire (and thorough conviction) to not to die with the dishonor of being a drunk.
headsoup 5y ago
I would prefer to see how we're progressing on the 'prevention of anxiety in the first place' front rather than another money-making band-aid for illusory effect. Not dismissing anxiety and a desire from those suffering to get out of it, but this wreaks of another case of solving difficult/complex problems with 'simple' solutions...
- rzmmm 5y ago
  This is what I think often when I see news about anxiety and other mental disorder. I have a lot of respect for researchers working on these topics, but I'd like to hear more from researchers who e.g. try to find more accurate picture of the risk factors of these things.
- tsol 5y ago
  How do you remove anxiety from life? Maybe I'm misunderstanding, but to me life is inevitably gonna cause anxiety and if you removed all of it life would just be boring
jotm 5y ago
Phenylethylamine works somewhat like that: take 2-3g and don't drink. If you do, you'll heavily regret it as it will fuck up your blood pressure to the point of getting all red and passing out. Not safe at all, but it did work for me for a while. Quitting out of fear can work. A better alternative to treating alcoholism and anxiety are gabapentinoids and gabaergics. There are a few of them, and indeed Gabapentin has been known to be used exactly for these purposes in the US (not Europe, God no, they'll think you're fucking insane). At low-moderate dosages, they give the anxiety relief/relaxation effects of alcohol with none of the negative effects, except withdrawals - several days of insomnia/nightmares if stopping them abruptly. They work on the same receptors as alcohol, so it's kind of a replacement, and it's much easier to taper off them. However if you start taking them together, that can be a problem, as they complement each other. You can end up drinking less... or getting even more fucked every night. As always, gotta be really careful and follow some rules. I have quit alcohol completely after more than a decade of use and abuse, I realized it's fucking me more than helping (actually always knew, but it was irresistible). Lately I was mainly using it to go to sleep, so I found this wonderful drug called Tizanidine, an alpha2 agonist prescribed as a muscle relaxant, but at slightly higher doses it quite literally knocks you tf out. No major negative side effects besides indeed, relaxing muscles (so it's best to exercise when waking up or your joints may be in danger), no withdrawals. Tolerance builds up rather fast, after 2 weeks you need double the dosage. But 4 weeks was enough for alcohol cravings to subside a bit. I still miss the taste of beer hah. Since I could fall asleep at any time, that was one major reason to not need alcohol. I even stopped myself from going to the store by taking Tizanidine as soon as I started thinking about beer (which was almost always in the evening). Then I found something for depression (SSRIs don't work). You'll say, "you just traded one drug for another" - yes, I did, however the positive:negative effects ratio has massively shifted towards the former. And I regularly quit my (self-made or self acquired... man, fuck mental healthcare) medication so I can test how addicted I am. It's nothing like alcohol was, that is absolutely life destroying shit that I hope I never taste ever again for the rest of my life.
- mtlmtlmtlmtl 5y ago
  Informative post, but I have one minor correction: Gabapentin(and pregabalin), while a GABA analogue, doesn't actually interact with GABA receptors og GABA itself at all. It acts on voltage-gated calcium channels, which is in part similar to the downstream signalling effects of GABA, and hence gives the effects you describe.
robwwilliams 5y ago
Tips on how to read a science paper like this that involves mice or rats and makes lots of implicit and explicit bd claims about relevance to humans: (from of a card carrying neurogeneticist who uses mice and rats to study the biology and treatment of human diseases, specifically alcoholism and substance use disorders) Step 1: Go to Methods section of the paper and check the SEX, AGE, and TYPE(s) of mice or rats that that the team used. Here is what this team writes: “Male ICR mice were used for behavioral experiments (age: 6–10 weeks; Tokyo Laboratory Animals Science Co., Ltd., Tokyo, Japan). The total number of animals used in the study were 232 animals.” So SEX = all males AGE = 6 to 10 wks, which in human terms is roughly 12 to 19 years-of-age — teenagers. TYPE = ICR = Imperial College Institute of Cancer Research albino outbred mouse stock Do you see any problems yet with the design? Step 2: How many mice did they study? ANSWER = 232. This is a substantial number of mice to study, so we expect to see dense data plots and low error terms. Step 3: Check if they tried to do the work blinded to the treatment groups. Step 4: Review the individual case data and statistics only if you feel the work passed steps 1, 2, and 3, above. The goal of the first four steps is to establish the likely relevance of results and their generality to both sexes, multiple ages, and to other types of mice or rodents. Once that is established then and only then can we speculate in relevance to humans. This study FAILS on all three of the first steps—one sex; one narrow age range, one quirky type of outbred stock. Do not even bother to read the results. Instead send the authors a letter asking them why they thought they could ignore studying female mice. Ask them why they only studied juveniles. Ask them why they did not study other types of mice before getting their public relations team all fired up. Ask them if they think this work robustly generalizes from young male iCR mice to humanity at large. I love using rodents in research because you CAN do the studies right! Work using rodents CAN be highly relevant to humans heath care. Mice and rats can be great models for human disease but only if used correctly—rodents and primates are in the same super-order of mammals—the euarchontoglires, aka the superprimates! They are evolutionarily a bit closer to us than are cats, dogs, pigs, bats, whales, and giraffes. Below is a link to my first study using mice if you want to see how research using rodents should be done. I was a young assistant professor with little funding at a second tier research institution. If I could do this then, then researchers at the top research institution in Japan should be able to do the right thing today. https://pubmed.ncbi.nlm.nih.gov/8929428/ https://pubmed.ncbi.nlm.nih.gov/8929428/
deleted 5y ago
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lesgobrandon 5y ago
thenerdhead 5y ago
I still worry about these types of drugs and their threat towards the human condition. Whether we create a "Soma" type drug from Brave New World which in little doses provides enough pleasure to forget our painful addictions, are we actually solving problems or simply inhibiting them so long as the drug is used? Does this now create a new dependency on another drug that can lead to other life ruin? I'm a firm believer in the duality of the world. The pain we go through in terms of alcoholism/anxiety can be life's cruel way of teaching us. In other words, the pain doesn't leave until it's done teaching you(in one way or the other). Having friends and family who coped with alcohol and are extremely anxious, you can see it as both the best and worst thing that has happened to them. To make real change away from alcoholism or anxiety, there's much more work than simply inhibiting the pain or providing more pleasure outweighing it. I believe this is more alongside the self and understanding one's purpose as both of these things are typically "symptoms" of the bigger human condition problem.
- deleted 5y ago
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dghughes 5y ago
My Dad was not an alcoholic but he had anxiety due to a long illness. Anxiety is terrifying to the person who has it but also to those around them. It starts silently and even people close to them may not even notice. Looking back when I was with my Dad little things now stand out more quirks as to why small things now upset him. As Dad's illness got worse I could see the anxiety but still I wasn't sure what I was seeing. My Dad a blue collar worker arms the size of my legs, impervious to anything, stoic. But to see the affects of anxiety on him was terrifying. Thank god for these types of drugs it made my Dad's life bearable. It's not perfect but living in terror versus being a bit drowsy is the better choice. I wouldn't wish anxiety on my worst enemy.
- thenerdhead 5y ago
  Did you ever get a chance to talk to your dad about the illness and the drugs effect on him personally? Did it take awhile to convince him to take it given his stoic nature?
  - dghughes 5y ago
    No not really but he was aware of the beneficial effects of the drugs for his lungs, and for his rheumatoid arthritis. But near the end he was also on morphine to help his breathing which was great but it's a terrible drug for causing constipation! His mind was clear up until the last two months because he was in the hospital and then palliative care. So that was not unexpected to be said since he'd never be home again. It was quick really only about a month until he died once in palliative care. Although I could tell he was putting on a brave face. Dad died by my side in his sleep in palliative care but he was clear of mind two days before. He was never alone at home, in the hospital, or in palliative care I was always there. Anyway I could ramble on about it more but really my family is lucky to live in a country with socialized medical system. I'm also thankful for drugs there are some amazingly helpful drugs can ease suffering of many people.
    - thenerdhead 5y ago
      Thanks for sharing. Wishing you well. I'm sure it took a lot just to type a response. Thanks again.
whalesalad 5y ago
Anecdotally I’ve heard a number of stories involving the use of psychedelics to treat alcohol and smoking addiction.
- QuercusMax 5y ago
  I know friends who report that drinking after taking microdoses or psilocybin is highly unpleasant and makes them want to vomit. Also the urge to drink is much reduced. This effect seems to last at least a few days.
relativeadv 5y ago
