Director, National Institute on Alcohol Abuse and Alcoholism
Abstract
Alcohol use disorder (AUD) causes an enormous amount of human suffering, loss of productivity and cost to our medical care system and the nation’s economy. Recent developments, including an increase in “deaths of despair” in the United States, increases in alcohol use by some individuals as a result of the 2019 coronavirus disease (COVID-19) pandemic, and limited availability of in-person treatment and recovery support, raise concerns about the use of alcohol and other drugs in an effort to cope with distress. A heuristic framework for studying addiction, characterized by a three-stage cycle—binge/intoxication, withdrawal/ negative affect, and preoccupation/anticipation—provides a starting point for exploring the intersection between alcohol addiction, deaths of despair, and social isolation that are caused by the COVID-19 pandemic. A key part of the addiction cycle is the withdrawal/negative affect stage and the symptoms of hyperkatifeia defined as a hypersensitive negative emotional state associated with drug withdrawal including such symptoms as hypohedonia, dysphoria, malaise, pain, irritability, sleep disturbances, etc. As such, advances in the science of alcohol use disorders can lead the way to better diagnosis, treatment and prevention of this significant public health problem. Using these heuristic frameworks, current challenges include addressing the intersection of pain, hyperkatifeia and negative reinforcement with deaths of despair impacts, and addressing the continuing challenges of women and alcohol, older adults and alcohol, pain and alcohol, and sleep and alcohol. In addition, using telehealth for prevention and treatment may help address continuing challenges in closing the treatment gap. Addressing such challenges will facilitate the implementation of evidence-based treatment for AUD in primary care, mental health, and other health care settings.
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