short essay on alcohol use

Essay on Drinking Alcohol

Students are often asked to write an essay on Drinking Alcohol in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Drinking Alcohol

What is alcohol.

Alcohol is a drink made from fermented fruits, grains, or other sources of sugar. It’s found in beer, wine, and spirits. When people drink alcohol, it can change the way they feel and act. Many adults enjoy it in small amounts.

Effects of Alcohol

Alcohol and the law.

In many places, it’s against the law for people under a certain age, often 18 or 21, to drink alcohol. This rule helps protect young people from the risks of drinking too early.

Being Responsible

If adults choose to drink, it’s important to do so responsibly. This means not drinking too much and never driving after drinking. It’s always best to follow the rules and know your limits.

250 Words Essay on Drinking Alcohol

When someone drinks alcohol, it goes into their blood and travels to different parts of the body. It can slow down the brain, making it harder to think, move, and speak properly. This is why people who drink too much might stumble or have trouble talking. Drinking a lot of alcohol can also make someone feel sick or even pass out.

Alcohol Can Be Dangerous

Drinking too much alcohol is very dangerous. It can hurt the liver, which is a part of your body that helps clean your blood. It can also lead to accidents because it’s hard to make good choices or move safely when you’ve had too much to drink. This is why driving after drinking alcohol is against the law.

Alcohol is Not for Kids

In many places, there are rules that say people must be a certain age, usually 18 or 21, to drink alcohol. This is because alcohol can be even more harmful to young people whose bodies are still growing. It’s best for kids and teenagers to avoid alcohol to stay healthy and safe.

Remember, drinking alcohol is a serious choice that adults make, and it’s okay to say no to alcohol to take care of your health and well-being.

500 Words Essay on Drinking Alcohol

Alcohol is a liquid that can change the way our body and mind work. It is found in drinks like beer, wine, and whiskey. People drink it at parties, dinners, and sometimes to relax. It is very common around the world, but it is not for everyone. You must be a certain age to drink alcohol in most places, usually when you are an adult.

Why Do People Drink Alcohol?

The good side of drinking alcohol.

In small amounts, alcohol can make people feel happy and relaxed. Some studies say that a little bit of alcohol, like a small glass of wine each day, might be good for your heart. But this does not mean it is good for everyone. It is still important to be very careful with alcohol.

The Bad Side of Drinking Alcohol

Drinking too much alcohol is not good. It can make you sick, cause headaches, and lead to bad decisions. When people drink a lot, they can become addicted, which means their body feels like it needs alcohol to feel normal. This is very dangerous and can harm their health, jobs, and families.

Alcohol and Health

For young people, alcohol is even more risky. Their bodies are still growing, and alcohol can cause problems with this growth. This is why there are laws about how old you must be to drink.

Alcohol and Society

Making choices about alcohol.

Remember, drinking alcohol is not necessary to have fun or to be part of a group. There are many ways to enjoy yourself without it. Being informed and making smart choices is the best way to take care of yourself and the people around you.

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Understanding alcohol use disorders and their treatment

People with alcohol use disorders drink to excess, endangering both themselves and others. This question-and-answer fact sheet explains alcohol problems and how psychologists can help people recover.

• Substance Use, Abuse, and Addiction

For many people, drinking alcohol is nothing more than a pleasant way to relax. People with alcohol use disorders, however, drink to excess, endangering both themselves and others. This question-and-answer fact sheet explains alcohol problems and how psychologists can help people recover.

When does drinking become a problem?

For most adults, moderate alcohol use — no more than two drinks a day for men and one for women and older people — is relatively harmless. (A "drink" means 1.5 ounces of spirits, 5 ounces of wine, or 12 ounces of beer, all of which contain 0.5 ounces of alcohol.

Moderate use, however, lies at one end of a range that moves through alcohol abuse to alcohol dependence:

Alcohol abuse is a drinking pattern that results in significant and recurrent adverse consequences. Alcohol abusers may fail to fulfill major school, work, or family obligations. They may have drinking-related legal problems, such as repeated arrests for driving while intoxicated. They may have relationship problems related to their drinking.

People with alcoholism — technically known as alcohol dependence — have lost reliable control of their alcohol use. It doesn't matter what kind of alcohol someone drinks or even how much: Alcohol-dependent people are often unable to stop drinking once they start. Alcohol dependence is characterized by tolerance (the need to drink more to achieve the same "high") and withdrawal symptoms if drinking is suddenly stopped. Withdrawal symptoms may include nausea, sweating, restlessness, irritability, tremors, hallucinations and convulsions.

Although severe alcohol problems get the most public attention, even mild to moderate problems cause substantial damage to individuals, their families and the community.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) , 6.2 percent of adults in the United States aged 18 and older had alcohol use disorder. 1 For example, a government survey revealed that about one in five individuals aged 12 to 20 were current alcohol users and about two in five young adults, aged 18 to 25, were binge alcohol users and about one in 10 were heavy alcohol users. 2

What causes alcohol-related disorders?

Problem drinking has multiple causes, with genetic, physiological, psychological,and social factors all playing a role. Not every individual is equally affected by each cause. For some alcohol abusers, psychological traits such as impulsiveness, low self-esteem and a need for approval prompt inappropriate drinking. Some individuals drink to cope with or "medicate" emotional problems. Social and environmental factors such as peer pressure and the easy availability of alcohol can play key roles. Poverty and physical or sexual abuse also increase the odds of developing alcohol dependence.

Genetic factors make some people especially vulnerable to alcohol dependence. Contrary to myth, being able to "hold your liquor" means you're probably more at risk — not less — for alcohol problems. Yet a family history of alcohol problems doesn't mean that children will automatically grow up to have the same problems. Nor does the absence of family drinking problems necessarily protect children from developing these problems.

Once people begin drinking excessively, the problem can perpetuate itself. Heavy drinking can cause physiological changes that make more drinking the only way to avoid discomfort. Individuals with alcohol dependence may drink partly to reduce or avoid withdrawal symptoms.

How do alcohol use disorders affect people?

While some research suggests that small amounts of alcohol may have beneficial cardiovascular effects, there is widespread agreement that heavier drinking can lead to health problems.

Short-term effects include memory loss, hangovers, and blackouts. Long-term problems associated with heavy drinking include stomach ailments, heart problems, cancer, brain damage, serious memory loss and liver cirrhosis. Heavy drinkers also markedly increase their chances of dying from automobile accidents, homicide, and suicide. Although men are much more likely than women to develop alcoholism, women's health suffers more, even at lower levels of consumption.

Drinking problems also have a very negative impact on mental health. Alcohol abuse and alcoholism can worsen existing conditions such as depression or induce new problems such as serious memory loss, depression or anxiety.

Alcohol problems don't just hurt the drinker. Spouses and children of heavy drinkers may face family violence; children may suffer physical and sexual abuse and neglect and develop psychological problems. Women who drink during pregnancy run a serious risk of damaging their fetuses. Relatives, friends and strangers can be injured or killed in alcohol-related accidents and assaults.

When should someone seek help?

Individuals often hide their drinking or deny they have a problem. How can you tell if you or someone you know is in trouble? Signs of a possible problem include having friends or relatives express concern, being annoyed when people criticize your drinking, feeling guilty about your drinking and thinking that you should cut down but finding yourself unable to do so, or needing a morning drink to steady your nerves or relieve a hangover.

Some people with drinking problems work hard to resolve them. With the support of family members or friends, these individuals are often able to recover on their own. However, those with alcohol dependence usually can't stop drinking through willpower alone. Many need outside help. They may need medically supervised detoxification to avoid potentially life-threatening withdrawal symptoms, such as seizures. Once people are stabilized, they may need help resolving psychological issues associated with problem drinking.

There are several approaches available for treating alcohol problems. No one approach is best for all individuals.

How can a psychologist help?

Psychologists who are trained and experienced in treating alcohol problems can be helpful in many ways. Before the drinker seeks assistance, a psychologist can guide the family or others in helping to increase the drinker's motivation to change.

A psychologist can begin with the drinker by assessing the types and degrees of problems the drinker has experienced. The results of the assessment can offer initial guidance to the drinker about what treatment to seek and help motivate the problem drinker to get treatment. Individuals with drinking problems improve their chances of recovery by seeking help early.

Using one or more of several types of psychological therapies, psychologists can help people address psychological issues involved in their problem drinking. A number of these therapies, including cognitive-behavioral coping skills treatment and motivational enhancement therapy, were developed by psychologists. Additional therapies include 12-Step facilitation approaches that assist those with drinking problems in using self-help programs such as Alcoholics Anonymous (AA).

These therapies can help people boost their motivation to stop drinking, identify circumstances that trigger drinking, learn new methods to cope with high-risk drinking situations, and develop social support systems within their own communities.

All three of these therapies have demonstrated their effectiveness. One analysis  of cognitive-behavioral approaches, for instance, found that 58 percent of patients receiving cognitive-behavioral treatment fared better than those in comparison groups. 3 In another study , motivational interventions reduced how often and how much adolescents drank following alcohol-related emergency room treatment. 4 And an intervention called Making Alcoholics Anonymous Easier significantly increased participants' odds of abstaining from alcohol. 5 Many individuals with alcohol problems suffer from other mental health conditions, such as severe anxiety and depression, at the same time. Psychologists can also diagnose and treat these "co-occurring" psychological conditions. Further, a psychologist may play an important role in coordinating the services a drinker in treatment receives from various health professionals.

Psychologists can also provide marital, family, and group therapies, which often are helpful for repairing interpersonal relationships and for resolving problem drinking over the long term. Family relationships influence drinking behavior, and these relationships often change during an individual's recovery. The psychologist can help the drinker and significant others navigate these complex transitions, help families understand problem drinking and learn how to support family members in recovery, and refer family members to self-help groups such as Al-Anon and Alateen.

Because a person may experience one or more relapses and return to problem drinking, it can be crucial to have a trusted psychologist or other health professional with whom that person can discuss and learn from these events. If the drinker is unable to resolve alcohol problems fully, a psychologist can help with reducing alcohol use and minimizing problems.

Psychologists can also provide referrals to self-help groups. Even after formal treatment ends, many people seek additional support through continued involvement in such groups.

Alcohol-related disorders severely impair functioning and health. But the prospects for successful long-term problem resolution are good for people who seek help from appropriate sources.

The American Psychological Association gratefully acknowledge the assistance of Peter E. Nathan, PhD, John Wallace, PhD, Joan Zweben, PhD, and A. Thomas Horvath, PhD, in developing this fact sheet . 

1 National Institute on Alcohol Abuse and Alcoholism. (2018). "Alcohol Use Disorder."

2 Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/

3 Magill, M., & Ray, L.A. (2009). "Cognitive-behavioral treatment with adult alcohol and illicit drug users: A meta-analysis of randomized controlled trials." Journal of Studies on Alcohol and Drugs, 70 (4): 516-527.

4 Spirito, A., Sindelar-Manning, H., Colby, S.M., Barnett, N.P., Lewander, W., Rohsenow, D.J., & et al. (2011). "Individual and family motivational interventions for alcohol-positive adolescents treated in an emergency department." Archives of Pediatrics and Adolescent Medicine, 165 (3): 269-274.

5 Kaskutas, L.A., Subbaraman, M.S., Witbrodt, J., & Zemore, S.E. (2009). "Effectiveness of Making Alcoholics Anonymous Easier: A group format 12-step facilitation approach." Journal of Substance Abuse Treatment, 37 (3): 228-239.

Updated Sept. 2018

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• Alcohol Use and Your Health
• Underage Drinking
• Publications
• About Surveys on Alcohol Use
• About Standard Drink Sizes
• CDC Alcohol Program
• Alcohol Outlet Density Measurement Tools
• Resources to Prevent Excessive Alcohol Use
• Alcohol Applications and Online Tools
• Funding to Prevent Excessive Alcohol Use

Related Topics:

• Show All Home
• Alcohol-Related Disease Impact (ARDI) Application
• Check Your Drinking. Make a Plan to Drink Less.
• Controle su forma de beber. Haga un plan para beber menos.
• Deaths from Excessive Alcohol Use in the United States
• Addressing Excessive Alcohol Use: State Fact Sheets
• Excessive alcohol use can have immediate and long-term effects.
• Excessive drinking includes binge drinking, heavy drinking, and any drinking during pregnancy or by people younger than 21.
• Drinking less is better for your health than drinking more.
• You can lower your health risks by drinking less or choosing not to drink.