In my early twenties, I took Buspirone for anxiety and it got the job done. Its my understanding that they also prescribe this to Alcoholics. I'm curious what overlap that old drug has with this or if it is entirely novel. Ironically, in my late twenties i would have considered myself an alcoholic, long after i got off buspirone. I am three years sober now.
- tsol 5y ago
  Busiprone is an atypical antianxiety medication. They can help some people with alcohol issues, it really depends on the person though. That's great it worked for you, it never did much more than make me sleepy
ChrisMarshallNY 5y ago
"Cures alcoholism"? That's interesting...
bannedbybros 5y ago
tnorthcutt 5y ago
Disulfiram, the subject of this article, has also shown promise in treating persistent or otherwise treatment-resistant Lyme disease: https://clinicaltrials.gov/ct2/show/NCT03891667 https://clinicaltrials.gov/ct2/show/NCT03891667
ed-209 5y ago
Maybe a useful (if redundant) part of a multipronged approach for self-medicators but can't touch the reality-avoidance component of addiction - that maladaptive behavioral pattern which has more in common with personality disorders than "chemical imbalance".
ineedasername 5y ago
It's quite a stretch to say that Disulfiram cures alcoholism. It inhibits metabolism and produces some nasty side effects if you drink alcohol. But it doesn't "cure" alcoholism. If you want to drink and don't have close monitoring to enforce taking the medication, you just stop taking.
eternityforest 5y ago
I've always thought try/catch is a very good model. When you have an error, you have to handle it, or someone up the chain has to, or the program crashes(Or behaves in an undefined way, if it's a language like C that makes it way too easy to ignore return codes). Try/catch directly expresses all that in a language construct without requiring you to explicitly think about it much, except in functions that throw or functions that catch. Requiring functions to declare throws fixes most of the issues with it.
okareaman 5y ago
Alcoholics Anonymous is not for everyone. The quality of the meetings varies widely. Sometimes I'll be in a meeting and shudder to think about a new comer walking into that meeting. A lot of people in meetings have issues other than alcohol that make them difficult to be around. Some meetings are full of lonely people who drink too much and want to cut down but aren't alcoholics, so they use AA as a social club. That said, there is value in studying the texts of AA. They contain a lot of wisdom. The 12 steps as written by Bill Wilson in Akron and modified through debate with other real alcoholics are especially interesting and are based on time tested methods of self-examination. The "God" word doesn't have to be a hangup. Bill Wilson and Dr. Bob were Christians, so they used God in the sense of the creator of the Universe, but it's acceptable and encouraged that a person substitute their own conception of God. You don't have to go to a meeting to find a sponsor. A sponsor is only supposed to explain how the 12 steps work. A sponsor is not your therapist, guru, priest or companion. This is often lost in modern AA since so many people are accustomed to talk therapy. You could call the AA hotline in your town and tell them you are looking for someone to take you through the 12 steps. People say a lot of things about AA without ever talking about the steps [1], which are the core of AA. It's hard to overestimate the brilliance of what Bill Wilson came up with on Dr. Bob's kitchen table. A quick summary: Steps 1 to 3: Getting clarity about how bad the problem is, about whether you can solve it by yourself, and if not, who can you ask for help and how willing your are to humble yourself to ask for help. Are you done yet? Are you ready to surrender? Steps 4 to 7: Cognitive Behavioral Therapy (CBT), Dialectic Behavioral Therapy (Wise Mind [2]), with Step 5 being Cognitive Processing Therapy for trauma, which entails telling your trauma to someone as a way to acknowledge and release it. In all this you learn meta-cognition or thinking about thinking and feeling. Are my feelings based on anything real or am I practicing one of the cognitive distortions [3]? You learn to be the observer of yourself, which is the key into meditation. Becoming the witness is that path to your higher power, so the last part of this phase is to resolve to not spin your wheels in repetive thoughts and emotions, but turn them over to your observer and witness of yourself. From that mental standpoint, it becomes much easier to ease your mind into a calmer state and hopefully eliminate what drove you to drink in the first place. Steps 8 to 12: Rejoining the human race, since most severe alcoholics end up isolated and alone. Getting right with others is an important part of maintaining getting right with yourself. This maintanence is extremely important and most successful recovery persons "carve out a little part of each day" to practice this maintenance. An important part of this maintenance is helping other alcoholics, which is expressed in the saying "You have to give it away to keep it" If you go to an AA meeting and no one there understands any of this, then find another meeting. I have previously written about this here: https://news.ycombinator.com/item?id=29951607 https://news.ycombinator.com/item?id=29951607 My not real name email is my profile if anyone has any questions about the 12 steps [1] https://www.aa.org/the-twelve-steps https://www.aa.org/the-twelve-steps [2] https://dbtselfhelp.com/dbt-skills-list/mindfulness/wise-mind/ https://dbtselfhelp.com/dbt-skills-list/mindfulness/wise-min... [3] http://www.pacwrc.pitt.edu/curriculum/313_MngngImpctTrmtcStrssChldWlfrPrfssnl/hndts/HO15_ThnkngAbtThnkng.pdf http://www.pacwrc.pitt.edu/curriculum/313_MngngImpctTrmtcStr...
ohiovr 5y ago
"The only thing that cures alcoholism is a desire (and thorough conviction) to not to die with the dishonor of being a drunk." - Ohiovr -1 I wanted to try my comment again to see if I could rectify my error and apparent hypocrisy. If anyone is still reading this thread and desires freedom from alcohol I will try to expand on this while it is still up. My desire to not die a drunk came suddenly to me late last year when one my beloved neighbor died one unfortunate night after a lifetime of alcoholism due to her drinking. She was a confessing christian and was not able to drive anymore because of a license suspension. I thought I too was a Christian. Because she could not drive and since I too was an alcohol abuser I sought to please her by answering her request to buy cheap liquor for her from the place she wished while I was pounding cheap six packs night after night day after day for years. Then one day her eyes turned yellow and I pleaded with her to seek medical attention. I said you probably better lay off the sauce for a while until you get well but she did not. Even if she had, it was already too late for her. A week later she was taken to the hospital and that night she died. My brother also went to the hospital a couple years ago because of a lifetime of strong drink and he was also near death. By God's mercy he survived and though he is still a drinker he only drinks beer now and we both enjoyed about a hundred gallons of cheap beer since that time. He was not a christian but I thought I was. I thought everyone who confessed the name of Christ was his and that his mercy could overlook such depraved behavior. I thought my neighbor was a confessing christian. When I was depressed she exhorted me over and over to read the book of Romans. Yet Paul had the harshest words for drunkenness. We tend to pick and choose what to accept and what to reject with what is already in our hearts and when our hearts are set one way we do not often let the truth in. When she died I felt not only grave sadness for her loss but also deep guilt in my own conscious for not only being exactly like her but also enabling her death. I had defeated the enemy in me at that point concerning pornography (which to this day I have been free of for 6 months) I thought man I've done it, I'm now a christian for real. I had an abundance of confidence. But it was not so at all true that I really knew Christ. Since December 27th I've been free of being a continuous alcoholic. I have to confess I did have one day of drink just recently but I did not seek any after. I do not intend on buying drink ever again. The drink I had was a gift from a friend (my landlord) who made wine with his own hands. I could not refuse. I did not feel the same pull I always did to have more and more. Indeed one drink ought to take me back to the abyss. My life has been in turmoil all year yet I refused to see it until I dreamed an extraordinary dream of my Dad fist fighting me and being unable to get away from his wrath. There was no where to run, there was no where to hide. I sought the meaning earnestly and received 2 other dreams. Some other dreams I had were completely humiliating. But all this was leading to something that I was not doing what I ought to do. I was proud, I needed a great deal of humility and I was unable to see that from what my peers were telling me. I had to seek my Heavenly Father's countenance earnestly to find peace. Dear friends, alcohol is a cruel master, it strips away your whole life. It will take the lives of those around you and leave you with guilt to consider what you did. It will take your job and your freedom. It will separate you from your family. It will even take away your communion with the Almighty. I'm not writing this to condemn but to help. I love Christ because he first loved me! Love is not mere acceptance, nor is it slave to us. It is our master. Christ is love and he is truth. Christ does not reprove people he hates, reproof is love. The loving son accepts his father's reproof. The unloving son hates reproof. The death of my neighbor may have indeed saved my soul. Because until that point I was living in grave error. Her death still reverberates day after day with her sister which is also now my beloved neighbor. That is why I said only the desire to not be an drunk will save you from being one. But we are powerless to do this on our own. Alcohol has a very strong hold on some of us trying to cure or fill something in us which only the spirit of God can fill with concrete. If you make Love your master, Christ incarnate is Love, instead of Alcohol, then nothing will be truly impossible for you if you remain in him. Pray earnestly for his splendid countenance and you will receive it.

