Alcohol overuse causes 140,000 American deaths annually. Why is it so undertreated?

Melinda Fawcett

Psychiatry.ufl.edu

Originally posted 28 Nov 23

Here is an excerpt:

How to treat the disorder

In the last decade, the medical community has come to recognize AUD as a disease that (like all others) needs medical treatment through a range of interventions. With new treatments coming out every day, hope exists that in the years to come more and more people will receive the care they need.

For those with the most severe forms of AUD, treatment aims at stopping the individual’s alcohol consumption entirely (while recognizing that having a drink or breaking abstinence isn’t a failure, but an almost inevitable part of the recovery cycle).

“What’s happened in the last probably 50 years or so is there’s a more medicalized understanding,” said Humphreys. “So there’s been the rise of neuroscience that looks at things like how the brain changes with repeated administration of alcohol, how that limits things like self-control, how that increases phenomena like craving.”

And as with any other mental health diagnosis, successful treatment for AUD often boils down to a combination of therapy and medication, the experts Vox spoke to said. Just as depression is treated with medication to balance chemicals in the brain, and therapy to help patients unlearn harmful behaviors, AUD often needs the same combination of treatments, said Disselkoen.

The Federal Drug Administration approved the first medication to treat AUD, disulfiram, in 1951. Disulfiram, whose brand name is Antabuse, is a daily pill that causes someone to fall ill — face redness, headache, nausea, sweating, and more — if they drink even a small amount of alcohol. Disulfiram is safe and effective, but the same characteristic that makes it successful (the way it induces illness) also makes it unpopular among patients, said Nixon.

The info is here.

Key points:

• Alarming death toll: 140,000 Americans die annually from alcohol overuse, highlighting a major public health crisis.
• Undertreatment disparity: Unlike other dangerous substances, alcohol issues lack the same attention and treatment resources.
• Neurological changes: Repeated alcohol misuse alters the brain, making it a serious health condition, not just a social issue.
• Market forces: The powerful alcohol industry and its growing revenue contribute to lax regulations and limited intervention.
• Policy gap: Inadequate taxation fails to curb consumption, while other harmful substances face stricter controls.
• Blind spot in drug policy: Recognizing alcohol as a harmful drug with addiction potential is crucial for tackling the problem.

Moral disciplining: The cognitive and evolutionary foundations of puritanical morality

Fitouchi, L., André, J., & Baumard, N. (2022).

Behavioral and Brain Sciences, 1-71.

doi:10.1017/S0140525X22002047

Abstract

Why do many societies moralize apparently harmless pleasures, such as lust, gluttony, alcohol, drugs, and even music and dance? Why do they erect temperance, asceticism, sobriety, modesty, and piety as cardinal moral virtues? According to existing theories, this puritanical morality cannot be reduced to concerns for harm and fairness: it must emerge from cognitive systems that did not evolve for cooperation (e.g., disgust-based “Purity” concerns). Here, we argue that, despite appearances, puritanical morality is no exception to the cooperative function of moral cognition. It emerges in response to a key feature of cooperation, namely that cooperation is (ultimately) a long-term strategy, requiring (proximately) the self-control of appetites for immediate gratification. Puritanical moralizations condemn behaviors which, although inherently harmless, are perceived as indirectly facilitating uncooperative behaviors, by impairing the self-control required to refrain from cheating. Drinking, drugs, immodest clothing, and unruly music and dance, are condemned as stimulating short-term impulses, thus facilitating uncooperative behaviors (e.g., violence, adultery, free-riding). Overindulgence in harmless bodily pleasures (e.g., masturbation, gluttony) is perceived as making people slave to their urges, thus altering abilities to resist future antisocial temptations. Daily self-discipline, ascetic temperance, and pious ritual observance are perceived as cultivating the self-control required to honor prosocial obligations. We review psychological, historical, and ethnographic evidence supporting this account. We use this theory to explain the fall of puritanism in WEIRD societies, and discuss the cultural evolution of puritanical norms. Explaining puritanical norms does not require adding mechanisms unrelated to cooperation in our models of the moral mind.

Conclusion

Many societies develop apparently unnecessarily austere norms, depriving people from the harmless pleasures of life. In face of the apparent disconnect of puritanical values from cooperation, the latter have either been ignored by cooperation-centered theories of morality, or been explained by mechanisms orthogonal to cooperative challenges, such as concerns for the purity of the soul, rooted in disgust intuitions. We have argued for a theoretical reintegration of puritanical morality in the otherwise theoretically grounded and empirically supported perspective of morality as cooperation. For deep evolutionary reasons, cooperation as a long-term strategy requires resisting impulses for immediate pleasures. To protect cooperative interactions from the threat of temptation, many societies develop preemptive moralizations aimed at facilitating moral self-control. This may explain why, aside from values of fairness, reciprocity, solidarity or loyalty, many societies develop hedonically restrictive standards of sobriety, asceticism, temperance, modesty, piety, and self-discipline.

A pdf is here.