Why it's important

• The rest of the alcohol can harm your liver and other organs as it moves through the body.
• Using alcohol excessively on occasion or over time can have immediate and long-term health risks.
• By drinking less alcohol, you can improve your health and well-being.

Deaths from excessive alcohol use‎

Understanding alcohol use, excessive alcohol use.

Excessive alcohol use is a term used to describe four ways that people drink alcohol that can negatively impact health. Excessive drinking can also be deadly.

Excessive alcohol use includes:

• Binge drinking—Four or more drinks for women, or five or more drinks for men during an occasion.
• Heavy drinking—Eight or more drinks for women, or 15 or more drinks for men during a week.
• Underage drinking —any alcohol use by people younger than 21.
• Drinking while pregnant—any alcohol use during pregnancy .

Moderate alcohol use

Moderate drinking is having one drink or less in a day for women, or two drinks or less in a day for men.

Keep in mind‎

Effects of short-term alcohol use.

Drinking excessively on an occasion can lead to these harmful health effects:

• Injuries— motor vehicle crashes , falls, drownings, and burns.
• Violence—homicide, suicide, sexual violence, and intimate partner violence.
• Alcohol poisoning—high blood alcohol levels that affect body functions like breathing and heart rate.
• Overdose—from alcohol use with other drugs , like opioids.
• Sexually transmitted infections or unplanned pregnancy—alcohol use can lead to sex without protection, which can cause these conditions.
• Miscarriage, stillbirth, or fetal alcohol spectrum disorder (FASD) —from any alcohol use during pregnancy.

Effects of long-term alcohol use

Over time, drinking alcohol can have these effects:

• The risk of some cancers increases with any amount of alcohol use. 2 This includes breast cancer (in women). 2 A
• More than 20,000 people die from alcohol-related cancers each year in the United States. 3

Other chronic diseases

Excessive alcohol use can lead to:

• High blood pressure.
• Heart disease.
• Liver disease.
• Alcohol use disorder—this affects both physical and mental health. B
• Digestive problems.
• Weaker immune system—increasing your chances of getting sick.

Social and wellness issues

• Mental health conditions, including depression and anxiety.
• Learning problems, and issues at school or work.
• Memory problems, including dementia.
• Relationship problems with family and friends.

You can take steps to lower your risk of alcohol-related harms.

The less alcohol you drink, the lower your risk for these health effects, including several types of cancer.

Check your drinking‎

• The risk of alcohol use leading to breast cancer in men has not been established.
• Most people who drink excessively do not have alcohol use disorder (also known as "alcohol dependence" or "alcoholism"). Many people who drink excessively can lower their alcohol use without specialized medical treatment. Facts about alcohol use disorder are available at: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder .
• Esser MB, Sherk A, Liu Y, Naimi TS. Deaths from excessive alcohol use — United States, 2016-2021. MMWR Morb Mortal Wkly Rep . 2024;73:154–161. doi: http://dx.doi.org/10.15585/mmwr.mm7308a1
• Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer . 2015;112(3):580-593. doi: 10.1038/bjc.2014.579
• Esser MB, Sherk A, Liu Y, Henley SJ, Naimi TS. Reducing alcohol use to prevent cancer deaths: estimated effects among U.S. adults. Am J Prev Med . 2024;66(4):725–729. doi: 10.1016/j.amepre.2023.12.003

Alcohol Use

Excessive alcohol use can harm people who drink and those around them. You and your community can take steps to improve everyone’s health and quality of life.

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Essay on Drug Abuse in 250 and 500 Words in English for Students

• Updated on  
• Apr 2, 2024

Drug abuse refers to the excessive and frequent consumption of drugs. Drug abuse can have several harmful effects on our mental and physical health. Ronald Reagan, the 40th President of the USA, passed the Anti-Drug Abuse Act of 1986 and initiated the War on Drugs . He said, ‘Let us not forget who we are. Drug abuse is a repudiation of everything America is.’

Consuming drugs not only harms the individual himself but also affects society as a whole. Studies have shown that people who consume drugs become addicted to it. This addiction turns into substance abuse, resulting in self-damage, behaviour changes, mood swings, unnecessary weight loss, and several other health problems. Let’s understand what drug abuse is and how to fight it.

Table of Contents

• 1 Essay on Drug Abuse in 250 Words
• 2.1 Why Do People Consume Drugs?
• 2.2 Why Is Drug Abuse Bad?
• 2.3 Laws in India Against Drug Consumption
• 2.4 Steps to Prevent Drug Addiction
• 2.5 Conclusion
• 3 10 Lines Essay on Drug Abuse

Quick Read: Essay on CAA (Citizenship Amendment Act)

Essay on Drug Abuse in 250 Words

‘When people consume drugs regularly and become addicted to it, it is known as drug abuse. In medical terminology, drugs means medicines. However, the consumption of drugs is for non-medical purposes. It involves the consumption of substances in illegal and harmful ways, such as swallowing, inhaling, or injecting. When drugs are consumed, they are mixed into our bloodstream, affecting our neural system and brain functioning.

The Indian government has taken significant steps to help reduce the consumption of drugs. In 1985, the Narcotics Drugs and Psychotropic Substances Act came into force. This act replaced the Opium Act of 1857, the Opium Act of 1878, and the Dangerous Drugs Act of 1930. 

Drug abuse can lead to addiction, where a person becomes physically or psychologically dependent on the substance and experiences withdrawal symptoms when attempting to stop using it. 

Drug abuse can have serious consequences for the individual and society as a whole. On an individual level, drugs can damage physical health, including organ damage, infectious diseases, and overdose fatalities. Not only this, a person already suffering from mental health disorders will face more harmful aftereffects. Addiction disrupts our cognitive functioning and impairs our decision-making abilities.

To fight drug abuse, we need collective action from all sections of society. Medical professionals say that early intervention and screening programmes can identify individuals at risk of substance misuse and provide them with the necessary support services. Educating people, especially those who are at-risk, about drug abuse and its harmful effects can significantly help reduce their consumption.

Drug abuse is serious and it must be addressed. Drug abuse is killing youth and society. Therefore, it is an urgent topic to address, and only through sustainable and collective efforts can we address this problem.

Quick Read: Success in Life Speech

Essay on Drug Abuse in 500 Words

Drug abuse is known as frequent consumption. In time, these people become dependent on drugs for several reasons. Curiosity drives adolescents and teenagers, who are among the most susceptible groups in our society. Cocaine, marijuana, methamphetamine, heroin, etc. are some of the popular drugs consumed. 

Why Do People Consume Drugs?

The very first question about drugs is: why do people consume drugs? Studies have shown that more than 50% of drug addicts consider drugs as a coping mechanism to alleviate emotional or psychological distress. In the beginning, drugs temporarily relieve feelings of anxiety, depression, or trauma, providing a temporary escape from difficult emotions or life circumstances. 

Some consume drugs out of curiosity, some under peer pressure, and some want to escape the painful experiences. Some people enjoy the effects drugs produce, such as euphoria, relaxation, and altered perceptions. Recreational drug use may occur in social settings or as a form of self-medication for stress relief or relaxation.

Why Is Drug Abuse Bad?

The National Institute on Drug Abuse states that drugs can worsen our eyesight and body movement, our physical growth, etc. Marijuana, one of the most popular drugs, can slow down our reaction time, affecting our time and distance judgement and decreasing coordination. Cocaine and Methamphetamine can make the consumer aggressive and careless.

Our brain is the first victim of drugs. Drugs can disorder our body in several ways, from damaging organs to messing with our brains. Drugs easily get mixed into our bloodstream, and affect our neural system. Prolonged and excessive consumption of drugs significantly harms our brain functioning.

The next target of drug abuse is our physical health and relationships. Drugs can damage our vital organs, such as the liver, heart, lungs, and brain. For example, heavy alcohol use can lead to cirrhosis of the liver, while cocaine use can increase the risk of heart attack and stroke.

Laws in India Against Drug Consumption

Here is an interesting thing; the USA has the highest number of drug addicts and also has strict laws against drug consumption. According to a report by the Narcotics Control Bureau, around 9 million people in India consume different types of drugs. The Indian government has implemented certain laws against drug consumption and production.

The Narcotic Drugs and Psychotropic Substances Act, 1985 (NDPS), prohibits the production, sale, purchase, and consumption of narcotics and other illegal substances, except for scientific and medical purposes.

Also, Article 47 of the Indian Constitution states that ‘ The State shall endeavour to bring about prohibition of the consumption, except for medicinal purposes, of intoxicating drinks and drugs which are injurious to health.’

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Steps to Prevent Drug Addiction

Several steps can be taken to prevent drug addiction. But before we start our ‘War on Drugs’ , it is crucial to understand the trigger point. Our social environment, mental health issues and sometimes genetic factors can play a role in drug abuse.

• Education and awareness are the primary weapons in the fight against drugs. 
• Keeping distance from people and places addicted to drugs.
• Encourage a healthy and active lifestyle and indulge in physical workouts.
• Watch motivating videos and listen to sound music.
• Self-motivate yourself to stop consuming drugs.
• Talk to a medical professional or a psychiatrist, who will guide you to the right path.

Drug abuse is a serious problem. The excessive and frequent consumption of drugs not only harms the individual but also affects society as a whole. Only a collective approach from lawmakers, healthcare professionals, educators, community leaders, and individuals themselves can combat drug abuse effectively. 

Quick Read: Speech About Life

10 Lines Essay on Drug Abuse

Here is a 10-line essay on drug abuse.

• Drug abuse can significantly affect our physical growth
• Drug abuse can affect our mental functioning.
• Drug abuse may provide instant pleasure, but inside, it weakens our willpower and physical strength.
• Educating people, especially those who are at-risk, about drug abuse and its harmful effects can significantly help reduce their consumption.
•  Drugs easily get mixed into our bloodstream, and affect our neural system. 
• Prolonged and excessive consumption of drugs significantly harms our brain functioning.
• In 1985, the Narcotics Drugs and Psychotropic Substances Act came into force.
• The USA has the highest number of drug addicts and also has strict laws against drug consumption.
• Drug addicts consider drugs as a coping mechanism to alleviate emotional or psychological distress.
•  Adolescents and teenagers are the most vulnerable section of our society and are driven by curiosity.

Ans: Drug abuse refers to the excessive and frequent consumption of drugs. Drug abuse can have several harmful effects on our mental and physical health.

Ans: ‘When people consume drugs regularly and become addicted to it, it is known as drug abuse. In medical terminology, drugs means medicines. However, the consumption of drugs is for non-medical purposes. It involves the consumption of substances in illegal and harmful ways, such as swallowing, inhaling, or injecting. When drugs are consumed, they are mixed into our bloodstream, affecting our neural system and brain functioning.

Ans: Drug abuse is known as frequent consumption. In time, these people become dependent on drugs for several reasons. Adolescents and teenagers are the most vulnerable section of our society who are driven by curiosity. Cocaine, marijuana, methamphetamine, heroin, etc. are some of the popular drugs consumed.  The Narcotic Drugs and Psychotropic Substances Act, 1985 (NDPS), prohibits the production, sale, purchase, and consumption of narcotics and other illegal substances, except for scientific and medical purposes.

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From Curiosity to Dependence: The 4 Stages of Alcohol Misuse

Learn the first step to break free from alcohol dependence..

Posted May 29, 2024 | Reviewed by Tyler Woods

• What Is Alcoholism?
• Find counselling to overcome addiction
• Curiosity about alcohol often begins with observing others and media portrayals.
• Alcohol enhances pleasure and numbs stress, leading to repeated use.
• Increased tolerance leads to higher alcohol consumption over time.
• Daily routines and cues trigger automatic drinking responses, making it hard to break free.