197 points by rustoo 5y ago

As I comment on many HN posts, I cannot exaggerate the impact that alcoholism medication has had on my life. It is only tangentially related here, as this comment is not about disulfiram but rather naltrexone, a drug with similar goals but a very different mechanism of action This is all to say, if you or a loved one is struggling with alcoholism, I highly recommend looking into The Sinclair Method. Check out /r/alcoholism_medication or this accounts recent comment history. That community supports those that use disulfiram as well, but I cannot comment on that medication myself

locusofself 5y ago
Good to hear it .. I've been sober 12 years (cold turkey after years of attempts) and when I was struggling I tried to get a prescription for Antabuse and doc said no. I see no reason not to try whatever tools are available to save someone from a terrible life (or death).
- tom899 5y ago
  Antabuse can lead to death or dangerous healh problems. The doctor is and will be responsible for that, so he wont take the risk.
  - Broken_Hippo 5y ago
    "Antabuse can lead to death or dangerous health problems." So can a slew of other drugs. You should see the drug risks for stuff folks take for autoimmune disorders. It isn't just up to the doctor to mitigate the risks: Patients must do their part as well (blood tests and so on). And most importantly: So can alcoholism. Alcoholism kills slowly. Withdrawal can kill not-so-slowly. Somehow, do you think the doctor is not responsible for refusing help when the alternative risks include death as well? That said, I'm not a doctor and there are generally (but not always) good reasons to avoid a drug or another. The risk of drugs by itself usually isn't it, though, as it depends on effectiveness compared to other drugs/methods and comparing the risk of cure to the risk of continued disease.
    - aaaaaaaaata 5y ago
      > So can a slew of other drugs Dr isn't legally liable for drugs you find on your own.
      - Broken_Hippo 5y ago
        I was speaking of prescription drugs here, the very ones you have to visit the doctor to get. I thought with the context that would have been clear.
      - dragonwriter 5y ago
        Dr. isn't legally liable if they act within the norms of the profession with with informed consent. Almost any drug can cause death or dangerous health problems.
    - MissionInfl 5y ago
      Sorry if you already know this, but the difference with disulfiram/Antabuse is that these side effects are intentional and are supposed to act as a deterrent to consuming alcohol. The fact that it can kill you if you mix it with booze is why people take it, as far as I understand it
hn_user82179 5y ago
I'm currently on a naltrexone/wellbutrin combo. I started it to try to finally end an infinite binge/purge cycle I find myself stuck in (an eating disorder). I also have depression/insomnia and had been self-medicating with alcohol (really, I just drank to relax -> drank to fall asleep -> didn't fall asleep -> drank more). I wouldn't say it was a lot compared to what you think of when you think of an alcoholic but it definitely fell under the category of binge drinking nightly (~3 beers a night). I had reached a point where I figured it'd be good to stop (after reading about how easily one can develop a Thiamine deficiency) but found it... not easy. I could go a few days but living alone, wfh, etc made me really enjoy my post-work/before-bed beer ritual - it felt like the only thing distinguishing night and day. The medication has helped all 3 issues, a lot. How much it's worked is incredible. I don't know how hard it would've been to stop alcohol without it, but I'm sure I would've failed more before succeeding. Honestly, I'm more impressed by how it's helped me manage my relationship with food. I've spent the last 15+ years obsessing over food. I still think about it far more than people without eating disorders, but my self-worth is not tied to whether or not I eat. I think my mood was better managed on my old antidepressant but things now feel... how I think "normal" is? That said, I do need to get a medical bracelet of some sort. My doctor didn't mention exactly how naltrexone worked and it wasn't until I stumbled across /r/alcholism_medication that I realized that if I got hit by a car or had some other accident, was unconscious and administered opiates - they wouldn't work, and being on naltrexone could have harmful effects if I underwent emergency surgery if the medical personnel were unaware of my prescription.
- refurb 5y ago
  Probably good to have an alert bracelet, but if you were undergoing emergency surgery, the anesthetist would monitor close enough to know something is off and respond appropriately.
  - aaaaaaaaata 5y ago
    How? By upping the pain medication?
    - 5y ago
beeboop 5y ago
I just wanted to say thanks for you mentioning this. I had never heard of naltrexone before and it's something I'm going to talk to my doctor about next week. I've been drinking way more than I want to and I'm finding it difficult to tone it down.

