Researchers at CASAA – the University of New Mexico’s Center on Alcoholism, Substance Abuse and Addictions – and the Mind Research Network recently won a $2.9 million grant from the National Institutes of Health, a top-dollar award.
The grant-funded five-year research project will follow 140 people with alcohol use disorder as they undergo effective treatments, proven by scores of research studies – cognitive behavioral treatment or mindfulness-based treatment.
“The brain gets hijacked when people have alcohol problems. We will be looking at neural networks as people resolve their problems,” says clinical psychologist and principal investigator Barbara McCrady.
Cognitive behavior therapy can help participants identify feelings and situations that lead to heavy drinking and respond with new ways of managing stress and changing old patterns.
Mindfulness-based treatment helps participants become more aware of their thinking and behavior patterns and develop deeper resources to cope.
Eric Claus, associate professor at the Mind Research Network, is also a principal investigator on the project.
“This grant is one of the first to investigate how the brain changes with different types of therapy for alcohol use disorders and could provide important clues as to which treatment may work best for a given individual,” Claus says.
Participants will have brain scans, fMRI or functional magnetic resonance imaging at the Mind Research Network, periodically – before they start treatment, immediately after treatment and six months after treatment – to discover how changes in their drinking behavior translates to changes in the brain.
Alcohol use disorder affects individuals in different ways and disturbs several brain centers in varying degrees.
Some problem drinkers have problems regulating and managing their emotions, some have trouble making plans and following through with them and some experience extreme cravings – each related to a different part of the brain.
Claus says that the frontal cortex is important for goal setting and making decisions, while the amygdala processes emotional responses and reward centers in the brain, such as the nucleus accumbens, activate when people are presented with things they find rewarding – like alcohol.
“We expect that when individuals reduce their drinking, there will be an increase in activity in the frontal cortex and also a decrease in activity in the amygdala and the reward centers of the brain,” he says.
Depending on outcomes, the study could lead to tailored treatments for individuals, targeting how their particular brain centers are effected by alcohol, McCrady says.
“We’re excited about the study,” McCrady says. She was named a distinguished professor of psychology last spring – one of the UNM’s highest honors – for her 46-year career and her ongoing research into addiction.
She says the National Institutes of Health reviewers told CASAA that “this is the kind of work we want to see done.”
While the study has greater implications for the future in helping people with severe alcohol issues, it also means that 140 New Mexicans will get scientifically proven treatment in the meantime, she adds.
New Mexico needs all the help it can get.
The state leads the nation in alcohol-related deaths, according to the New Mexico Department of Health, nmhealth.org.
In 2017, the most recent year that statistics are available, 1,461 people died due to alcohol, or four people everyday – twice the national rate.
In 2010, the latest year these figures were analyzed, excessive alcohol use cost the state $2.2 billion in lost work productivity, health care expenses and crime.
The latest study will add to ongoing research at CASAA.
CASAA has pioneered many of the leading effective treatments for alcohol and drug abuse, supported by empirical research, says Katie Witkiewitz, a UNM regents professor of psychology.
Among them are contingency management, behavioral couple therapy as it relates to alcohol and drug use, motivational interviewing and the community reinforcement approach.
Witkiewitz, also a CASAA researcher, will give a lecture about alcohol’s history, why people like it, its use and misuse and explore prevention and treatment options at the New Mexico Natural History Museum’s Dynatheater, from 6:30 to 8 p.m. May 22.
“One of the earliest pieces of writing is a beer recipe,” Witkiewitz says of the Sumerian clay tablet, Hymn to Ninkasi, the goddess of beer, created about 1800 BCE. “For as long as we’ve been around, people have found a way to get high. It’s human nature not to want to feel bad. They don’t call it happy hour for nothing.”
It’s important for people struggling with problems, their families and professionals to understand that humans come to use drugs for myriad reasons, she says.
All those reasons and all those individuals make treating alcohol and drug problems all the more complex.
“I like to use the analogy of hypertension and diabetes. They are never going to be easy to control,” she says, adding that success relies on a multi-pronged approach that can include drugs, diet and exercise – a focus on the whole person.
Resolving problems with alcohol and drugs require the same rigorous approach. She says about 10-15% of those who use alcohol have severe emotional or physical consequences, or both.
“Not everyone becomes addicted. People don’t choose to be addicted,” she says. “Choice really isn’t going on in those brain areas (that misfire).”
“We have to treat the underlying problem of why someone came to develop a disorder in the first place. We have to help people cope in other ways,” she says.
She says many options are available for people who want to change their use. Abstinence can be important for some dealing with severe physical and medical issues related to alcohol, but abstinence isn’t the only beneficial outcome of treatment, she says.
Reducing use can help reduce the negative consequences of addiction, she says.
“I really want to let people to know that’s (abstinence) not the only way,” she says.
McCrady says after treatment, “Less than one-third will maintain abstinence. Reductions in drinking is a much more common outcome.”
Good outcomes are better relationships, greater ability to work and reducing medical risk, she says.
“We meet people where they are. A person may really want help, but not be ready to stop. Abstinence is not the only safe goal,” McCrady says. “I’m not going to tell someone to go away. I’m going to say let’s figure it out.”