Have you ever heard how a pitcher plant works?

A beautiful, vibrant pitcher plant stands out in the tropical forest, its sweet nectar irresistibly attracting unsuspecting insects. A fly, captivated by the plant's charm, lands on the rim and begins to sip the nectar. It seems secure at first. Yet, little does the fly know, the inner walls of the pitcher are coated with a slippery, waxy substance. As the fly slowly ventures deeper into the tube, it starts to lose its footing. By the time the fly realizes the danger, it's too late. The fly struggles to escape, but only slides deeper into the plant's tubular body. Here, downward-pointing hairs prevent its ascent, and digestive enzymes begin to break it down. The fly slides deeper and deeper, eventually finding itself trapped in a place where escape seems impossible.

Similarly, alcohol, attractively packaged and widely celebrated, calls to us. We drink it willingly, unaware that we might be sinking into a trap, much like the fly in the pitcher plant. Let's explore the four stages of alcohol misuse and how we can recognize the signs.

Phase 1: Curiosity—The Allure That Starts Before the First Taste

The allure starts before the first taste. Our curiosity about alcohol often begins long before our first drink. According to social learning theory , we learn through observing and imitating others around us. Our first impressions about alcohol are often based on what we see of our parents, family, friends, or people on TV.

We watch our parents laugh and cheer over dinner, see a successful businessman on TV unwind with a cocktail after a stressful day, and notice the "cool" kids who sneak beer into the party. These experiences shape our initial curiosity and expectations about alcohol: good times, relaxation, a ticket to popularity.

Like the fly that was drawn to the pitcher plant by its sweet smell and vibrant color, our curiosity for alcohol begins with a harmless, even glamorous, impression of what the liquid in the bottle represents. One day, curiosity turns into the first sip—the harmless first taste.

Phase 2: Expected Enjoyment—The First Taste Is Delicious

There is something delicious about our first taste of alcohol, although not in a literal sense. The truth is that most of us squint at our first sips until we learn to acquire the taste over time. But the deliciousness does not have to come from the taste—it comes from the feelings. With two party tricks up its sleeve, alcohol has its way to help us feel good, at least temporarily.

Its first party trick is to enhance pleasant feelings. By stimulating the brain's pleasure center, alcohol allows our brain to release extra dopamine over a short period, creating a sense of euphoria. This immediate reward makes us associate alcohol with positive experiences: fun, joy, and excitement. Its second party trick is to relieve unpleasant feelings. Alcohol, as a numbing agent, dulls unwanted emotions such as stress, anxiety , and sadness. This dual role of enhancing pleasure and alleviating discomfort often makes us return to the bottle, like the fly that gulps down the nectar—it seems harmless. However, as our reliance on alcohol grows, a slow descent may begin.

Phase 3: Coping Method—A Slow Descent With Few Warning Signs

The descent is often gradual. With alcohol, our consumption and dependency grow over time, ever so subtly. Besides its two pleasant party tricks, alcohol has another two secret tricks hidden up its sleeve that hijack our brains.

Its first secret trick is building tolerance through neuroadaptation. As we drink more, our bodies adapt, requiring higher quantities to achieve the same effects, pushing us deeper into the pitcher plant. Its second trick is habit formation , driven by cues and cravings. The basal ganglia, a part of our brain involved in habit formation, strengthens the association between drinking and the context in which it occurs. With enough repetition and strong enough rewarding experiences, alcohol use becomes more and more automatic over time.

After a stressful day at work, reaching for a drink becomes an automatic response. Initially, it's one glass of wine to unwind. Over time, it becomes two or three glasses every evening, with the act of pouring a drink becoming as routine as turning on the TV or checking emails.

The fly noticed itself slipping deeper into the pitch, but a few more sips seemed okay - after all, the fly has wings and could fly out any time. When alcohol becomes a daily habit, we find ourselves slipping further down the pit.

Phase 4: Way of Life—When the Feet Are Trapped and the Wings Are Covered by Syrup

Eventually, near the bottom of the pit, after one last gulp, the fly is ready to depart. That’s when it realizes flying away is not as easy as it thought.

Over time, alcohol becomes associated with many cues, such as social gatherings, stress, or even daily routines. Other cues, such as getting off from work, the sight of an empty wine glass, or a sense of boredom , trigger the craving and a default response of reaching for a drink. These ingrained behaviors make it challenging to break the cycle, as the brain has learned to expect to turn to alcohol in these situations.

However, as our consumption increases, we start to experience negative consequences associated with heavy drinking. Alcohol, once a source of enjoyment and relief, now becomes a source of problem and distress. When the downward-pointing hairs block the way up and the digestive enzymes begin to paralyze the fly—is it too late to fly away?

Unlike the Fly, We Can Break Free

Although it may seem challenging, even impossible, to make changes once alcohol becomes intertwined with many aspects of one’s life, breaking free is possible. It often starts with awareness and insight. Understanding the stages of alcohol misuse and recognizing our patterns can be the first crucial steps toward a better relationship with alcohol.

By becoming aware of our drinking patterns and the effects of each drink, we can begin to make more mindful choices. I developed a 5-minute drinking diary to help. It will guide you in tracking your drinking habits, uncovering the underlying reasons for your consumption, and starting to create positive shifts.

Jeanette Hu, AMFT , based in California, is a former daily drinker, psychotherapist, and Sober Curiosity Guide. She supports individuals who long for a better relationship with alcohol, helping them learn to drink less without living less.

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• v.5(9); 2019 Sep

Advances in the science and treatment of alcohol use disorder

K. witkiewitz.

1 Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd. SE, Albuquerque, NM 87106, USA.

R. Z. Litten

2 Division of Medications Development and Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892-6902, USA.

3 Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, 10 Center Drive (10CRC/15330), Bethesda, MD 21224, USA.

4 Medication Development Program, National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd., Baltimore, MD 21224, USA.

5 Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA.

Pharmacological and behavioral treatments exist for alcohol use disorder, but more are needed, and several are under development.

Alcohol is a major contributor to global disease and a leading cause of preventable death, causing approximately 88,000 deaths annually in the United States alone. Alcohol use disorder is one of the most common psychiatric disorders, with nearly one-third of U.S. adults experiencing alcohol use disorder at some point during their lives. Alcohol use disorder also has economic consequences, costing the United States at least $249 billion annually. Current pharmaceutical and behavioral treatments may assist patients in reducing alcohol use or facilitating alcohol abstinence. Although recent research has expanded understanding of alcohol use disorder, more research is needed to identify the neurobiological, genetic and epigenetic, psychological, social, and environmental factors most critical in the etiology and treatment of this disease. Implementation of this knowledge in clinical practice and training of health care providers is also needed to ensure appropriate diagnosis and treatment of individuals suffering from alcohol use disorder.

INTRODUCTION

In most regions of the world, most adults consume alcohol at least occasionally ( 1 ). Alcohol is among the leading causes of preventable death worldwide, with 3 million deaths per year attributable to alcohol. In the United States, more than 55% of those aged 26 and older consumed alcohol in a given month, and one in four adults in this age group engaged in binge drinking (defined as more than four drinks for women and five drinks for men on a single drinking occasion) ( 2 ). Excessive alcohol use costs U.S. society more than $249 billion annually and is the fifth leading risk factor for premature death and disability ( 3 ).

The morbidity and mortality associated with alcohol are largely due to the high rates of alcohol use disorder in the population. Alcohol use disorder is defined in the Diagnostic and Statistical Manual for Mental Disorders , 5th edition (DSM-5) ( 4 ) as a pattern of alcohol consumption, leading to problems associated with 2 or more of 11 potential symptoms of alcohol use disorder (see Table 1 for criteria). In the United States, approximately one-third of all adults will meet criteria for alcohol use disorder at some point during their lives ( 5 ), and approximately 15.1 million of U.S. adults meet criteria for alcohol use disorder in the previous 12 months ( 6 ). The public health impacts of alcohol use extend far beyond those individuals who drink alcohol, engage in heavy alcohol use, and/or meet criteria for an alcohol use disorder. Alcohol use is associated with increased risk of accidents, workplace productivity losses, increased medical and mental health costs, and greater rates of crime and violence ( 1 ). Analyses that take into account the overall harm due to drugs (harm to both users and others) show that alcohol is the most harmful drug ( 7 ).

Only a small percent of individuals with alcohol use disorder contribute to the greatest societal and economic costs ( 8 ). For example, in the 2015 National Survey on Drug Use and Health survey (total n = 43,561), a household survey conducted across the United States, 11.8% met criteria for an alcohol use disorder ( n = 5124) ( 6 ). Of these 5124 individuals, 67.4% ( n = 3455) met criteria for a mild disorder (two or three symptoms, based on DSM-5), 18.8% ( n = 964) met criteria for a moderate disorder (four or five symptoms, based on DSM-5), and only 13.8% ( n = 705) met criteria for a severe disorder (six or more symptoms) ( 6 ). There is a large treatment gap for alcohol use disorder, arising from the fact that many individuals with alcohol use disorder do not seek treatment. Those with a mild or moderate alcohol use disorder may be able to reduce their drinking in the absence of treatment ( 9 ) and have a favorable course; but it is those with more severe alcohol use disorder who most often seek treatment and who may experience a chronic relapsing course ( 10 ).

HISTORY OF TREATMENT FOR ALCOHOL USE DISORDER

Near the end of the 18th century, the Pennsylvania physician Benjamin Rush described the loss of control of alcohol and its potential treatments ( 11 ). His recommendations for remedies and case examples included practicing the Christian religion, experiencing guilt and shame, pairing alcohol with aversive stimuli, developing other passions in life, following a vegetarian diet, taking an oath to not drink alcohol, and sudden and absolute abstinence from alcohol. Through the 1800s and early 1900s, the temperance movement laid the groundwork for mutual help organizations, and the notion of excessive alcohol use as a moral failing. During the same period, inebriate asylums emerged as a residential treatment option for excessive alcohol use, although the only treatment offered was forced abstinence from alcohol ( 12 ). The founding of Alcoholics Anonymous (A.A.) in the 1930s ( 13 ) and the introduction of the modern disease concept of alcohol use disorder (previously called “alcoholism”) in the 1940s ( 14 ) laid the groundwork for many of the existing treatment programs that remain widely available today. Over the past 80 years, empirical studies have provided support for both mutual support [A.A. and other support groups, such as SMART (Self-Management and Recovery Training)] and medical models of treatment for alcohol use disorder, as well as the development of new pharmacological and behavioral treatment options. In addition, there are several public health policy initiatives (e.g., taxation, restrictions on advertising, and outlet density) and brief intervention programs (e.g., social norms interventions) that can be effective in reducing prevalence of alcohol use disorder and alcohol-related harms ( 1 ).

NEUROBIOLOGY OF ALCOHOL USE DISORDER

Alcohol use disorder is characterized by loss of control over alcohol drinking that is accompanied by changes in brain regions related to the execution of motivated behaviors and to the control of stress and emotionality (e.g., the midbrain, the limbic system, the prefrontal cortex, and the amygdala). Mechanisms of positive and negative reinforcement both play important roles with individual drinking behavior being maintained by positive reinforcement (rewarding and desirable effects of alcohol) and/or negative reinforcement mechanisms (negative affective and physiological states that are relieved by alcohol consumption) ( 15 , 16 ). At the neurotransmitter level, the positive reinforcing effects of alcohol are primarily mediated by dopamine, opioid peptides, serotonin, γ-aminobutyric acid (GABA), and endocannabinoids, while negative reinforcement involves increased recruitment of corticotropin-releasing factor and glutamatergic systems and down-regulation of GABA transmission ( 16 ). Long-term exposure to alcohol causes adaptive changes in several neurotransmitters, including GABA, glutamate, and norepinephrine, among many others. Discontinuation of alcohol ingestion results in the nervous system hyperactivity and dysfunction that characterizes alcohol withdrawal ( 15 , 16 ). Acting on several types of brain receptors, glutamate represents one of the most common excitatory neurotransmitters. As one of the major inhibitory neurotransmitters, GABA plays a key role in the neurochemical mechanisms involved in intoxication, tolerance, and withdrawal. This brief review can offer only a very simplified overview of the complex neurobiological basis of alcohol use disorder. For deeper, more detailed analysis of this specific topic, the reader is encouraged to consult other reviews ( 15 , 16 ).