noelwelsh 5y ago

The people I know who like to drink the most are also people I would say are highly anxious, which makes me wonder if they're using alcohol as self medication. Just an informal observation---not claiming a universal truth here.

dclusin 5y ago
Addiction is very commonly diagnosed with other mental health disorders.
rootw0rm 5y ago
as a person new to recovery, i can definitely say that alcoholism was the direct result of my social anxiety.
brohoolio 5y ago
100% that the folks I know who are alcoholics have high anxiety. It’s not the same exact kind of anxiety in all of them, but I believe it’s at the root of their problem with alcohol. Part of my understanding is that for at least some of these folks they never learned to deal with emotions. They never learned how to feel and accept that feelings exist. Alcohol is the agent that they utilize to help keep those feelings at a level they can manage. It’s a numbing agent. The social chaos that these individuals because of their alcoholism is so enormous. And I’m at a point where I can see how it influences their adult children and it’s depressing. You can see how the disease is transmitted from generation to generation. Someone might be disposed towards alcoholism, but coming from an alcoholic family and the chaos that comes from that makes it even more likely that the kids will become alcoholics.
- tom899 5y ago
  You are right with your observations. The root cause are mental health disorders like depression. There is no fast working anti-depressant like alcohol. People try to solve their problems in the short path with it, it works, but in the long run, the problems coming back even more severe. Untreated disorders will be amplified like abuse, depression etc. But its understandable people try alcohol first, until therapy and medication works, its a hard time.

Quequau 5y ago

Given the extremely strong negative reaction to alcohol that patients who are taking Disulfiram experience and given that this is apparently the sole effect that alcohol abuse cessation treatment using it relies on, it is my belief that the treatment is unconscionable and inhumane. I quit drinking after more than 25 years of problematic drinking using naltrexone (The Sinclair Method) and, given my experience with alcohol, it was the easiest thing I've ever done. I urge people who have a problem with drinking and wish to quit, who for whatever reason do not feel that 12 step programs like Alcoholics Anonymous are right for them to find a doctor who is willing and able to prescribe naltrexone and have a serious discussion with them. Had I known it was effective as it is I probably would have been able to stop drinking 20 years sooner than I did.

okareaman 5y ago
Antabuse is a way to stop drinking for a period for whatever reason, maybe you have surgery in two weeks and the doctor says you must stop but you can't. No one in danger of having seizures from withdrawels should suddenly stop. I took Antabuse when I wasn't a very bad alcoholic and I stopped for two weeks. Later, when I was much worse, I would shake in the morning until I got a drink. At that point cessation therapy would be dangerous. I did a medical detox.
- raptorraver 5y ago
  Antabuse helped me quiting few years a go. It wasn't THE solution but one of the components in my success. It felt liberating that I didn't have to think that could/should I have a drink. That door was closed.
heavyset_go 5y ago
As long as it's voluntary, it should remain a tool for those who choose to use it. I don't like the idea of court compelled psychiatric or addiction treatment possibly putting people in situations where they might have to take it or otherwise be considered non-compliant to the courts. The Marchman Act in Florida is particularly worrying in that aspect, as it doesn't require someone to have committed a crime at all to be involuntarily ordered into rehab, and non-compliance can mean being in contempt of court. It's cliche, but it reminds me a little too much of the Ludovico technique.

okareaman 5y ago

Antabuse (Disulfiram) does not cure alcoholism. I think there's been a translation error from Japanese to English, because I don't believe the Japanese think they have a cure for alcoholism.

loeg 5y ago
Could it just be a case of an over-enthusiastic headline writer? The article body says "treat" repeatedly; never "cure."
- okareaman 5y ago
  You're right, misleading headline

tom899 5y ago

I am an alcoholic myself, sober for five months now after a long-term therapy. I am sceptical about taking meds for this desease. The change of life and coping with stress is the best way to avoid getting in relapse of use. The therapists said meds might be a help, but are not the solution. Its a trap for the dependant who might think now hes cured and does not find himself changing his life and solving problems which have caused the desease. I was working in IT and have now time to change, i will be working in a less stressful job and will undergo further treatment of depression and narcicisstic personalty disorder i suffer. In the long run, alcoholism can be avoided by selling it only in special stores, people need more knowledge about it and society itself must be more aware how dangerous alcohol is. I live in bavaria,germany. I can purchase hard liqour around the clock and in amounts with no limit. Its cheap and i have no problem with the people around me. The drinking culture makes it possible to be offerd a beer to almost every occasion. Sure the openly and public drinking in broad daylight is some kind of awkward, but people dont take it too serious. We have no laws exept driving cars or being drunk at the workplace. But well, meds can help a bit to get someone stable enough be treatabel for a long term therapy, but a cure, they are not. The nucleus accumbens has stored the associative information that drinking can help with insomnia, depression and makes live a bit easier. To get rid of this is a long and hard way, the most is done by undergo treatment, self help groups and finding new hobbies or something replacing the habits that led before to the addiction.

blenderdt 5y ago
Multiple studies have shown that alcohol sits in the top two of most destructive harddrugs for both the user and the user's surrounding. And still we can buy it everywhere. Like you say: the drinking culture must change.
- alar44 5y ago
  > the drinking culture must change. Why? Because a small fraction of people can't handle alcohol? If you don't want to drink, don't. But don't tell me how to live.
  - 5y ago

russellbeattie 5y ago

Crap. This topic just reminded me that I haven't done my taxes yet. I wish I was kidding.

toxicFork 5y ago

https://pubmed.ncbi.nlm.nih.gov/25586396/ https://pubmed.ncbi.nlm.nih.gov/25586396/ > Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study Mushrooms will help us.

taneq 5y ago
Are you sure? One time in a Amsterdam I tried mushrooms and I’m pretty sure I drank the same pint of Heineken four times.

