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

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.

Most individuals either find that model sufficiently useful that they don't need to expand it. Or, they're more or less fully aware of the gaps but still find that model useful. Or they don't find it useful and quietly use another model personally. All kinds of approaches in there.

If we're talking about 'the real world' then "It is never safe for you to begin drinking again, in any context" is a highly conservative and risk-averse approach, but it has been valuable for so many, and the consequences of relapse can be so high. AA is full of people who "went back out there" after 2, 5, 10+ years of sobriety because they thought they could reintroduce it into their lives and were wrong. Also many stories of people who did and just straight died in the relapse. Often our support networks can't handle another round, plus kindling is a real thing.

AA is where I first heard about van der Kolk's research, which demonstrates very convincingly that in some very real ways there's not a meaningful difference between "biological" and "psychological" components of trauma or addiction.

The AA framework has some incredible faults don't get me wrong. But above all those people are intensely, almost pathologically sometimes focused on "the real world." You'll hear some weird shit coming out of there sometimes because of that, but it doesn't mean they're not aware of the contradictions, or unwilling to apply more "scientific" models. Just, they have a system that works for a lot of people so they keep it going.

> "Opioid Systems. Endogenous opioids are small molecules naturally produced in the body that resemble morphine and have long been implicated in the actions of opiate drugs and alcohol. There are three classes of endogenous opioids: endorphins, enkephalins, and dynorphins. They all exert their effects by interacting with three subtypes of opioid receptors—μ, δ, and κ. Researchers have hypothesized that positive alcohol reinforcement is mediated at least in part by the release of endogenous opioids in the brain. This hypothesis is supported by numerous studies demonstrating that opioid antagonists acting either at all opioid receptor subtypes or only at specific subtypes suppress alcohol drinking in a variety of species and models (for a review, see Ulm et al. 1995). Moreover, complete inactivation (i.e., knockout) of the μ-opioid receptor blocks alcohol self-administration in mice (Roberts et al. 2000b). The agent naltrexone, a subtype-nonspecific opioid receptor antagonist, currently is approved as a treatment for alcoholism in humans and is particularly effective in reducing heavy drinking."

Neurobiology of Alchohol Dependence, Focus on Motivational Mechanisms https://pubs.niaaa.nih.gov/publications/arh313/185-195.htm

Psychedelic drugs have also been used very effectively under controlled conditions (clinical settings) to break both opiate and alcohol addiction with remarkably high success rates. This is an entirely different approach than using blockers like naltrexone. For example:

"Psychedelics as an emerging novel intervention in the treatment of substance use disorder: a review " https://pubmed.ncbi.nlm.nih.gov/33231817/

> "It is believed that these agents allow for the reorganization of disordered neural pathways in the default mode network and attenuate maladaptive signaling in mesolimbic reward circuitry. The aim of this review is to examine the current standing of evidence regarding psychedelic psychopharmacology and to provide an overview of the use and effectiveness of these drugs in the treatment of SUD, alcohol use disorder, and for smoking cessation."