CLINICAL MANAGEMENT OF ALCOHOL WITHDRAWAL SYNDROME

Alcohol withdrawal symptoms may include anxiety, tremors, nausea, insomnia, and, in severe cases, seizures and delirium tremens. Although up to 50% of individuals with alcohol use disorder present with some withdrawal symptoms after stopping drinking, only a small percentage requires medical treatment for detoxification, and some individuals may be able to reduce their drinking spontaneously. Medical treatment may take place either in an outpatient or, when clinically indicated, inpatient setting. In some cases, clinical monitoring may suffice, typically accompanied by supportive care for hydration and electrolytes and thiamine supplementation. For those patients in need of pharmacological treatment, benzodiazepines (e.g., diazepam, chlordiazepoxide, lorazepam, oxazepam, and midazolam) are the most commonly used medications to treat alcohol withdrawal syndrome. Benzodiazepines work by enhancing the effect of the GABA neurotransmitter at the GABA A receptor. Notably, benzodiazepines represent the gold standard treatment, as they are the only class of medications that not only reduces the severity of the alcohol withdrawal syndrome but also reduces the risk of withdrawal seizures and/or delirium tremens. Because of the potential for benzodiazepine abuse and the risk of overdose, if benzodiazepine treatment for alcohol withdrawal syndrome is managed in an outpatient setting, careful monitoring is required, particularly when combined with alcohol and/or opioid medications ( 17 ).

a-2 agonists (e.g., clonidine) and β-blockers (atenolol) are sometimes used as an adjunct treatment to benzodiazepines to control neuro-autonomic manifestations of alcohol withdrawal not fully controlled by benzodiazepine administration ( 18 ). However, because of the lack of efficacy of a-2 agonists and β-blockers in preventing severe alcohol withdrawal syndrome and the risk of masking withdrawal symptoms, these drugs are recommended not as monotherapy, but only as a possible adjunctive treatment.

Of critical importance to a successful outcome is the fact that alcohol withdrawal treatment provides an opportunity for the patient and the health care provider to engage the patient in a treatment program aimed at achieving and maintaining long-term abstinence from alcohol or reductions in drinking. Such a treatment may include pharmacological and/or psychosocial tools, as summarized in the next sections.

PHARMACOLOGICAL APPROACHES TO THE TREATMENT OF ALCOHOL USE DISORDER

U.s. food and drug administration–approved pharmacological treatments.

Development of novel pharmaceutical reagents is a lengthy, costly, and expensive process. Once a new compound is ready to be tested for human research use, it is typically tested for safety first via phase 0 and phase 1 clinical studies in a very limited number of individuals. Efficacy and side effects may then be further tested in larger phase 2 clinical studies, which may be followed by larger phase 3 clinical studies, typically conducted in several centers and are focused on efficacy, effectiveness, and safety. If approved for use in clinical practice, this medication is still monitored from a safety standpoint, via phase 4 postmarketing surveillance.

Only three drugs are currently approved by the U.S. Food and Drug Administration (FDA) for use in alcohol use disorder. The acetaldehyde dehydrogenase inhibitor disulfiram was the first medication approved for the treatment of alcohol use disorder by the FDA, in 1951. The most common pathway in alcohol metabolism is the oxidation of alcohol via alcohol dehydrogenase, which metabolizes alcohol to acetaldehyde, and aldehyde dehydrogenase, which converts acetaldehyde into acetate. Disulfiram leads to an irreversible inhibition of aldehyde dehydrogenase and accumulation of acetaldehyde, a highly toxic substance. Although additional mechanisms (e.g., inhibition of dopamine β-hydroxylase) may also play a role in disulfiram’s actions, the blockade of aldehyde dehydrogenase activity represents its main mechanism of action. Therefore, alcohol ingestion in the presence of disulfiram leads to the accumulation of acetaldehyde, resulting in numerous related unpleasant symptoms, including tachycardia, headache, nausea, and vomiting. In this way, disulfiram administration paired with alcohol causes the aversive reaction, initially proposed as a remedy for alcohol use disorder by Rush ( 11 ) in 1784. One challenge in conducting a double-blind, placebo-controlled alcohol trial of disulfiram is that it is easy to break the blind unless the “placebo” medication also creates an aversive reaction when consumed with alcohol, which would then provide the same mechanism of action as the medication (e.g., the placebo and disulfiram would both have the threat of an aversive reaction). Open-label studies of disulfiram do provide support for its efficacy, as compared to controls, with a medium effect size ( 19 ), as defined by Cohen’s d effect size ranges of small d = 0.2, medium d = 0.5, and large d = 0.8 ( 20 ). The efficacy of disulfiram largely depends on patient motivation to take the medication and/or supervised administration, given that the medication is primarily effective by the potential threat of an aversive reaction when paired with alcohol ( 21 ).

The next drug approved for treatment of alcohol use disorder was acamprosate; first approved as a treatment for alcohol dependence in Europe in 1989, acamprosate has subsequently been approved for use in the United States, Canada, and Japan. Although the exact mechanisms of acamprosate action are still not fully understood, there is evidence that it targets the glutamate system by modulating hyperactive glutamatergic states, possibly acting as an N -methyl- d -aspartate receptor agonist ( 22 ). The efficacy of acamprosate has been evaluated in numerous double-blind, randomized controlled trials and meta-analyses, with somewhat mixed conclusions ( 23 – 26 ). Although a meta-analysis conducted in 2013 ( 25 ) indicated small to medium effect sizes in favor of acamprosate over placebo in supporting abstinence, recent large-scale trials conducted in the United States ( 27 ) and Germany ( 28 ) failed to find effects of acamprosate distinguishable from those of a placebo. Overall, there is evidence that acamprosate may be more effective in promoting abstinence and preventing relapse in already detoxified patients than in helping individuals reduce drinking ( 25 ), therefore suggesting its use as an important pharmacological aid in treatment of abstinent patients with alcohol use disorder. The most common side effect with acamprosate is diarrhea. Other less common side effects may include nausea, vomiting, stomachache, headache, and dizziness, although the causal role of acamprosate in giving these side effects is unclear.

A third drug, the opioid receptor antagonist naltrexone, was approved for the treatment of alcohol dependence by the FDA in 1994. Later, a monthly extended-release injectable formulation of naltrexone, developed with the goal of improving patient adherence, was also approved by the FDA in 2006. Naltrexone reduces craving for alcohol and has been found to be most effective in reducing heavy drinking ( 25 ). The efficacy of naltrexone in reducing relapse to heavy drinking, in comparison to placebo, has been supported in numerous meta-analyses ( 23 – 25 ), although there is less evidence for its efficacy in supporting abstinence ( 25 ). Fewer studies have been conducted with the extended-release formulation, but its effects on heavy drinking, craving, and quality of life are promising ( 29 , 30 ). Common side effects of naltrexone may include nausea, headache, dizziness, and sleep problems. Historically, naltrexone’s package insert has been accompanied by a risk of hepatotoxicity, a precaution primarily due to observed liver toxicity in an early clinical trial with administrating a naltrexone dosage of 300 mg per day to obese men ( 31 ). However, there is no published evidence of severe liver toxicity at the lower FDA-approved dosage of naltrexone for alcohol use disorder (50 mg per day). Nonetheless, transient, asymptomatic hepatic transaminase elevations have also been observed in some clinical trials and in the postmarketing period; therefore, naltrexone should be used with caution in patients with active liver disease and should not be used in patients with acute hepatitis or liver failure.

Additional pharmacological treatments approved for alcohol use disorder in Europe

Disulfiram, acamprosate, and naltrexone have been approved for use in Europe and in the United States. Pharmacologically similar to naltrexone, nalmefene was also approved for the treatment of alcohol dependence in Europe in 2013. Nalmefene is a m- and d-opioid receptor antagonist and a partial agonist of the k-opioid receptor ( 32 ). Side effects of nalmefene are similar to naltrexone; compared to naltrexone, nalmefene has a longer half-life. Meta-analyses have indicated that nalmefene is effective in reducing heavy drinking days ( 32 ). An indirect meta-analysis of these two drugs concluded that nalmefene may be more effective than naltrexone ( 33 ), although whether a clinically relevant difference between the two medications really exists is still an open question ( 34 ). Network meta-analysis and microsimulation studies suggest that nalmefene may have some benefits over placebo for reducing total alcohol consumption ( 35 , 36 ). The approval of nalmefene in Europe was accompanied by some controversy ( 37 ); a prospective head-to-head trial of nalmefene and naltrexone could help clarify whether nalmefene has added benefits to the existing medications available for alcohol use disorder. Last, nalmefene was approved in Europe as a medication that can be taken “as needed” (i.e., on days when drinking was going to occur). Prior work has also demonstrated the efficacy of taking naltrexone only on days that drinking was potentially going to occur ( 38 ).

In addition to these drugs, a GABA B receptor agonist used to treat muscle spasms, baclofen, was approved for treatment of alcohol use disorder in France in 2018 and has been used off label for alcohol use disorder for over a decade in other countries, especially in other European countries and in Australia ( 39 , 40 ). Recent human laboratory work suggests that baclofen may disrupt the effects of an initial priming dose of alcohol on subsequent craving and heavy drinking ( 41 ). Meta-analyses and systematic reviews examining the efficacy of baclofen have yielded mixed results ( 35 , 39 , 42 ); however, there is some evidence that baclofen might be useful in treatment of alcohol use disorder among individuals with liver disease ( 43 , 44 ). Evidence of substantial heterogeneity in baclofen pharmacokinetics among different individuals with alcohol use disorder ( 41 ) could explain the variability in the efficacy of baclofen across studies. The appropriate dose of baclofen for use in treatment of alcohol use disorder remains a controversial topic, and a recent international consensus statement highlighted the importance of tailoring doses based on safety, tolerability, and efficacy ( 40 ).

Promising pharmacological treatments

Numerous other medications have been used off label in the treatment of alcohol use disorder, and many of these have been shown to be modestly effective in meta-analyses and systematic reviews ( 23 , 24 , 26 , 35 ). Systematic studies of these medications suggest promising findings for topiramate, ondansetron, gabapentin, and varenicline. The anticonvulsant drug topiramate represents one of the most promising medications in terms of efficacy, based on its medium effect size from several clinical trials [for a review, see ( 45 )], including a multisite clinical study ( 46 ). One strength of topiramate is the possibility of starting treatment while people are still drinking alcohol, therefore serving as a potentially effective treatment to initiate abstinence (or to reduce harm) rather than to prevent relapse in already detoxified patients ( 45 ). Although not approved by the FDA, it is worth noticing that topiramate is a recommended treatment for alcohol use disorder in the U.S. Department of Veterans Affairs ( 47 ). A concern with topiramate is the potential for significant side effects, especially those affecting cognition and memory, warranting a slow titration of its dose and monitoring for side effects. Furthermore, recent attention has been paid on zonisamide, another anticonvulsant medication, whose pharmacological mechanisms of actions are similar to topiramate but with a better tolerability and safety profile ( 48 ). Recently published and ongoing research focuses on a potential pharmacogenetic approach to treatment in the use of topiramate to treat alcohol use disorder, based on the possibility that both efficacy and tolerability and safety of topiramate may be moderated by a functional single-nucleotide polymorphism (rs2832407) in GRIK1, encoding the kainate GluK1 receptor subunit ( 49 ). Human laboratory studies ( 50 ) and treatment clinical trials ( 51 ) have also used a primarily pharmacogenetic approach to testing the efficacy of the antinausea drug ondansetron, a 5HT 3 antagonist, in alcohol use disorder. Overall, these studies suggest a potential role for ondansetron in alcohol use disorder, but only in those individuals with certain variants of the genes encoding the serotonin transporter 5-HTT and the 5-HT 3 receptor. The anticonvulsant gabapentin has shown promising results in human laboratory studies and clinical trials ( 52 – 54 ), although a more recent multisite trial with an extended-release formulation of the medication did not have an effect of gabapentin superior to that of a placebo ( 55 ). Although the latter findings might be related to potential pharmacokinetic issues secondary to the specific formulation used, it is nonetheless possible that gabapentin may be more effective in patients with more clinically relevant alcohol withdrawal symptoms ( 52 ). Several human laboratory studies support a role for varenicline, a nicotinic acetylcholine receptor partial agonist approved for smoking cessation, in alcohol use disorder [for a review, see ( 56 )], and two of three clinical trials also support its efficacy on alcohol outcomes ( 57 – 59 ), especially in heavy drinkers who are males ( 59 ) and in male and female alcohol-dependent individuals who are also smokers ( 60 ). Additional details on the FDA-approved medications and other medications tested in clinical research settings for the treatment of alcohol use disorder are summarized in Table 2 .