shisisms 5y ago

The madness of assuming that by treating the symptoms you remove the cause. Isn’t one of the most dangerous aspects of our current industrial medical complex the risk that by avoiding the underlying causes the anxiety manifests elsewhere, thereby not actually solving anything. Small bandaid. It’s where mindfulness and accelerated capitalism became such a potent and dangerous game. One of the upshots of the current trends in psilocybin treatment is that it at least places an equal emphasis on a therapeutic environment.

magicconch 5y ago

Another alternative drug is emoxypine [1], sold under the brand name Mexidol. It also possesses anti-anxiety effects. Rather than make the user feel terrible when they drink (as in the case of disulfiram), it has effects more similar to naltrexone: reducing the effects of alcohol so the user does not experience the feelings they usually would. I think this is a lot more humane than disulfiram. [1] https://en.wikipedia.org/wiki/Emoxypine https://en.wikipedia.org/wiki/Emoxypine

kraussvonespy 5y ago
I was just looking to see if someone had posted emoxypine. I have some experience with this med and it does work as intended for alcoholism. Plus it does the job a lot more gently than what I imagine disulfiram does.

braingenious 5y ago

Oh thank goodness that there’s a CURE for alcoholism! This must be new, because the last time I heard an outlandish claim like that was from some complete moron pastor trying to pitch somebody on taking Antabuse after having read a sales pamphlet that said something to that effect. I’ve seen people take obscure research benzos that led to weeks long blackouts, belladonna alkaloids that led to assaulting firefighters, bath salts that led to arson charges… and I’d suggest any one of those over the absolute abject misery that I’ve seen disulfiram cause. Anybody that calls a drug that’s essentially a form of torture a “cure” for something as complex as alcoholism is at the very best dangerously stupid, at the very worst a liar with a conscious fetish for abusing strangers, and on average somewhere in between. No matter what, they aren’t real scientists by any stretch of the imagination.

jrapdx3 5y ago

Disulfiram is a very familiar and very old line drug. It doesn't (directly) stop people from drinking alcohol, but just makes it very unpleasant. Disulfiram interferes with the breakdown of the normal metabolic products of alcohol, which cause nausea, headache, flushing, sweating and other autonomic symptoms. With large amounts of alcohol the interaction can be dangerous, rarely even fatal. But the article is reporting a different effect altogether. Disulfiram indirectly inhibits glutamate signaling, which produces a putative "antianxiety" effect in an animal model of anxiety. It makes sense in that glutamate is the primary activating neurotransmitter in the brain. After all existing antianxiety agents like benzodiazepine drugs work by binding to GABA receptors. GABA is the primary inhibitory neurotransmitter. The logic is increase inhibitory effect == reduce activating effect. BTW it's not coincidence that alcohol also binds to GABA receptors, the reason people reach for a drink when they're feeling nervous. But the problem remains that taking disulfiram for anxiety means using NO alcohol at all. Maybe a few people are OK with this but I bet most will be unwilling to give up having a drink now and again. So it creates a problem since people will forget and with both on board it can be a big headache, in more ways than one.

trompetenaccoun 5y ago
Being unable to tolerate drinking alcohol is the norm, not the other way around. There are a lot of people around the world who have an alcohol intolerance or "allergy", interestingly the exact same effect you experience when taking this drug. Trust me, from personal experience you're not going to forget. There's a reason they treat addicts with this.
- deleted 5y ago
  [deleted]
- jrapdx3 5y ago
  Yes, it's true that a significant fraction of certain populations have an intrinsic disulfiram-like reaction to alcohol. (Affected individuals don't produce the enzyme that disulfiram interferes with.) For sure these people have a good reason to avoid alcohol. Whether this inherited intolerance of alcohol is the norm depends on which populations we're talking about. For example among people with European ancestry this genetic variation is uncommon. And indeed alcohol dependence is a huge issue in many parts of the world. In my experience disulfiram is only useful with people who are motivated to quit drinking. Forcing alcoholics to take disulfiram is asking for catastrophe. (Courts used to impose this condition on people charged with driving while intoxicated.) I've known individuals who drank anyway and wound up in the Emergency Department. Fortunately none died but it can happen. Anyway it's an issue because having an anxiety disorder often leads to abusing alcohol. But the article's real story is not only the potential antianxiety benefit of disulfiram, but the intriguing finding regarding novel mechanisms of action, and that is worthwhile exploring further whether the drug ever gets approved for this new use, or not. Not at all contradicting your point. It just goes to show we have to take things in context, the context itself being subject to infinite variation.

02020202 5y ago

fitba72 5y ago

Need to point out that the disease theory of addiction is hotly debated in the US. Not so much in developed countries where socialized medicine is available, where the theory is widely discounted. Those interested should take a look at the work of Stanton Peele.

emerged 5y ago
I’d imagine most addiction occurs when the body has a natural imbalance in certain neurotransmitters (GABA), so it seeks a way to adjust the balance (alcohol). Seems fair to call that natural imbalance a disease.
- netizen-936824 5y ago
  You're onto something there. These imbalances (rather, deviation from the average in terms of various regulatory pathways) are absolutely key to differences not only in personality but perspective, cognitive abilities, and as you mention propensity to use psychoactive substances. I've been thinking something similar for a while now, that most people with addictions to psychoactive are likely attempting to correct for something. Not to mention, most of the illegal compounds have pharmacological activity that would be nearly impossible to get from a prescription for most people.
- fitba72 5y ago
  Your US medical insurance will cover an illness or disease (why 12 step for profit rehabs continue to lobby this idea). Less likely to cover you for a lifestyle choice that became a learned behavior.

xanaxagoras 5y ago

There is absolutely no sense in which antabuse "cures alcoholism", I really can't think of a worse way to put that. All it does is cause a violent physical reaction when alcohol is consumed. Alcoholism is an umbrella term for 2 co-occurring disorders, one physical and one mental. On the physical side, alcohol produces an allergy which manifests as an intense physical craving for more alcohol - craving in the sense of a physiological need, which the alcoholic experiences on equal footing as a need for food, water or oxygen. The mental side of things (often referred to in AA as a spiritual ailment) is a sort of compulsive disorder in which the alcoholic becomes absolutely obsessed with proving to himself and others that he can "drink normally". The obsession is why the first drink is taken and the allergy is why it will never be enough. Now, the allergy is relieved immediately by removing the allergen, say by going to rehab or drying out at home, but as anyone who has spent any time at all around one of us knows, this purely physical "sobriety" is usually short lived if the mental obsession is left untreated. The proposition of antabuse is basically identical. Everyone I've ever known who took antabuse simply stopped X days ahead of a relapse. It is completely useless. As for whether or not it alleviates anxiety in rodents, I will leave that to the people who are studying it.

