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As the nation grapples with a substance abuse crisis that shatters lives every day, scientists and doctors at the University of Colorado Anschutz Medical Campus are working diligently in their labs and clinics, hoping to prevent tragedies of addiction

While deaths from fentanyl and heroin flood the headlines and capture the attention of the research campus, another longtime killer is claiming an increasing number of lives. Alcohol use disorder (AUD) claims more than 95,000 Americans each year, with deaths increasing 25% between 2019 and 2020. The largest increase in fatalities occurred among people 25 at 44 years old.

Impressed early in his career by how addictive and ubiquitous drinking was, Joseph Schacht, PhD, an associate professor in the Division of Addiction Science, Prevention and Treatment in the CU Department of Psychiatry, has avoiding alcohol toxicity a primary goal.

“You talk to people clinically, and they know it’s bad, that it hurts them, and yet they can’t stop doing it,” said Schacht, a licensed clinical psychologist and principal investigator at the Translational Addiction Imaging Laboratory (TrAIL) at CU Anschutz. “I found that really compelling. I felt like I wanted to make a difference clinically to help people like that.”

With statistics suggesting that half of all American families have at least one member with AUD, Schacht’s target group is large. “Everyone knows someone affected by alcohol or is affected themselves.”

For Schacht and his colleagues at the Academic Medical Research Campus, which is home to UCHealth’s Center for Addiction, Addiction and Rehabilitation (CeDAR), the state’s top-rated recovery center, science has many the answers

Leveraging science in recovery

Also a clinical neuroscientist, Schacht combines psychology and neuroscience in his search for new drugs aimed at curbing alcohol consumption. “Unfortunately, there hasn’t been much progress on that front,” Schacht said, noting that the last Food and Drug Administration approval of this drug was in 2006, and that the three drugs available have not they work for everyone. “We need better treatments and more.”

Scientists today have an advanced biological understanding of AUD, a term adopted by the medical field to emphasize that alcoholism is a disease, not a character flaw. With better tools and a wealth of data at their fingertips, researchers are focusing on recovery techniques with a more personalized and technology-based approach.

In Schacht’s lab, for example, NIH-funded researchers compare before-and-after brain scans of trial participants, looking for evidence that their experimental drugs work based on their knowledge of the AUD brain.

Once people develop AUD from binge drinking, their brains become more sensitive to the mood-altering “rewards” of alcohol and things associated with drinking (bars, parties, frothy mugs of beer , etc.). Schacht’s team monitors this “alcohol cue reactivity” by scanning the brains of study participants while showing them alcohol-related images.

Brain changes trigger AUD behaviors

“What we find is consistent with research from many other animal model studies that indicate that the parts of the brain that process reward are hyperactive in the AUD brain. So it’s somewhat primed to respond to things that predict alcohol.”

An AUD brain also gets smaller with age, losing critical functions, especially in the prefrontal cortex, Schacht said, referring to the part of the brain primarily responsible for controlling behavior.

“So there’s this big reward signal that says, ‘This feels good.’ Go find it. And then you have this reduced control system that’s not able to say, “Don’t do it, because you have to pick up your kids from school or because you have to be able to go to work in the morning.” ” Schacht said. “It’s like the gas gets too hard and the brakes fail.”

Customizing the recovery approach

In their lab in the new Anschutz Health Sciences Building (AHSB), Schacht’s team tailors experimental drugs to these neurological differences. Two of the drugs being tested at the Colorado Institute of Clinical and Translational Sciences at the AHSB they aim to make alcohol less rewarding. “They’re meant to take your foot off the accelerator a little bit and make you want less alcohol.”

With one such drug, scientists are taking a “pharmacogenetic approach,” personalizing treatment by identifying a specific genetic subgroup of people for whom the drug should be most effective.

Long-term health risks of excessive alcohol consumption

  • High blood pressure, heart disease, stroke, liver disease and digestive problems.
  • Cancer of the breast, mouth, throat, esophagus, voice box, liver, colon and rectum.
  • Weakening of the immune system.
  • Learning and memory problems, including dementia.
  • Mental health problems, including depression and anxiety.
  • Social problems, including family and work problems.
  • Alcohol use disorders or alcohol dependence.

A third drug aims to improve control and is also being tested in participants with attention deficit hyperactivity disorder (ADHD), as scientists work to learn more about the bidirectional relationship between AUD and other attention disorders. mental health

“Having AUD increases the risk of many other psychiatric disorders: depression, anxiety, ADHD,” Schacht said. Conversely, having these mental health disorders increases the risk of AUD and other substance use disorders, with the risk two to four times higher in people with ADHD, he said.

Importance of science-based care

Schacht’s research is an example of the recovery-related science and innovation taking place on the CU Anschutz campus — science that translates into classrooms and clinics, changing the course of substance use recovery.

“We are an academic medical center,” said Patrick Fehling, MD, associate clinical professor of psychiatry and psychiatrist at CeDAR, nationally recognized for its outpatient and inpatient treatment programs for all substance use disorders.

As the largest center of its kind in the region, CU Anschutz offers patients strategic, science-based care in an environment that meets all medical needs “right down the street,” Fehling said.

CeDAR’s full-time on-site staff of physicians, nurses, medical fellows, and students leverages these resources and provides progressive care that meets current research and trends.

“We are currently building a truly cutting-edge protocol for liver transplant recipients,” Fehling said. Alcohol consumption has overtaken hepatitis as the leading cause of liver transplants today. Many of these patients, especially last year, were in their 20s and 30s.

“After they stabilize here, they’ll get a transplant, and then they’ll come back and live in our program for a couple of months for alcohol recovery treatment,” Fehling said.

Current research covers all stages of recovery, potentially easing the lifelong journey and slowing the toll alcohol can take on people’s health. “That’s the goal,” Schacht said. “We hope to catch people before we get to that point and intervene.”

Other promising areas of recovery research include:

Neuromodulation: Noninvasive neuromodulation studies, including transcranial magnetic stimulation (TMS), are common in treatment research for substance use disorders, with TMS already cleared by the FDA for smoking cessation therapy. Invasive neuromodulation, or deep brain stimulation used for Parkinson’s disease and able to target deep structures in the brain, has shown early promise. Joseph Sakai, MD, associate professor in the department of psychiatry and physician in the TMS Clinic at CU Anschutz, recently received a grant to study deep brain stimulation for methamphetamine addiction.

cannabis: Kent Hutchison, PhD, professor of psychiatry, is the principal investigator of a study with Schacht that tests whether increasing cannabidiol levels in people who already use cannabis can help them reduce their alcohol consumption. Preclinical studies suggest that cannabidiol, a non-psychoactive component of cannabis, has a reduced craving effect. Researchers are also preparing for a study testing cannabidiol as an aid to help people who want to reduce their cannabis use.

Smart device technology: Computing tools, wearable devices, and mobile technology have spawned many studies in health care, including for long-term substance use recovery. At the Peters Mile High Lab for Emotional Wellness and Addiction Recovery on campus, for example, researchers are studying devices that offer guided breathing exercises to help people maintain emotional wellness and prevent physical relapse triggers. Devices that identify spikes in blood pressure and sweating, for example, are also being studied to help predict moments of high-risk relapse, leading to quicker intervention.

To participate in a TRAIL breathalyzer study, call (303) 724-2424 or email alcoholstudy@ucdenver.edu. Check the CU Anschutz Research Studies Page for further testing.

Source: Can science stop a drinking crisis? Addiction experts at CU Anschutz are counting on you