FDA, U.S. Food and Drug Administration; AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid; NMDA, N -methyl- d -aspartate; PO, per os (oral); IM, intramuscular; HT, serotonin.

The medications and targets described above have shown promising results in phase 2 or phase 3 medication trials. However, owing to the development of novel neuroscience techniques, a growing and exciting body of data is expanding the armamentarium of targets currently under investigation in animal models and/or in early-phase clinical studies. Pharmacological approaches with particular promise for future drug development include, but are not limited to the following [for recent reviews, see, e.g., ( 56 , 61 – 68 )]: the antipsychotic drug aripiprazole, which has multiple pharmacological actions (mainly on dopamine and serotonin receptors), the antihypertensive alpha-1 blocker drugs prazosin and doxazosin, neurokinin-1 antagonism, the glucocorticoid receptor blocker mifepristone, vasopressin receptor 1b antagonism, oxytocin, ghrelin receptor antagonism, glucagon-like peptide-1 agonism, and pharmacological manipulations of the nociception receptor (We are intentionally using a general pharmacological terminology for the nociceptin receptor, given that it is unclear whether agonism, antagonism, or both may represent the best approach.). New medications development is particularly important for the treatment of comorbid disorders that commonly co-occur among individuals with alcohol use disorder, particularly affective disorders, anxiety disorders, suicidality, and other substance use disorders. This aspect of alcohol use disorder is relevant to the fact that addictive disorders often present with significantly more severe symptoms when they coexist with other mental health disorders ( 69 ). Likewise, there is evidence that pharmacotherapy is most effective when implemented in conjunction with behavioral interventions ( 70 ), and all phase 2 and phase 3 medication trials, mentioned above, have included a brief psychosocial behavioral treatment in combination with medication.

BEHAVIORAL/PSYCHOLOGICAL TREATMENTS FOR ALCOHOL USE DISORDER

Evidence-based treatments.

A wide range of behavioral and psychological treatments are available for alcohol use disorder, and many treatments are equally effective in supporting abstinence or drinking reduction goals ( 71 – 74 ). Treatments with the greatest evidence of efficacy range from brief interventions, including motivational interviewing approaches, to operant conditioning approaches, including contingency management and the community reinforcement approach, to cognitive behavioral treatments, including coping skills training and relapse prevention, and to acceptance- and mindfulness-based approaches. Twelve-step facilitation, which was designed specifically to connect individuals with mutual support groups, has also been shown to be effective ( 75 ). In addition, harm reduction treatments, including guided self-control training and controlled drinking interventions, have been successful in supporting drinking reduction goals ( 70 ).

Meta-analyses and systematic reviews have found that brief interventions, especially those based on the principles of motivational interviewing, are effective in the treatment of alcohol use disorder. These interventions can include self-monitoring of alcohol use, increasing awareness of high-risk situations, and training in cognitive and behavioral techniques to help clients cope with potential drinking situations, as well as life skills training, communication training, and coping skills training. Cognitive behavioral treatments can be delivered in individual or group settings and can also be extended to the treatment of families and couples ( 72 , 73 ).

Acceptance- and mindfulness-based interventions are increasingly being used to target alcohol use disorder and show evidence of efficacy in a variety of settings and formats, including brief intervention formats ( 76 ). Active ingredients include raising present moment awareness, developing a nonjudgmental approach to self and others, and increasing acceptance of present moment experiences. Acceptance- and mindfulness-based interventions are commonly delivered in group settings and can also be delivered in individual therapy contexts.

Computerized, web-based, and mobile interventions have also been developed, incorporating the principles of brief interventions, behavioral and cognitive behavioral approaches, as well as mindfulness and mutual support group engagement; many of these approaches have demonstrated efficacy in initial trials ( 77 – 79 ). For example, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has developed the Take Control computerized intervention that includes aspects of motivational interviewing and coping skills training and was designed to provide psychosocial support (particularly among those assigned to the placebo medication) and also to increase adherence and retention among individuals enrolled in pharmacotherapy trials ( 80 ).

Mutual support group (e.g., A.A. and SMART) attendance and engagement have been shown to be associated with recovery from alcohol use disorder, even in the absence of formal treatment ( 81 ). However, selection biases (e.g., people selecting to attend these groups) raise difficulties in assessing whether other factors that are associated with treatment effectiveness may be the active ingredients for improving outcomes among those who attend mutual support groups. For example, individuals who are highly motivated to change might be more likely to attend mutual support groups. Likewise, mutual support groups often provide individuals with increased social network support for abstinence ( 82 ). Motivation to change and having a social network that supports abstinence (or reductions in drinking) are both factors that are associated with greater treatment effectiveness ( 83 ).

As noted above, most behavioral and psychological treatments are equally effective with small effect size differences [Cohen’s d = 2.0 to 0.3 ( 20 )] between active treatments ( 84 – 88 ). Behavioral interventions have also been shown to be as effective as pharmacotherapy options, with a 16-week cognitive behavioral intervention shown to be statistically equivalent to naltrexone in reducing heavy drinking days in a large randomized trial ( 27 ). One of the challenges of examining behavioral interventions in randomized trials is that intervention blinding and placebo controls cannot be implemented in most contexts, other than in computerized interventions. Furthermore, the general therapeutic factors common to most behavioral interventions (e.g., therapist empathy and supportive therapeutic relationship) in treatment of alcohol use disorder are as powerful as the specific therapeutic targets of specific behavioral interventions (e.g., teaching skills in a cognitive behavioral treatment) in facilitating behavioral change ( 89 ).

Promising future behavioral treatments and neuromodulation treatments

With respect to behavioral treatments, there are numerous opportunities for the development of novel mobile interventions that could provide treatment and recovery support in near real time. This mobile technology may also extend the reach of treatments to individuals with alcohol use disorder, particularly in rural areas. On the basis of a contextual self-regulation model of alcohol use ( 90 ), it is critical to address the immediate situational context alongside the broader social, environmental, and familial context in which an individual experiences the world and engages in momentary decision-making. Ambulatory assessment, particularly tools that require only passive monitoring (e.g., GPS, heart rate, and skin conductance) and real-time support via mobile health, could provide immediate environmental supports and could extend the reach of medications and behavioral treatments for alcohol use disorder. For example, a mobile device could potentially signal a high-risk situation by indicating the geographic location (near a favorite drinking establishment) and the heart rate (increased heart rate when approaching the establishment). The device could provide a warning either to the individual under treatment and/or to a person supporting that individual’s recovery. In addition, developments in alcohol sensing technology (e.g., transdermal alcohol sensors) could greatly increase rigor of research on alcohol use disorder and also provide real-time feedback on alcohol consumption levels to individuals who are attempting to moderate and/or reduce their alcohol use.

Recent advances in neuromodulation techniques may also hold promise for the development of novel treatments for alcohol use disorder. Deep brain stimulation, transcranial magnetic stimulation, transcranial electrical stimulation (including transcranial direct current stimulation and transcranial alternating current stimulation), and real-time neurofeedback have recently been tested as potential treatments for addiction, although evidence in favor of these treatments is currently uncertain and focused mostly on intermediate targets (e.g., alcohol craving) ( 91 ). These techniques attempt to directly target specific brain regions and addiction-related cognitive processes via surgically implanted electrodes (deep brain stimulation), electrical currents or magnetic fields applied to the scalp (transcranial electrical and magnetic stimulation, respectively), or individual self-generated modulation via feedback (neurofeedback). Although robust large scale trials with double-blind, sham controls, and long-term follow-ups of alcohol behavior change and relapse have not been conducted ( 91 ), the heterogeneity of alcohol use disorder suggests that targeting one specific neural region may be insufficient to treat such a complex disorder, with its multiple etiologies and diverse clinical courses ( 92 ).

Factors contributing to the effectiveness of treatments

Numerous models have examined factors that predict treatment readiness, treatment engagement, and treatment outcomes for alcohol use disorder. The transtheoretical model of change proposes that an individual’s own readiness to change his or her drinking behavior may have an impact on treatment engagement and effectiveness ( 93 ). The dynamic model of relapse proposes the involvement of multiple interacting biological, psychological, cognitive, emotional, social, and situational risk factors that are static and dynamic in their association with treatment outcomes ( 83 ). Neurobiological models of addiction focus on the brain reward and stress system dysfunction that contributes to the development and maintenance of alcohol use disorder, that is, the “addiction cycle” ( 15 , 16 ). The alcohol and addiction research domain criteria (AARDoC) ( 92 ), which have been operationalized in the addictions neuroclinical assessment ( 94 ), focus on the following three domains that correspond to particular phases in the addiction cycle: incentive salience in the binge/intoxication phase, negative emotionality in the withdrawal/negative affect phase, and executive function in the preoccupation/anticipation phase. Within each domain of the AARDoC, the addictions neuroclinical assessment proposes constructs that can be measured at multiple levels of analysis, such as craving in the incentive salience domain, negative affect and emotion dysregulation in the negative emotionality domain, and cognitive impairment and impulsivity in the executive function domain. The AARDoC acknowledge that environmental and contextual factors play a role in alcohol use disorder and treatment outcomes. Moreover, because of the heterogeneity of alcohol use disorder, the significance of these domains in causing alcohol use disorder and alcohol-related problems will vary among individuals.

Each of the abovementioned theoretical models proposes factors that may affect treatment effectiveness; however, many of the constructs proposed in each of these models are overlapping and likely contribute to the effectiveness of alcohol use disorder treatment across a range of populations and settings. A heuristic model combining components from each of these models is shown in Fig. 1 . Specifically, this model highlights the precipitants of alcohol use that are influenced by the neurobiological adaptations proposed in the addiction cycle (indicated by bold font) and additional contextual factors (regular font) that decrease or increase the likelihood of drinking in context, depending on whether an individual uses effective coping regulation in the moment. The domains supporting alcohol use/coping regulation (negative emotionality, executive function, incentive salience, and social environment) may interact to predict alcohol use or coping regulation in the moment. For example, network support for abstinence could improve decision-making and decrease likelihood of drinking. Conversely, experiences of physical pain are associated with increases in negative affect and poorer executive function, which could both increase likelihood of drinking. Both of these examples require environmental access to alcohol and a desire to drink alcohol. Treatment effectiveness will depend on the extent to which a particular treatment targets those risk factors that are most likely to increase or decrease the likelihood of drinking for each individual, as well as the personal resources that each individual brings to treatment and/or that could be enhanced in treatment. A functional analysis of contextual risk and protective factors can be critically important in guiding treatment.

Risk factors proposed in the AARDoC, including incentive salience, negative emotionality, executive function, and social environmental factors, are shown in black bold font encircling alcohol use. Contextual risk factors, including decision-making, self-efficacy, pain, craving, etc., are shown in black font in colored boxes. Risk and protective factors overlap with alcohol use and interact in predicting coping regulation and alcohol use among individual patients.

