Alcohol dependence affects millions of Americans, and the overall public health burden is enormous. Auto accidents, lost productivity at work and school, domestic violence, and several types of cancer are among the direct consequences of alcohol abuse. In spite of its enormous economic and sociological toll, alcohol dependence remains stubbornly difficult to treat.
Science has revealed that, for many people who are addicted to alcohol, genetics and environmental conditions conspire in a vicious cycle. In many cases, alcohol abuse runs in families. Children growing up in unsettled conditions often take up drinking at an early age. This early onset alcoholism represents the most treatment-resistant population. When alcohol abuse begins during adolescence, the brain undergoes profound and lasting changes. Undoing such damage is a herculean task.
Researchers have long theorized that genetics and age of onset play a large role in how well those with alcoholism respond to various treatments. People who begin drinking heavily before the age of 25 are classified as having early-onset alcoholism. These individuals typically exhibit heavier drinking in combination with other maladaptive behaviors.
Social support and group therapy are nearly always beneficial, but pharmaceutical interventions are naturally more complex, requiring careful assessment. There are mixed results as to whether antidepressant medications confer any benefits in the presence of alcoholism. A recent clinical study involving adults with alcoholism tested the effect of Zoloft (sertraline) in relation to genetic profile and age of onset.
Participants were given daily doses of either placebo or Zoloft, and completed self-report diaries of mood and drinking habits. In the study of Zoloft, those who experienced greater reductions in drinking were the participants with late-onset alcoholism. The individuals with early-onset alcoholism actually showed more improvement with placebo, a troubling finding for practicing physicians. Additionally, these positive and negative results were confined to one genetic subgroup of alcoholics. For the other subgroup, results were less significant. If nothing else, these study results call for increased genetic profiling before prescription of particular medications.
Alcoholism is a complex psychological issue, comprised of many intertwined factors. Therefore, no single treatment approach will work for all patients. As demonstrated in the study of Zoloft, only those with late-onset alcoholism carrying a certain genetic marker stand to benefit from antidepressant therapy. For some, antidepressants combined with alcohol may even precipitate an increase in drinking. It’s vitally important, therefore, that attending physicians fully comprehend the medical histories of people with alcoholism.
Kranzler, H.R., Armeli, S., Tennen, H., Covault, J., Feinn, R., Arias, A.J., Pettinati, H. et al. (2011). A double-blind, randomized trial of sertraline for alcohol dependence: moderation by age of onset and 5-HTTLPR genotype. Journal of Clinical Psychopharmacology, 31, (1), 22-30.
Sertraline – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001017/
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