bee_rider 5y ago
Is there any medically backed information on the idea that alcoholism is an allergic reaction to alcohol? I mean -- it doesn't seem like a great analogy, but I don't generally have an uncontrollable desire to overindulge in cat dander and pollen, personally.
- gitfan86 5y ago
  No. Allergic reactions are the immune system responding to a substance in a hypersensitive way[1]. There is however a genetic component to how people respond to alcohol. Some people after having 1 drink have a strong desire to continue drinking to blackout levels. Others are more likely to feel sick or sleepy after 2 drinks and have a desire to stop. It isn't an immune system reaction, but it is a reaction. The AA community generally considers this a disease that has no cure. Once an alcoholic you are permanently an alcoholic. So that is why you'll see people pushing the idea that it is similar to an allergy. They are correct that genetic differences exist, but in the real world, many people have substance abuse problems due to stress or anxiety or childhood trauma. Meaning the biological components are far less of an issue than the psychological and mental health component in most cases of substance abuse. A well documented point of evidence of this is heroin use in Vietnam [2] [1] https://en.wikipedia.org/wiki/Type_I_hypersensitivity https://en.wikipedia.org/wiki/Type_I_hypersensitivity [2] https://jamanetwork.com/journals/jamapsychiatry/article-abstract/490667 https://jamanetwork.com/journals/jamapsychiatry/article-abst...

yread 5y ago

take this with a large amount of salt. Disulfiram reacts with a lot of stuff so it pops up on all kinds of screenings. Some people saw its activity against cancer, even covid but it never pans out

TedShiller 5y ago

There are plenty of drugs that will stop you from drinking. They will also stop you from doing anything else.

throawayAlcohol 5y ago

I logged out and made a throwaway because I'm somewhat sad to see the responses here. While it isn't helpful to every alcoholic, and should never be forced upon any alcoholic at all, it is to some. It's the alcohol equivalent of suboxone, for better and worse. You cannot force an addict of either sort to recover until the person wants to, for sure, I've been there. I chose to seek Antabuse of my own volition some years ago after failing repeatedly with every other method including naltrexone and rehab. It worked for me brilliantly to stop my brain from sabotaging my life. Humans are not immune to the biological and evolutionary mechanisms that every other animal also suffers from, and there's just as much no reason to ignore things that can work. I know this'll just get labeled as shill post since it's anon throwaway, but I promise I'm not. It does work for some people and gave me my life back. Maybe not that many, but more than zero.

adwi 5y ago
Congratulations on finding a method and making it work, that’s all that matters.

Rainymood 5y ago

I'm half asian and I get the "Asian flush" [0] which for all intents and purposes induces the same effect as this drug (DSF) >Individuals who experience the alcohol flushing reaction may be less prone to alcoholism. Disulfiram, a drug sometimes given as treatment for alcoholism, works by inhibiting acetaldehyde dehydrogenase, causing a five to tenfold increase in the concentration of acetaldehyde in the body. The resulting irritating flushing reaction tends to discourage affected individuals from drinking.[9][10] I literally have a negative feedback loop from drinking alcohol, it makes me feel really bad, my skin flushes, I feel my heartbeat in my chest/neck/head, and I literally feel miserable. Honestly, it kind of sucks, because when you can't drink you notice how much socialising is based around alcohol. I've found ways to cope with this and am on good terms with myself now but it really took me a long time. Especially to get around the social/peer pressure of having to drink. On the bright side, I'll likely never become an alcoholic.

darkerside 5y ago
You might enjoy this https://dynomight.net/alcohol/ https://dynomight.net/alcohol/
- cypherpunks01 5y ago
  Interesting article, thanks!
zbentley 5y ago
The effect you describe is only one of the effects of antabuse. The others are substantially worse (in that they are extremely painful and in that they can be medically quite severe). The mechanism is similar, you're right, but not quite the same.

ohiovr 5y ago

The only thing that cures alcoholism is a desire (and thorough conviction) to not to die with the dishonor of being a drunk.

headsoup 5y ago

I would prefer to see how we're progressing on the 'prevention of anxiety in the first place' front rather than another money-making band-aid for illusory effect. Not dismissing anxiety and a desire from those suffering to get out of it, but this wreaks of another case of solving difficult/complex problems with 'simple' solutions...

rzmmm 5y ago
This is what I think often when I see news about anxiety and other mental disorder. I have a lot of respect for researchers working on these topics, but I'd like to hear more from researchers who e.g. try to find more accurate picture of the risk factors of these things.
tsol 5y ago
How do you remove anxiety from life? Maybe I'm misunderstanding, but to me life is inevitably gonna cause anxiety and if you removed all of it life would just be boring

jotm 5y ago

Phenylethylamine works somewhat like that: take 2-3g and don't drink. If you do, you'll heavily regret it as it will fuck up your blood pressure to the point of getting all red and passing out. Not safe at all, but it did work for me for a while. Quitting out of fear can work. A better alternative to treating alcoholism and anxiety are gabapentinoids and gabaergics. There are a few of them, and indeed Gabapentin has been known to be used exactly for these purposes in the US (not Europe, God no, they'll think you're fucking insane). At low-moderate dosages, they give the anxiety relief/relaxation effects of alcohol with none of the negative effects, except withdrawals - several days of insomnia/nightmares if stopping them abruptly. They work on the same receptors as alcohol, so it's kind of a replacement, and it's much easier to taper off them. However if you start taking them together, that can be a problem, as they complement each other. You can end up drinking less... or getting even more fucked every night. As always, gotta be really careful and follow some rules. I have quit alcohol completely after more than a decade of use and abuse, I realized it's fucking me more than helping (actually always knew, but it was irresistible). Lately I was mainly using it to go to sleep, so I found this wonderful drug called Tizanidine, an alpha2 agonist prescribed as a muscle relaxant, but at slightly higher doses it quite literally knocks you tf out. No major negative side effects besides indeed, relaxing muscles (so it's best to exercise when waking up or your joints may be in danger), no withdrawals. Tolerance builds up rather fast, after 2 weeks you need double the dosage. But 4 weeks was enough for alcohol cravings to subside a bit. I still miss the taste of beer hah. Since I could fall asleep at any time, that was one major reason to not need alcohol. I even stopped myself from going to the store by taking Tizanidine as soon as I started thinking about beer (which was almost always in the evening). Then I found something for depression (SSRIs don't work). You'll say, "you just traded one drug for another" - yes, I did, however the positive:negative effects ratio has massively shifted towards the former. And I regularly quit my (self-made or self acquired... man, fuck mental healthcare) medication so I can test how addicted I am. It's nothing like alcohol was, that is absolutely life destroying shit that I hope I never taste ever again for the rest of my life.

mtlmtlmtlmtl 5y ago
Informative post, but I have one minor correction: Gabapentin(and pregabalin), while a GABA analogue, doesn't actually interact with GABA receptors og GABA itself at all. It acts on voltage-gated calcium channels, which is in part similar to the downstream signalling effects of GABA, and hence gives the effects you describe.