For example, there is considerable heterogeneity in treatment response to naltrexone, which may vary in efficacy in some individuals. Recent studies conducted to determine whether certain patients may benefit more from naltrexone have yielded mixed findings ( 95 ). Promising evidence suggests that individuals with the OPRM1 A118G G (Asp40) allele may have a better response to naltrexone ( 96 – 98 ); however, a prospective study of medication response among individuals stratified by presence of the Asp40 allele did not provide support for the genotype by treatment interaction ( 99 ), and recent human laboratory studies have not confirmed the hypothesized mechanisms underlying the pharmacogenomic effect ( 100 ). Initial evidence suggests that naltrexone may be more effective in reducing heavy drinking among smokers ( 101 ) and among those with a larger number of heavy drinkers in their social networks ( 102 ). With respect to reinforcement typologies, recent work has found that naltrexone may be more effective among those who tend to drink alcohol for rewarding effects ( 103 ), and acamprosate may also be more effective for individuals who drink to relieve negative affect ( 104 ).

GAPS IN SCIENTIFIC KNOWLEDGE AND NEW RESEARCH DIRECTIONS

Heterogeneity of individuals with alcohol use disorder.

This review has briefly summarized the treatments currently available for alcohol use disorder that are relatively effective, at least in some patients. Many new treatments are also being developed, and some of them seem promising. Nevertheless, numerous gaps in scientific knowledge remain. Notably, most people who drink alcohol do not develop an alcohol use disorder, most people with alcohol use disorder do not seek treatment, and most of those who do not seek treatment “recover” from alcohol use disorder without treatment ( 2 ). Very little is known about factors, particularly neurobiological, genetic, and epigenetic factors, that predict the transition from alcohol use to alcohol use disorder, although basic science models suggest that a cycle of neuroadaptations could be at play ( 15 , 16 ). We also lack a basic understanding of how individuals recover from alcohol use disorder in the absence of treatment and what neurobiological, psychological, social, and environmental factors are most important for supporting recovery from alcohol use disorder. Gaining a better understanding of recovery in the absence of treatment, particularly modifiable psychological, neurobiological, and epigenetic factors, could provide novel insights for medications and behavioral treatment development. Among many other factors, special attention is needed in future studies to shed light on the role of sex and gender in the development and maintenance of alcohol use disorder and on the response to pharmacological, behavioral, and other treatments.

The heterogeneity of alcohol use disorder presents a major challenge to scientific understanding and to the development of effective treatments for prevention and intervention ( 92 ). For example, a DSM-5 diagnosis of alcohol use disorder requires 2 or more symptoms, out of 11, over the past year. That requirement equates to exactly 2048 potential symptom combinations that would meet the criteria of alcohol use disorder. An individual who only meets criteria for tolerance and withdrawal (i.e., physiological dependence) likely requires a very different course of treatment from an individual who only meets the criteria for failure to fulfill role obligations and use of alcohol in hazardous situations. Gaining a better understanding of the etiology and course of alcohol use disorder, as well as identifying whether different subtypes of drinkers may respond better to certain treatments ( 103 , 104 ), is critical for advancing the science of alcohol use disorder prevention and treatment. Alternative conceptualizations of alcohol use disorder may also aid in improving our understanding of the disorder and reducing heterogeneity. For example, the pending International Classification of Diseases , 11th edition, will simplify the diagnosis of alcohol dependence to requiring only two of three criteria in the past 12 months: (i) impaired control over alcohol use; (ii) alcohol use that dominates over other life activities; and (iii) persistence of alcohol use despite consequences. The diagnosis will be made with or without physiological dependence, as characterized by tolerance, withdrawal, or repeated use to prevent or alleviate withdrawal ( 105 ). It remains to be seen whether simplification of the criteria set will narrow our conceptualization or potentially increase heterogeneity of this disorder among those diagnosed with alcohol dependence.

Placebo effect

An additional challenge to development of pharmacological treatments for alcohol use disorder is the high placebo response rates seen in drug trials ( 106 ). The tendency for individuals to have a good treatment response when assigned to placebo medication reflects both the high probability of recovery without treatment and the heterogeneity in the disorder itself. Many people who enter treatment are already motivated to change behavior, and receiving a placebo medication can help these individuals continue the process of change. Gaining a better understanding of which kinds of individuals respond to placebo and of the overall physiological and behavioral complexities in the placebo response is critical to identifying those individuals who will benefit the most from active medication. More generally, very little is understood about how motivation to change drinking behavior may influence the efficacy of active medications, particularly via adherence mechanisms. Additional research on targeted (i.e., as needed) dosing of medications, such as nalmefene and naltrexone ( 32 , 38 ), would be promising from the perspective of increasing adherence to medications and also raising awareness of potentially heavy drinking occasions.

Recent developments in pharmacological and behavioral approaches

In addition to gaining a better understanding of the disorder and who benefits from existing treatments, the examination of molecular targets for alcohol use disorder could open up multiple innovative directions for future translational research on the treatment of alcohol use disorder. Recent research has identified many targets that might be important for future medication trials ( 67 ). For example, most of the medication development efforts in past decades have focused on pathways and targets typically related to reward processing and positive reinforcement. While important, this approach ignores the important role of stress-related pathways (e.g., corticotropin release factor and other related pathways) in negative reinforcement and in the later stages of alcohol use disorder, which is often characterized by physical dependence, anxiety, and relief drinking [for reviews, see ( 15 , 16 )]. Furthermore, it is also becoming more and more apparent that other promising targets may be identified by looking at the brain not as an isolated system but rather as an organ with bidirectional interactions with peripheral systems. Examples of the latter approach include the growing evidence suggesting a potential role of inflammation and neuroinflammation and of the gut-liver-brain axis in the neurobiological mechanisms that regulate the development and/or maintenance of alcohol use disorder ( 107 – 109 ). Moving medications development from phase 1 to phase 2 and 3 trials has also been a difficulty in the field. Future directions that might improve translation of basic science into clinical practice include the broader use of human laboratory models and pilot clinical trials ( 110 ), as well as expanding the outcomes that might be targeted in phase 2 and phase 3 trials to include drinking reduction outcomes ( 111 , 112 ).

New directions for behavioral treatment development include a greater focus on identifying effective elements of behavioral treatments and on the components of treatment that are most critical for successful behavior change ( 89 , 113 ). Studies investigating the effects of specific treatment components are critical for refining treatment protocols to more efficiently target the symptoms of alcohol use disorder. Continued development of mobile health interventions will also help with disseminating treatment to a wider range of individuals struggling with alcohol use disorder.

Translation of addiction science to clinical practice

Last, but not the least, there is also a critical need for more research on dissemination and implementation, given the fact that many treatment programs still do not incorporate evidence-based practices, such as cognitive behavioral skills training, mindfulness-based interventions, and medications. Both pharmacological and behavioral treatments for alcohol use disorder are markedly underused; the recent Surgeon General’s report Facing Addiction in America ( 114 ) highlights the fact that only about 1 in 10 people with a substance use disorder receives any type of specialty treatment. Therefore, basic science and human research efforts will need to be accompanied by translational approaches, where effective novel medications and precision medicine strategies are effectively translated from research settings to clinical practice. Greater integration of alcohol screening and medication in primary care and other clinical settings, as well as research on best methods for implementation, has great potential for expanding access to effective treatment options ( 115 ). Because the heterogeneity of alcohol use disorder makes it highly unlikely that one single treatment will work for all individuals, it is important to provide a menu of options for pharmacological and behavioral therapies to both clinicians and patients. Reducing the stigma of alcohol use disorder and moving toward a public health approach to addressing this problem may further increase the range of acceptable treatment options.

Acknowledgment

Funding: This research was supported by a grant from NIAAA (R01 AA022328) awarded to K.W. (principal investigator). R.Z.L. is funded by NIAAA. L.L. is jointly funded by NIAAA and the National Institute on Drug Abuse (NIDA) (ZIA-AA000218). The content of this review does not necessarily represent the official views of the funders. Author contributions: K.W. wrote the first draft of the manuscript. K.W., R.Z.L., and L.L. provided additional text and edits. All authors approved the final draft. Competing interests: The authors declare that they have no competing interests. Data and materials availability: All data needed to evaluate the conclusions in the paper are present in the paper and/or in the materials cited herein. Additional data related to this paper may be requested from the authors.

REFERENCES AND NOTES

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• Alcohol use disorder

Alcohol use disorder is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol or continuing to use alcohol even when it causes problems. This disorder also involves having to drink more to get the same effect or having withdrawal symptoms when you rapidly decrease or stop drinking. Alcohol use disorder includes a level of drinking that's sometimes called alcoholism.

Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems. It also includes binge drinking — a pattern of drinking where a male has five or more drinks within two hours or a female has at least four drinks within two hours. Binge drinking causes significant health and safety risks.

If your pattern of drinking results in repeated significant distress and problems functioning in your daily life, you likely have alcohol use disorder. It can range from mild to severe. However, even a mild disorder can escalate and lead to serious problems, so early treatment is important.

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Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms you experience. Signs and symptoms may include:

• Being unable to limit the amount of alcohol you drink
• Wanting to cut down on how much you drink or making unsuccessful attempts to do so
• Spending a lot of time drinking, getting alcohol or recovering from alcohol use
• Feeling a strong craving or urge to drink alcohol
• Failing to fulfill major obligations at work, school or home due to repeated alcohol use
• Continuing to drink alcohol even though you know it's causing physical, social, work or relationship problems
• Giving up or reducing social and work activities and hobbies to use alcohol
• Using alcohol in situations where it's not safe, such as when driving or swimming
• Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
• Experiencing withdrawal symptoms — such as nausea, sweating and shaking — when you don't drink, or drinking to avoid these symptoms

Alcohol use disorder can include periods of being drunk (alcohol intoxication) and symptoms of withdrawal.

• Alcohol intoxication results as the amount of alcohol in your bloodstream increases. The higher the blood alcohol concentration is, the more likely you are to have bad effects. Alcohol intoxication causes behavior problems and mental changes. These may include inappropriate behavior, unstable moods, poor judgment, slurred speech, problems with attention or memory, and poor coordination. You can also have periods called "blackouts," where you don't remember events. Very high blood alcohol levels can lead to coma, permanent brain damage or even death.
• Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to 4 to 5 days later. Signs and symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations.

What is considered 1 drink?

The National Institute on Alcohol Abuse and Alcoholism defines one standard drink as any one of these:

• 12 ounces (355 milliliters) of regular beer (about 5% alcohol)
• 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about 7% alcohol)
• 5 ounces (148 milliliters) of wine (about 12% alcohol)
• 1.5 ounces (44 milliliters) of hard liquor or distilled spirits (about 40% alcohol)

When to see a doctor

If you feel that you sometimes drink too much alcohol, or your drinking is causing problems, or if your family is concerned about your drinking, talk with your health care provider. Other ways to get help include talking with a mental health professional or seeking help from a support group such as Alcoholics Anonymous or a similar type of self-help group.

Because denial is common, you may feel like you don't have a problem with drinking. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to relatives, friends or co-workers when they ask you to examine your drinking habits or to seek help. Consider talking with someone who has had a problem with drinking but has stopped.

If your loved one needs help

Many people with alcohol use disorder hesitate to get treatment because they don't recognize that they have a problem. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about someone who drinks too much, ask a professional experienced in alcohol treatment for advice on how to approach that person.

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Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder.

Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.

Risk factors

Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s, though it can start at any age.

Risk factors for alcohol use disorder include:

• Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder.
• Starting at an early age. People who begin drinking — especially binge drinking — at an early age are at a higher risk of alcohol use disorder.
• Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be influenced by genetic factors.
• Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances.
• History of trauma. People with a history of emotional trauma or other trauma are at increased risk of alcohol use disorder.
• Having bariatric surgery. Some research studies indicate that having bariatric surgery may increase the risk of developing alcohol use disorder or of relapsing after recovering from alcohol use disorder.
• Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it's OK to drink too much. For young people, the influence of parents, peers and other role models can impact risk.

Complications

Alcohol depresses your central nervous system. In some people, the initial reaction may feel like an increase in energy. But as you continue to drink, you become drowsy and have less control over your actions.

Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you're taking certain medications that also depress the brain's function.

