As the nation is rocked by a drug abuse crisis that shatters lives every day, scientists and clinicians at the University of Colorado’s Anschutz Medical campus work diligently in their labs and clinics in hopes of preventing addiction tragedies.
As fentanyl and heroin deaths grab headlines and the attention of the research campus, another longtime killer is claiming a growing number of lives. Alcohol use disorder (AUD) claims more than 95,000 Americans each year, with deaths increasing 25% from 2019 to 2020. The largest increase in deaths was seen among 25-44 year olds.
Joseph Schacht, PhD, associate professor in the Department of Addiction Science, Prevention and Treatment at CU’s Department of Psychiatry, was struck early in his career by how addictive and pervasive drinking was and has made it his mission to avert the toll of alcohol toxicity.
“They’re clinically talking to people, and they know it’s bad, that it’s hurting them, and they still can’t stop,” said Schacht, a licensed clinical psychologist and principal investigator in CU’s Translational Addiction Imaging Lab (TrAIL). Anschutz. “I found that really convincing. I felt like I wanted to make a clinical difference by helping people like that.”
With statistics suggesting that half of all American families have at least one member with AUD, Schacht’s audience is large. “Everyone knows someone who is affected by alcohol or is affected themselves.”
For Schacht and his colleagues at the academic medical research campus — home to CeDAR (UCHealth’s Center for Dependency, Addiction and Rehabilitation), the state’s top-rated recovery center — science holds many of the answers.
Using Science in Recovery
Schacht is also a clinical neuroscientist, combining psychology and neuroscience in his search for novel alcohol control drugs. “Unfortunately, there hasn’t been much progress on that front,” Schacht said, noting that the last time the Food and Drug Administration approved such a drug was in 2006, and that the three drugs available don’t work for everyone. “We need better treatments and more of them.”
Scientists now have an advanced biological understanding of AUD, a term adopted by medicine to emphasize that alcoholism is a disease and not a character defect. With better tools and a wealth of data at their disposal, researchers are focusing on recovery techniques with a more personalized, technology-driven approach.
In Schacht’s lab, for example, NIH-funded researchers are comparing before-and-after scans of subjects’ brains, looking for evidence that their experimental drugs are working based on their knowledge of the AUD brain.
Once people develop AUD from excessive drinking, their brains become more sensitized to the mood-altering “rewards” of alcohol and things associated with drinking (bars, parties, frothy beer mugs, etc.). Schacht’s team monitors this “alcohol cue reactivity” by scanning the brains of study participants and showing them alcohol-related images.
Brain changes trigger AUD behavior
“What we are finding is consistent with research from many other animal model studies, which suggest that the parts of the brain that process reward are hyperactive in the AUD brain. So it’s primed to respond to things that alcohol predicts.”
An AUD brain also gets smaller over the years and loses important functions, particularly in the prefrontal cortex, Schacht said, referring to the part of the brain primarily responsible for behavior control.
“So there’s this big reward signal that’s like, ‘This looks good. Go and get that.’ And then you have this diminished control system that can’t say, “Don’t do this because you have to pick up your kids from school or because you have to go to work in the morning,” Schacht said. “So it’s like pushing the gas too hard and the brakes failing.”
Personalization of the recovery approach
In his laboratory in the new Anschutz Health Sciences Building, Schacht’s team is tailoring experimental drugs to these neurological differences. Two of the drugs tested aim to make alcohol less rewarding. “They should take your foot off the gas pedal a bit and make you less want to drink alcohol.”
For one of these drugs, scientists are taking a ‘pharmacogenetic approach’, personalizing treatment by identifying a specific genetic subset of people for whom the drug should be most effective.
Long-term health risks from excessive alcohol consumption
A third drug, aimed at improved control, is also being tested in participants with attention-deficit hyperactivity disorder (ADHD) while scientists work to learn more about the bi-directional relationship of AUD and other mental disorders.
“Having AUDD increases your risk of many other psychiatric disorders: depression, anxiety, ADHD,” Schacht said. Conversely, these mental disorders increase the risk of AUD and other substance use disorders, with the risk being two to four times greater in people with ADHD, he said.
Importance of science-based care
Schacht’s research exemplifies the recovery-related science and innovation happening on the CU Anschutz campus—science that is translating into classrooms and clinics and transforming 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, which is nationally recognized for its inpatient and outpatient treatment programs for all substance use disorders.
As the largest such center in the region, CU Anschutz offers patients strategic, science-based care in a setting that meets every medical need “right across the street,” Fehling said.
CeDAR’s full-time on-site staff, consisting of physicians, nurses, medical professionals and students, leverages these resources and provides advanced care that reflects current research and trends.
“We are currently building a really state-of-the-art protocol for liver transplant recipients,” Fehling said. Alcohol consumption has surpassed hepatitis and is now the #1 cause of liver transplants. Many of these patients, especially in the last year, were in their 20s and 30s.
“After they’re stabilized here, they get a transplant, and then they come back and live in our alcohol rehabilitation treatment program for a couple of months,” Fehling said.
Today’s research covers all stages of recovery, potentially easing the lifelong journey and curbing the toll alcohol can have on people’s health. “That’s the goal,” said Schacht. “We’re hoping to catch people before they get to that point and intervene.”
Other promising areas of research for recovery include:
neuromodulation: Studies of noninvasive neuromodulation, including transcranial magnetic stimulation (TMS), are common in substance use disorder treatment research, with TMS already approved by the FDA for smoking cessation therapy. Invasive neuromodulation, or deep brain stimulation, which is used in Parkinson’s disease and can target structures deep in the brain, has shown promise. Joseph Sakai, MD, Associate Professor in the Department of Psychiatry and Clinician at the TMS Clinic at CU Anschutz, recently received a grant to study deep brain stimulation in methamphetamine addiction.
cannabis: Kent Hutchison, PhD, professor of psychiatry, is the principal investigator of a study with Schacht that tested whether increased levels of cannabidiol in people already using cannabis could help them reduce alcohol consumption. Pre-clinical studies suggest that cannabidiol, a non-psychoactive component of cannabis, has a reduced effect on cravings. Researchers are also preparing for a study testing cannabidiol to help people who want to reduce their cannabis use.
Smart device technology: Computing tools, wearable devices, and mobile technology have prompted many studies in healthcare, including long-term substance use recovery. For example, at the on-campus Peters Mile High Lab for Emotional Wellness and Addiction Recovery, researchers are studying devices that offer guided breathing exercises to help people maintain emotional well-being and prevent physical relapse triggers. Technologies that detect spikes in blood pressure and sweating, for example, are also being explored to help predict high-risk moments of relapse, leading to faster intervention.
To participate in a TrAIL alcohol study, call (303) 724-2424 or email [email protected]. Check the Research page of the CU Anschutz for further attempts.