robwwilliams 5y ago

Tips on how to read a science paper like this that involves mice or rats and makes lots of implicit and explicit bd claims about relevance to humans: (from of a card carrying neurogeneticist who uses mice and rats to study the biology and treatment of human diseases, specifically alcoholism and substance use disorders) Step 1: Go to Methods section of the paper and check the SEX, AGE, and TYPE(s) of mice or rats that that the team used. Here is what this team writes: “Male ICR mice were used for behavioral experiments (age: 6–10 weeks; Tokyo Laboratory Animals Science Co., Ltd., Tokyo, Japan). The total number of animals used in the study were 232 animals.” So SEX = all males AGE = 6 to 10 wks, which in human terms is roughly 12 to 19 years-of-age — teenagers. TYPE = ICR = Imperial College Institute of Cancer Research albino outbred mouse stock Do you see any problems yet with the design? Step 2: How many mice did they study? ANSWER = 232. This is a substantial number of mice to study, so we expect to see dense data plots and low error terms. Step 3: Check if they tried to do the work blinded to the treatment groups. Step 4: Review the individual case data and statistics only if you feel the work passed steps 1, 2, and 3, above. The goal of the first four steps is to establish the likely relevance of results and their generality to both sexes, multiple ages, and to other types of mice or rodents. Once that is established then and only then can we speculate in relevance to humans. This study FAILS on all three of the first steps—one sex; one narrow age range, one quirky type of outbred stock. Do not even bother to read the results. Instead send the authors a letter asking them why they thought they could ignore studying female mice. Ask them why they only studied juveniles. Ask them why they did not study other types of mice before getting their public relations team all fired up. Ask them if they think this work robustly generalizes from young male iCR mice to humanity at large. I love using rodents in research because you CAN do the studies right! Work using rodents CAN be highly relevant to humans heath care. Mice and rats can be great models for human disease but only if used correctly—rodents and primates are in the same super-order of mammals—the euarchontoglires, aka the superprimates! They are evolutionarily a bit closer to us than are cats, dogs, pigs, bats, whales, and giraffes. Below is a link to my first study using mice if you want to see how research using rodents should be done. I was a young assistant professor with little funding at a second tier research institution. If I could do this then, then researchers at the top research institution in Japan should be able to do the right thing today. https://pubmed.ncbi.nlm.nih.gov/8929428/ https://pubmed.ncbi.nlm.nih.gov/8929428/

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lesgobrandon 5y ago

thenerdhead 5y ago

I still worry about these types of drugs and their threat towards the human condition. Whether we create a "Soma" type drug from Brave New World which in little doses provides enough pleasure to forget our painful addictions, are we actually solving problems or simply inhibiting them so long as the drug is used? Does this now create a new dependency on another drug that can lead to other life ruin? I'm a firm believer in the duality of the world. The pain we go through in terms of alcoholism/anxiety can be life's cruel way of teaching us. In other words, the pain doesn't leave until it's done teaching you(in one way or the other). Having friends and family who coped with alcohol and are extremely anxious, you can see it as both the best and worst thing that has happened to them. To make real change away from alcoholism or anxiety, there's much more work than simply inhibiting the pain or providing more pleasure outweighing it. I believe this is more alongside the self and understanding one's purpose as both of these things are typically "symptoms" of the bigger human condition problem.

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dghughes 5y ago

My Dad was not an alcoholic but he had anxiety due to a long illness. Anxiety is terrifying to the person who has it but also to those around them. It starts silently and even people close to them may not even notice. Looking back when I was with my Dad little things now stand out more quirks as to why small things now upset him. As Dad's illness got worse I could see the anxiety but still I wasn't sure what I was seeing. My Dad a blue collar worker arms the size of my legs, impervious to anything, stoic. But to see the affects of anxiety on him was terrifying. Thank god for these types of drugs it made my Dad's life bearable. It's not perfect but living in terror versus being a bit drowsy is the better choice. I wouldn't wish anxiety on my worst enemy.

thenerdhead 5y ago
Did you ever get a chance to talk to your dad about the illness and the drugs effect on him personally? Did it take awhile to convince him to take it given his stoic nature?
- dghughes 5y ago
  No not really but he was aware of the beneficial effects of the drugs for his lungs, and for his rheumatoid arthritis. But near the end he was also on morphine to help his breathing which was great but it's a terrible drug for causing constipation! His mind was clear up until the last two months because he was in the hospital and then palliative care. So that was not unexpected to be said since he'd never be home again. It was quick really only about a month until he died once in palliative care. Although I could tell he was putting on a brave face. Dad died by my side in his sleep in palliative care but he was clear of mind two days before. He was never alone at home, in the hospital, or in palliative care I was always there. Anyway I could ramble on about it more but really my family is lucky to live in a country with socialized medical system. I'm also thankful for drugs there are some amazingly helpful drugs can ease suffering of many people.
  - thenerdhead 5y ago
    Thanks for sharing. Wishing you well. I'm sure it took a lot just to type a response. Thanks again.

whalesalad 5y ago

Anecdotally I’ve heard a number of stories involving the use of psychedelics to treat alcohol and smoking addiction.

QuercusMax 5y ago
I know friends who report that drinking after taking microdoses or psilocybin is highly unpleasant and makes them want to vomit. Also the urge to drink is much reduced. This effect seems to last at least a few days.

relativeadv 5y ago

In my early twenties, I took Buspirone for anxiety and it got the job done. Its my understanding that they also prescribe this to Alcoholics. I'm curious what overlap that old drug has with this or if it is entirely novel. Ironically, in my late twenties i would have considered myself an alcoholic, long after i got off buspirone. I am three years sober now.

tsol 5y ago
Busiprone is an atypical antianxiety medication. They can help some people with alcohol issues, it really depends on the person though. That's great it worked for you, it never did much more than make me sleepy

ChrisMarshallNY 5y ago

"Cures alcoholism"? That's interesting...

bannedbybros 5y ago

tnorthcutt 5y ago

Disulfiram, the subject of this article, has also shown promise in treating persistent or otherwise treatment-resistant Lyme disease: https://clinicaltrials.gov/ct2/show/NCT03891667 https://clinicaltrials.gov/ct2/show/NCT03891667

ed-209 5y ago

Maybe a useful (if redundant) part of a multipronged approach for self-medicators but can't touch the reality-avoidance component of addiction - that maladaptive behavioral pattern which has more in common with personality disorders than "chemical imbalance".

ineedasername 5y ago

It's quite a stretch to say that Disulfiram cures alcoholism. It inhibits metabolism and produces some nasty side effects if you drink alcohol. But it doesn't "cure" alcoholism. If you want to drink and don't have close monitoring to enforce taking the medication, you just stop taking.

eternityforest 5y ago

I've always thought try/catch is a very good model. When you have an error, you have to handle it, or someone up the chain has to, or the program crashes(Or behaves in an undefined way, if it's a language like C that makes it way too easy to ignore return codes). Try/catch directly expresses all that in a language construct without requiring you to explicitly think about it much, except in functions that throw or functions that catch. Requiring functions to declare throws fixes most of the issues with it.