Impact on your safety

Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:

• Motor vehicle accidents and other types of accidental injury, such as drowning
• Relationship problems
• Poor performance at work or school
• Increased likelihood of committing violent crimes or being the victim of a crime
• Legal problems or problems with employment or finances
• Problems with other substance use
• Engaging in risky, unprotected sex, or experiencing sexual abuse or date rape
• Increased risk of attempted or completed suicide

Impact on your health

Drinking too much alcohol on a single occasion or over time can cause health problems, including:

• Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis) and inflammation of the liver (alcoholic hepatitis). Over time, heavy drinking can cause irreversible destruction and scarring of liver tissue (cirrhosis).
• Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It can also interfere with your body's ability to get enough B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis).
• Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause serious irregular heartbeats (arrhythmia) called atrial fibrillation.
• Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin or some other diabetes medications to lower your blood sugar level.
• Issues with sexual function and periods. Heavy drinking can cause men to have difficulty maintaining an erection (erectile dysfunction). In women, heavy drinking can interrupt menstrual periods.
• Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamin). A thiamin deficiency can result in other brain changes, such as irreversible dementia, if not promptly treated.
• Birth defects. Alcohol use during pregnancy may cause miscarriage. It may also cause fetal alcohol spectrum disorders (FASDs). FASDs can cause a child to be born with physical and developmental problems that last a lifetime.
• Bone damage. Alcohol may interfere with making new bone. Bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding.
• Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.
• Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
• Increased risk of cancer. Long-term, excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, esophagus, colon and breast cancers. Even moderate drinking can increase the risk of breast cancer.
• Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.

Early intervention can prevent alcohol-related problems in teens. If you have a teenager, be alert to signs and symptoms that may indicate a problem with alcohol:

• Loss of interest in activities and hobbies and in personal appearance
• Red eyes, slurred speech, problems with coordination and memory lapses
• Difficulties or changes in relationships with friends, such as joining a new crowd
• Declining grades and problems in school
• Frequent mood changes and defensive behavior

You can help prevent teenage alcohol use:

• Set a good example with your own alcohol use.
• Talk openly with your child, spend quality time together and become actively involved in your child's life.
• Let your child know what behavior you expect — and what the consequences will be for not following the rules.

Alcohol use disorder care at Mayo Clinic

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Alcohol is a chemical substance derived from the fermentation or distillation of various fruits, grains, or other natural sources. It is commonly consumed in the form of alcoholic beverages and is known for its psychoactive effects. Alcohol, specifically ethanol, acts as a central nervous system depressant, affecting brain function and altering behavior.

The origin and history of alcohol can be traced back to ancient civilizations. The earliest evidence of alcohol production dates back to around 7000 to 6600 BCE in China, where fermented beverages made from rice, honey, and fruit were consumed. Similarly, in the Middle East, evidence of alcoholic beverages made from barley dates back to around 5400 to 5000 BCE. Throughout history, alcohol has played a significant role in various cultures and societies. It was often associated with religious rituals, social gatherings, and medicinal purposes. The Ancient Egyptians, Greeks, and Romans had a wide variety of alcoholic beverages, and the art of brewing and distillation spread through trade routes. During the Middle Ages, monasteries in Europe became centers of brewing and distillation, and the production of alcoholic beverages became more organized. In the 18th and 19th centuries, the Industrial Revolution led to the mass production of alcohol, contributing to social issues related to alcohol abuse.

Alcohol has both short-term and long-term effects on the body and mind. In the short term, alcohol acts as a depressant, slowing down the central nervous system and affecting coordination, judgment, and reaction time. It can cause relaxation, euphoria, and lowered inhibitions. However, excessive consumption can lead to negative effects such as impaired judgment, blurred vision, slurred speech, and increased risk-taking behavior. Long-term alcohol use can have detrimental effects on various organs and systems. Prolonged heavy drinking can damage the liver, leading to conditions such as cirrhosis and alcoholic hepatitis. It can also weaken the immune system, increase the risk of cardiovascular diseases, and contribute to the development of certain types of cancer. Alcohol misuse and addiction can have profound social and psychological consequences. It can strain relationships, lead to financial difficulties, and contribute to mental health disorders such as depression and anxiety. Additionally, excessive alcohol consumption is associated with an increased risk of accidents, injuries, and even fatalities. It is important to note that moderate alcohol consumption can have some potential health benefits, such as a reduced risk of heart disease. However, these potential benefits must be balanced with the risks and individual circumstances, and it is always advisable to consume alcohol responsibly and in moderation.

Public opinion about alcohol varies greatly depending on cultural, social, and individual factors. It is a complex and multifaceted topic that elicits diverse perspectives. Some individuals and societies view alcohol consumption as an acceptable and enjoyable part of social gatherings and celebrations. They may see it as a way to relax, socialize, and enhance the enjoyment of certain experiences. In these contexts, alcohol is often seen as a normal and integral aspect of everyday life. On the other hand, there are those who hold more cautious or negative views towards alcohol. They may emphasize the potential risks and harms associated with its use, such as addiction, health problems, and impaired judgment. Concerns about alcohol-related accidents, violence, and addiction can shape public opinion and lead to stricter regulations and policies. Public opinion on alcohol is also influenced by cultural and religious beliefs, as well as personal experiences and values. Some individuals may have witnessed the negative consequences of alcohol misuse and therefore hold more critical views. Others may have positive associations with alcohol and view it as a benign or enjoyable substance when consumed responsibly.

Alcohol is a frequently depicted substance in various forms of media, including movies, television shows, music, and advertising. Its portrayal in media can range from positive and glamorous to negative and cautionary, reflecting the diverse perspectives and attitudes towards alcohol. In some media representations, alcohol is shown as a symbol of sophistication, celebration, and socializing. It is often associated with luxury and enjoyment, depicted in glamorous settings where characters are seen drinking champagne, cocktails, or wine. This positive representation can be found in movies like "The Great Gatsby" and TV shows like "Mad Men," where characters are shown indulging in alcohol as a part of their lifestyle. However, media also portrays the negative consequences and risks associated with alcohol consumption. Films like "Leaving Las Vegas" and "Flight" depict the destructive effects of alcohol addiction, showcasing the devastating impact it can have on individuals and their relationships. Such portrayals serve as cautionary tales and highlight the potential dangers of excessive alcohol use. Furthermore, there are public service announcements and campaigns that aim to raise awareness about responsible drinking and the harmful effects of alcohol abuse. These messages often depict the negative consequences of alcohol-related accidents, impaired judgment, and addiction.

1. According to the World Health Organization (WHO), alcohol is responsible for more than 3 million deaths worldwide each year. This includes deaths from alcohol-related diseases, accidents, and violence. It is a significant public health concern that requires attention and prevention efforts. 2. A study published in the journal Addiction revealed that alcohol consumption is a leading risk factor for disease burden and premature death globally. It ranked as the seventh leading risk factor for both death and disability-adjusted life years (DALYs) in 2016, highlighting the significant impact of alcohol on population health. 3. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that alcohol-related problems cost the United States economy an estimated $249 billion in 2010. These costs include healthcare expenses, lost productivity, and criminal justice costs associated with alcohol-related incidents. This statistic emphasizes the economic burden of alcohol misuse on society.

Alcohol is an important topic to explore in an essay due to its widespread use and the complex implications it has on individuals, society, and public health. Understanding the various aspects of alcohol, including its history, effects, public opinion, and representation in media, can provide valuable insights into its impact on individuals and communities. By delving into the history of alcohol, one can examine its cultural, social, and economic significance throughout different time periods and regions. Exploring the effects of alcohol on the human body and mind helps shed light on the risks and potential consequences associated with its consumption. Analyzing public opinion allows for an understanding of societal attitudes, perceptions, and debates surrounding alcohol use and abuse. Furthermore, the representation of alcohol in media and popular culture plays a significant role in shaping public perceptions and behaviors. Investigating how alcohol is portrayed in films, advertisements, and literature can reveal underlying messages and narratives about its consumption.

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Drug and Substance Abuse Essay

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Introduction

Physiology and psychology of addiction, prescription drug abuse, depressants, hallucinogens.

Drug and substance abuse is an issue that affects entirely all societies in the world. It has both social and economic consequences, which affect directly and indirectly our everyday live. Drug addiction is “a complex disorder characterized by compulsive drug use” (National Institute on Drug Abuse, 2010).

It sets in as one form a habit of taking a certain drug. Full-blown drug abuse comes with social problems such as violence, child abuse, homelessness and destruction of families (National Institute on Drug Abuse, 2010). To understand to the impact of drug abuse, one needs to explore the reasons why many get addicted and seem unable pull themselves out of this nightmare.

Many experts consider addiction as a disease as it affects a specific part of the brain; the limbic system commonly referred to as the pleasure center. This area, which experts argue to be primitive, is affected by various drug substances, which it gives a higher priority to other things. Peele (1998) argues that alcoholism is a disease that can only be cured from such a perspective (p. 60). Genetics are also seen as a factor in drug addiction even though it has never been exclusively proven.

Other experts view addiction as a state of mind rather than a physiological problem. The environment plays a major role in early stages of addiction. It introduces the agent, in this case the drug, to the abuser who knowingly or otherwise develops dependence to the substance. Environmental factors range from violence, stress to peer pressure.

Moreover, as an individual becomes completely dependent on a substance, any slight withdrawal is bound to be accompanied by symptoms such as pain, which is purely psychological. This is because the victim is under self-deception that survival without the substance in question is almost if not impossible. From his psychological vantage point, Isralowitz (2004) argues that freedom from addiction is achievable provided there is the “right type of guidance and counseling” (p.22).

A doctor as regulated by law usually administers prescription drugs. It may not be certain why many people abuse prescription drugs but the trend is ever increasing. Many people use prescription drugs as directed by a physician but others use purely for leisure. This kind of abuse eventually leads to addiction.

This problem is compounded by the ease of which one can access the drugs from pharmacies and even online. Many people with conditions requiring painkillers, especially the elderly, have a higher risk of getting addicted as their bodies become tolerant to the drugs. Adolescents usually use some prescription drugs and especially painkillers since they induce anxiety among other feelings as will be discussed below.

Stimulants are generally psychoactive drugs used medically to improve alertness, increase physical activity, and elevate blood pressure among other functions. This class of drugs acts by temporarily increasing mental activity resulting to increased awareness, changes in mood and apparently cause the user to have a relaxed feeling. Although their use is closely monitored, they still find their way on the streets and are usually abused.

Getting deeper into the biochemistry of different stimulants, each has a different metabolism in the body affecting different body organs in a specific way. One common thing about stimulants is that they affect the central nervous system in their mechanism. Examples of commonly used stimulants include; cocaine, caffeine, nicotine, amphetamines and cannabis. Cocaine, which has a tremendously high addictive potential, was in the past used as anesthetic and in treatment of depression before its profound effects were later discovered.

On the streets, cocaine is either injected intravenously or smoked. Within a few minutes of use, it stimulates the brain making the user feel euphoric, energetic and increases alertness. It has long-term effects such as seizures, heart attacks and stroke. Cocaine’s withdrawal symptoms range from anxiety, irritability to a strong craving for more cocaine.

Cannabis, also known as marijuana , is the most often abused drug familiar in almost every corner of the world, from the streets of New York to the most remote village in Africa. Although its addiction potential is lower as compared to that of cocaine, prolonged use of cannabis results to an immense craving for more.

It produces hallucinogenic effects, lack of body coordination, and causes a feeling of ecstasy. Long-term use is closely associated with schizophrenia, and other psychological conditions. From a medical perspective, cannabis is used as an analgesic, to stimulate hunger in patients, nausea ameliorator, and intraocular eye pressure reducer. Insomnia, lack of appetite, migraines, restlessness and irritability characterize withdrawal symptoms of cannabis.

Unlike stimulants, depressants reduce anxiety and the central nervous system activity. The most common depressants include barbiturates, benzodiazepines and ethyl alcohol. They are of great therapeutically value especially as tranquilizers or sedatives in reducing anxiety.

Depressants can be highly addictive since they seem to ease tension and bring relaxation. After using depressants for a long time, the body develops tolerance to the drugs. Moreover, body tolerance after continual use requires one use a higher dose to get the same effect. Clumsiness, confusion and a strong craving for the drug accompany gradual withdrawal. Sudden withdrawal causes respiratory complications and can even be fatal.

Narcotics have been used for ages for various ailments and as a pain reliever pain. They are also characterized by their ability to induce sleep and euphoria. Opium, for instance was used in ancient China as a pain reliever and treatment of dysentery and insomnia. Some narcotics such as morphine and codeine are derived from natural sources.

Others are structural analogs to morphine and these include heroin, oxymorphone among others. Narcotics are highly addictive resulting to their strict regulation by a majority of governments. Narcotics act as painkillers once they enter the body.

They are used legally in combination with other drugs as analgesics and antitussives but are abused due to their ability to induce a feeling of well being. Their addiction potential is exceptionally high due to the body’s tolerance after consistent use, forcing the user to use and crave for more to get satisfaction. Increase in respiration rate, diarrhea, anxiety, nausea and lack of appetite are symptoms common to narcotic withdrawal. Others include; running nose, stomach cramps, muscle pains and a strong craving for the drugs.

Hallucinogens affect a person’s thinking capacity causing illusions and behavioral changes especially in moods. They apparently cause someone to hear sounds and see images that do not exist. Lysergic acid diethylamide (LSD), which commonly abused hallucinogen, has a low addiction potential because it does not have withdrawal effects. They also affect a person’s sexual behavior and other body functions such as body temperature. There are no outright withdrawal symptoms for hallucinogens.

Isralowitz, R. (2004). Drug use: a reference handbook . Santa Barbara, Clif.: ABC-CLIO. Print.

National Institute on Drug Abuse. (2010). NIDA INfoFacts: Understanding Drug Abuse and Addiction . Web.

Peele, S. (1998). The meaning of Addiction : Compulsive Experience and its Interpretation . San Francisco: Jossey-Bass.

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Cholesterol gallstones and long-term use of statins: is gut microbiota dysbiosis bridging over uncertainties.

Graphical Abstract

1. Introduction

2. materials and methods, 2.1. research participant approach, 2.2. gsd diagnostic methodology, 2.3. gs classification and analysis, 2.4. dyslipidemia diagnostic methodology, 2.5. diabetes mellitus diagnostic methodology, 2.6. microbiological and sequencing assessment of stools, 4. discussion, limitations, 5. conclusions, supplementary materials, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Share and Cite

Georgescu, D.; Lighezan, D.-F.; Ionita, I.; Hadaruga, N.; Buzas, R.; Rosca, C.-I.; Ionita, M.; Suceava, I.; Mitu, D.-A.; Ancusa, O.-E. Cholesterol Gallstones and Long-Term Use of Statins: Is Gut Microbiota Dysbiosis Bridging over Uncertainties? Diagnostics 2024 , 14 , 1234. https://doi.org/10.3390/diagnostics14121234

Georgescu D, Lighezan D-F, Ionita I, Hadaruga N, Buzas R, Rosca C-I, Ionita M, Suceava I, Mitu D-A, Ancusa O-E. Cholesterol Gallstones and Long-Term Use of Statins: Is Gut Microbiota Dysbiosis Bridging over Uncertainties? Diagnostics . 2024; 14(12):1234. https://doi.org/10.3390/diagnostics14121234

Georgescu, Doina, Daniel-Florin Lighezan, Ioana Ionita, Nicoleta Hadaruga, Roxana Buzas, Ciprian-Ilie Rosca, Mihai Ionita, Ioana Suceava, Diana-Alexandra Mitu, and Oana-Elena Ancusa. 2024. "Cholesterol Gallstones and Long-Term Use of Statins: Is Gut Microbiota Dysbiosis Bridging over Uncertainties?" Diagnostics 14, no. 12: 1234. https://doi.org/10.3390/diagnostics14121234

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The Healthcare Professional's

Core Resource on Alcohol

Knowledge. Impacts. Strategies.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Helping your patients with alcohol-related problems, what to know, ask, and offer.

Alcohol contributes to more than 200 health conditions and about 178,000 deaths in the U.S. each year. Yet alcohol-related risks often go unaddressed in healthcare settings. The Core Resource on Alcohol provides evidence-based content to help healthcare professionals:

• Gain new insights—and earn FREE CME or CE credit —with 14 articles on alcohol and health covering basic principles, clinical impacts, and patient care from screening through recovery.
• Overcome barriers to care for patients with alcohol problems —by filling training gaps for providers who are not addiction specialists, including ways to counteract patient stigma.

"This resource is a good way to increase your confidence when you see patients with alcohol-related concerns , which you're going to see often." — Primary care practitioner

Learn how to apply the Core Resource in clinical practice.

Explore the Core Resource on Alcohol and Earn FREE CME or CE Credit

View the 14 Core articles below in any order and earn CME/CE credit for as many or as few as you wish. Each article provides instructions at the end for earning credit, which is available for physicians, physician assistants, nurses, pharmacists, and psychologists,  as well as other healthcare professionals whose licensing boards accept APA or AMA credits. Others may earn a certificate of completion. The CME/CE system will keep a history of the articles you have completed for credit.

See also the Additional Links for Patient Care for many helpful alcohol-related healthcare resources for different types of providers.  Learn more about the Core Resource on Alcohol.

• The Basics : Defining How Much Alcohol is Too Much (Topic 1) 0.75 credit hour
• Risk Factors : Varied Vulnerability to Alcohol-Related Harm  (Topic 2) 0.75 credit hour
• Neuroscience : The Brain in Addiction and Recovery  (Topic 3) 0.75 credit hour
• Stigma : Overcoming a Pervasive Barrier to Optimal Care  (Topic 4) 0.75 credit hour

• Medical Complications : Common Alcohol-Related Concerns  (Topic 5) 1.0 credit hour
• Alcohol-Medication Interactions : Potentially Dangerous Mixes  (Topic 6) 0.75 credit hour
• Mental Health Issues : Alcohol Use Disorder and Common Co-occurring Conditions  (Topic 7) 0.75 credit hour
• Alcohol Use Disorder : From Risk to Diagnosis to Recovery  (Topic 8) 0.75 credit hour

• Screen and Assess : Use Quick, Effective Methods  (Topic 9) 0.75 credit hour
• Conduct a Brief Intervention : Build Motivation and a Plan for Change  (Topic 10) 0.75 credit hour
• Recommend Evidence-Based Treatment : Know the Options  (Topic 11) 0.75 credit hour
• Make Referrals : Connect Patients to Alcohol Treatment That Meets Their Needs  (Topic 12) 0.75 credit hour
• Support Recovery : It’s a Marathon, Not a Sprint  (Topic 13) 0.75 credit hour

• Promote Practice Change : Take Manageable Steps Toward Better Care  (Topic 14) 0.75 credit hour
• How to Apply The Core Resource on Alcohol in Clinical Practice  (Sample workflow—not for credit)

Helpful Links

• About the Core Resource on Alcohol
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For comments about the content, please contact us at [email protected]

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"When you make progress with a patient with alcohol use disorder, you've really made a difference not only for the patient, but often for a whole family." -Internist

In support of improving patient care, CME/CE activities offered have been planned and implemented by the Postgraduate Institute for Medicine and NIAAA. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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Is America’s weed habit dangerous?

Our analysis of the data.

F EW RICH countries have taken to legal weed quite like America. Although federal regulation remains tight, the drug is legal for recreational use in 24 states and for medical use in 38. One in six American adults now uses marijuana at least monthly, according to the National Survey on Drug Use and Health ( NSDUH ); nearly one in 20—about 11m people—gets high every day. A recent paper by Jonathan Caulkins of Carnegie Mellon University estimates that the number of “daily or near-daily” marijuana users—defined as those who report getting high on at least 21 of the past 30 days—surpassed the number of daily alcohol users in 2022.

That finding grabbed headlines. It does not mean that weed is a bigger health risk than alcohol, but it does have some worrying implications.

The first point to note is that a lot more Americans drink alcohol than get high from cannabis; drinking is a lot more dangerous. Around two-thirds of American adults have had a drink in the past year, compared with a fifth who have had a toke. More than half imbibe at least once a month. The Centres for Disease Control and Prevention reckons that the number of deaths in America that can be attributed to alcohol, either in full or in part, is now nearly 180,000 per year. The mortality risk from marijuana is virtually nil. The main danger comes from driving under the influence.

But weed users tend to indulge their habit more often. One in five marijuana users gets high every day (before legalisation by some states the figure was around one in ten). By our calculations, disregarding “near-daily users” the number of daily tokers surpassed the number of daily drinkers in 2018. Their habit may not be harmless.

Studies have shown that people who use cannabis regularly may develop schizophrenia and other psychotic disorders earlier than they might otherwise have done. Heavy users may also have an increased risk of cardiovascular diseases, including heart attacks and strokes. In an article for the Washington Monthly Mr Caulkins explained that heavy use may also harm short-term memory, concentration and motivation, resulting in “lost opportunities in schools and the workplace”. Our analysis appears to back this up. Data from the NSDUH survey show that in 2022 just 42% of daily or near-daily marijuana users said they had “very good” or “excellent” health, compared with 53% of monthly users and 56% of yearly ones (see chart 2). Those differences remain even after controlling for demographic characteristics such as age, race and education, and excluding people who use marijuana for medical purposes. Daily pot users also tend to report worse mental health, with a larger share saying that they suffered an episode of depression in the past year.

On measures of employment the findings are less stark. Serious stoners fare only slightly worse in the workplace than more casual pot users. Working-age adults who use marijuana every day or nearly every day are only slightly less likely to be employed than are monthly users. They work roughly the same number of hours, too. But the data also show that heavy marijuana users tend to skip work more often than do casual users and non-users. They also earn less (see chart 3).

Correlation is not causation. It may be that people with lower incomes and poorer health are more inclined to become heavy pot users; or that some third factor causes all three outcomes. Whatever the explanation, the number of daily smokers could rise as legalisation becomes more common. As many as five states could legalise recreational use of the drug in 2024. Voters in Florida and South Dakota are already set to vote on the issue in November. ■

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Advertisement

5 Takeaways From Hunter Biden’s Conviction in a Gun Case

The president’s son, who was convicted of three felonies, could face a stiffer sentence if he is convicted in a separate tax case scheduled for September.

• Share full article

By Eileen Sullivan

• June 11, 2024

Hunter Biden, the president’s son, was found guilty on three felony counts related to buying a gun while he was in the throes of drug addiction. On Oct. 12, 2018, he filled out the required federal background check form, marking “no” to a question about his drug use.

His lawyers argued that the special counsel who brought the case, David C. Weiss, had no evidence that Mr. Biden used drugs the day of his purchase or in the surrounding period.

Before deciding to convict him on all three charges, the jury heard about Mr. Biden’s spiraling addiction to crack cocaine from women in his life, as well as in Mr. Biden’s own words, which the prosecution shared by using excerpts from the audiobook of his memoir.

Here are some takeaways.

The verdict comes amid questions about the intersection of politics and the justice system.

The verdict in Mr. Biden’s trial came just weeks after former President Donald J. Trump was convicted in a Manhattan courtroom of falsifying business records to cover up a hush-money payment to a porn star. Both trials were surrounded by partisan dynamics and questions about the criminal justice system’s ability to operate without regard to politics.

Mr. Biden’s trial was held in the Biden family’s hometown, in the middle of a presidential campaign and amid intense pressure from Republicans to find criminality by Hunter Biden. The fact that juries have now convicted both the presumptive Republican presidential nominee and the son of his opponent, the sitting president, will not end debate about politics and the courts. But it might keep the issue from becoming further inflamed.

The trial has been a painful reminder of the struggles the Biden family has weathered over decades.

In his 2021 memoir, Hunter Biden laid bare his unrelenting abuse of crack cocaine. Witness testimony and text messages added to the damaging portrait of the president’s son, a stark reminder of his yearslong troubles at a time when his father is in a close re-election race.

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