okareaman 5y ago

Alcoholics Anonymous is not for everyone. The quality of the meetings varies widely. Sometimes I'll be in a meeting and shudder to think about a new comer walking into that meeting. A lot of people in meetings have issues other than alcohol that make them difficult to be around. Some meetings are full of lonely people who drink too much and want to cut down but aren't alcoholics, so they use AA as a social club. That said, there is value in studying the texts of AA. They contain a lot of wisdom. The 12 steps as written by Bill Wilson in Akron and modified through debate with other real alcoholics are especially interesting and are based on time tested methods of self-examination. The "God" word doesn't have to be a hangup. Bill Wilson and Dr. Bob were Christians, so they used God in the sense of the creator of the Universe, but it's acceptable and encouraged that a person substitute their own conception of God. You don't have to go to a meeting to find a sponsor. A sponsor is only supposed to explain how the 12 steps work. A sponsor is not your therapist, guru, priest or companion. This is often lost in modern AA since so many people are accustomed to talk therapy. You could call the AA hotline in your town and tell them you are looking for someone to take you through the 12 steps. People say a lot of things about AA without ever talking about the steps [1], which are the core of AA. It's hard to overestimate the brilliance of what Bill Wilson came up with on Dr. Bob's kitchen table. A quick summary: Steps 1 to 3: Getting clarity about how bad the problem is, about whether you can solve it by yourself, and if not, who can you ask for help and how willing your are to humble yourself to ask for help. Are you done yet? Are you ready to surrender? Steps 4 to 7: Cognitive Behavioral Therapy (CBT), Dialectic Behavioral Therapy (Wise Mind [2]), with Step 5 being Cognitive Processing Therapy for trauma, which entails telling your trauma to someone as a way to acknowledge and release it. In all this you learn meta-cognition or thinking about thinking and feeling. Are my feelings based on anything real or am I practicing one of the cognitive distortions [3]? You learn to be the observer of yourself, which is the key into meditation. Becoming the witness is that path to your higher power, so the last part of this phase is to resolve to not spin your wheels in repetive thoughts and emotions, but turn them over to your observer and witness of yourself. From that mental standpoint, it becomes much easier to ease your mind into a calmer state and hopefully eliminate what drove you to drink in the first place. Steps 8 to 12: Rejoining the human race, since most severe alcoholics end up isolated and alone. Getting right with others is an important part of maintaining getting right with yourself. This maintanence is extremely important and most successful recovery persons "carve out a little part of each day" to practice this maintenance. An important part of this maintenance is helping other alcoholics, which is expressed in the saying "You have to give it away to keep it" If you go to an AA meeting and no one there understands any of this, then find another meeting. I have previously written about this here: https://news.ycombinator.com/item?id=29951607 https://news.ycombinator.com/item?id=29951607 My not real name email is my profile if anyone has any questions about the 12 steps [1] https://www.aa.org/the-twelve-steps https://www.aa.org/the-twelve-steps [2] https://dbtselfhelp.com/dbt-skills-list/mindfulness/wise-mind/ https://dbtselfhelp.com/dbt-skills-list/mindfulness/wise-min... [3] http://www.pacwrc.pitt.edu/curriculum/313_MngngImpctTrmtcStrssChldWlfrPrfssnl/hndts/HO15_ThnkngAbtThnkng.pdf http://www.pacwrc.pitt.edu/curriculum/313_MngngImpctTrmtcStr...

ohiovr 5y ago

"The only thing that cures alcoholism is a desire (and thorough conviction) to not to die with the dishonor of being a drunk." - Ohiovr -1 I wanted to try my comment again to see if I could rectify my error and apparent hypocrisy. If anyone is still reading this thread and desires freedom from alcohol I will try to expand on this while it is still up. My desire to not die a drunk came suddenly to me late last year when one my beloved neighbor died one unfortunate night after a lifetime of alcoholism due to her drinking. She was a confessing christian and was not able to drive anymore because of a license suspension. I thought I too was a Christian. Because she could not drive and since I too was an alcohol abuser I sought to please her by answering her request to buy cheap liquor for her from the place she wished while I was pounding cheap six packs night after night day after day for years. Then one day her eyes turned yellow and I pleaded with her to seek medical attention. I said you probably better lay off the sauce for a while until you get well but she did not. Even if she had, it was already too late for her. A week later she was taken to the hospital and that night she died. My brother also went to the hospital a couple years ago because of a lifetime of strong drink and he was also near death. By God's mercy he survived and though he is still a drinker he only drinks beer now and we both enjoyed about a hundred gallons of cheap beer since that time. He was not a christian but I thought I was. I thought everyone who confessed the name of Christ was his and that his mercy could overlook such depraved behavior. I thought my neighbor was a confessing christian. When I was depressed she exhorted me over and over to read the book of Romans. Yet Paul had the harshest words for drunkenness. We tend to pick and choose what to accept and what to reject with what is already in our hearts and when our hearts are set one way we do not often let the truth in. When she died I felt not only grave sadness for her loss but also deep guilt in my own conscious for not only being exactly like her but also enabling her death. I had defeated the enemy in me at that point concerning pornography (which to this day I have been free of for 6 months) I thought man I've done it, I'm now a christian for real. I had an abundance of confidence. But it was not so at all true that I really knew Christ. Since December 27th I've been free of being a continuous alcoholic. I have to confess I did have one day of drink just recently but I did not seek any after. I do not intend on buying drink ever again. The drink I had was a gift from a friend (my landlord) who made wine with his own hands. I could not refuse. I did not feel the same pull I always did to have more and more. Indeed one drink ought to take me back to the abyss. My life has been in turmoil all year yet I refused to see it until I dreamed an extraordinary dream of my Dad fist fighting me and being unable to get away from his wrath. There was no where to run, there was no where to hide. I sought the meaning earnestly and received 2 other dreams. Some other dreams I had were completely humiliating. But all this was leading to something that I was not doing what I ought to do. I was proud, I needed a great deal of humility and I was unable to see that from what my peers were telling me. I had to seek my Heavenly Father's countenance earnestly to find peace. Dear friends, alcohol is a cruel master, it strips away your whole life. It will take the lives of those around you and leave you with guilt to consider what you did. It will take your job and your freedom. It will separate you from your family. It will even take away your communion with the Almighty. I'm not writing this to condemn but to help. I love Christ because he first loved me! Love is not mere acceptance, nor is it slave to us. It is our master. Christ is love and he is truth. Christ does not reprove people he hates, reproof is love. The loving son accepts his father's reproof. The unloving son hates reproof. The death of my neighbor may have indeed saved my soul. Because until that point I was living in grave error. Her death still reverberates day after day with her sister which is also now my beloved neighbor. That is why I said only the desire to not be an drunk will save you from being one. But we are powerless to do this on our own. Alcohol has a very strong hold on some of us trying to cure or fill something in us which only the spirit of God can fill with concrete. If you make Love your master, Christ incarnate is Love, instead of Alcohol, then nothing will be truly impossible for you if you remain in him. Pray earnestly for his splendid countenance and you will receive it.