For now, the data says no. – Psychology Today

Report on Alcohol Use Disorder Treatment and Alignment with Sustainable Development Goal 3

Introduction: The Public Health Challenge of Alcohol Use Disorder (AUD)

Alcohol Use Disorder (AUD) presents a significant obstacle to achieving Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all. The disorder, characterized by compulsive alcohol use and negative emotional states, directly undermines SDG Target 3.5, which calls for strengthening the prevention and treatment of substance abuse, including the harmful use of alcohol. The high relapse rate, approaching 60-70% within one year of treatment cessation, and its linkage to non-communicable diseases like dementia, further challenge the objectives of SDG Target 3.4 concerning mental health and well-being.

Current Evidence-Based Treatments and Barriers to Access

Underutilization of Proven Therapies in Achieving SDG Target 3.5

Despite the availability of effective, FDA-approved medications, their implementation remains critically low, hindering progress toward global health targets. Less than 2% of individuals with AUD receive these medications. The primary, evidence-based pharmacological interventions include:

1. Naltrexone: Reduces relapse risk and heavy drinking days. It is available in oral form or as a long-acting monthly injection (Vivitrol), which improves treatment adherence.
2. Acamprosate: Supports abstinence maintenance post-detoxification by stabilizing neurochemical imbalances caused by chronic alcohol consumption.
3. Disulfiram: Functions as a powerful aversive conditioning agent, inducing severe nausea if alcohol is consumed. It demonstrates high efficacy rates when administered under supervision.

The underutilization of these proven treatments represents a failure to leverage existing tools to meet the goals of SDG 3. This gap is exacerbated by stigma, shame, and a lack of public and professional awareness.

Innovations in Treatment Accessibility to Support Universal Health Coverage (SDG Target 3.8)

Modernizing Access to Care

To align with SDG Target 3.8, which advocates for universal access to quality and affordable essential medicines, innovative models are being explored to overcome barriers to AUD treatment. These include:

• Direct-to-Consumer Models: Telehealth platforms are increasingly delivering medications like naltrexone directly to patients, normalizing treatment and enhancing patient control.
• Over-the-Counter (OTC) Availability: Experts from institutions such as Mass General Hospital have proposed making oral naltrexone available OTC. This strategy could significantly reduce harm and high-intensity drinking, mirroring successful public health initiatives like OTC nicotine replacement therapies.

The Role of Harm Reduction and Psychosocial Support

A harm-reduction approach, which supports goals of reduced or controlled drinking rather than complete abstinence, is a valid public health strategy. Naltrexone is effective within this model by reducing the reinforcing effects of alcohol. Furthermore, integrating pharmacotherapy with cost-effective, community-based support systems like Alcoholics Anonymous (AA) has been shown to be highly effective in maintaining long-term abstinence, contributing to the holistic well-being central to SDG 3.

Evaluating Psychedelic-Assisted Therapies for AUD

A Critical Review of Current Evidence

While there is considerable enthusiasm for using psychedelics like psilocybin and LSD to treat AUD, a critical evaluation reveals that this enthusiasm has outpaced scientific evidence. This premature focus risks diverting attention and resources from proven strategies needed to achieve SDG Target 3.5.

• Historical and Methodological Flaws: Early studies in the 1960s lacked randomization, blinding, and standardized measures.
• Limited Efficacy in Modern Trials: A recent Phase 2 trial found that psilocybin only reduced heavy drinking days in the final four weeks of a 36-week study, with no significant difference from a placebo in most assessments.
• Challenges with Blinding: The distinct psychoactive effects of psychedelics make it difficult to conduct truly blinded studies, as up to 90% of participants can correctly guess whether they received the active drug or a placebo.
• Expert Consensus: Addiction psychiatrists caution that the current data is insufficient and flawed, urging a focus on advocating for the wider use of established, safer, and more effective treatments.

The Broader Therapeutic Potential of Psychedelics

Promising Research in Other Mental Health Conditions

While the evidence for AUD is weak, psychedelic-assisted therapies show significant promise for other conditions, aligning with the broader mental health objectives of SDG 3. Rigorous, controlled research has demonstrated potential benefits in:

• Major Depression: Randomized controlled trials have shown that psilocybin-assisted therapy can produce rapid and dramatic reductions in depressive symptoms.
• Anxiety and End-of-Life Distress: Psychedelics have been shown to reduce distress and death anxiety in terminally ill patients, addressing existential suffering that conventional medications often fail to manage.
• Other Disorders: Emerging research suggests potential for treating Generalized Anxiety Disorder (GAD), PTSD, and eating disorders by disrupting rigid cognitive patterns.

Conclusion and Recommendations for Advancing SDG 3

Prioritizing Proven Interventions for AUD

To make meaningful progress on SDG Target 3.5, the immediate public health priority must be the widespread implementation of existing, evidence-based treatments for AUD. The focus should be on scaling access to naltrexone, acamprosate, and disulfiram, combined with psychosocial support. Innovations in service delivery, such as telehealth and potential OTC availability, are crucial for achieving the universal health coverage goals of SDG 3.8.

A Path Forward for Research and Public Health

The path forward requires a dual strategy: prioritizing and scaling proven treatments for AUD while simultaneously supporting rigorous, controlled clinical research into the potential of psychedelics for other specific mental health conditions. It is imperative to distinguish between scientifically validated therapeutic applications and the significant risks associated with uncontrolled self-medication. For AUD, the tools to save lives and restore function are already available; the challenge lies in ensuring they are used effectively to meet global health goals.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The entire article is centered on health, specifically mental health and substance use disorders. It discusses Alcohol Use Disorder (AUD), its connection to other health issues like dementia, and various treatments aimed at improving the health and well-being of affected individuals. The article explores both existing pharmacological treatments and potential new therapies using psychedelics for a range of conditions including depression, anxiety, and PTSD, all of which fall under the umbrella of promoting health and well-being.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.

  This target is the most directly relevant. The article’s primary focus is on the treatment of “harmful use of alcohol,” as defined by Alcohol Use Disorder (AUD). It evaluates the efficacy of existing medications (naltrexone, acamprosate, disulfiram), behavioral support (Alcoholics Anonymous), and investigates new potential treatments (psychedelics). The text explicitly addresses the challenge of high relapse rates (“relapses approach 60-70 percent”) and the critical need to improve treatment outcomes for substance abuse.

• Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

  The article connects directly to this target by discussing the treatment of several mental health conditions, including AUD, major depression, generalized anxiety disorder (GAD), and PTSD. It highlights that AUD itself is linked to non-communicable diseases like dementia. The exploration of more effective treatments for these conditions is a core component of promoting mental health and well-being and, by extension, preventing premature mortality associated with these disorders.

• Target 3.8: Achieve universal health coverage, including… access to safe, effective, quality and affordable essential medicines…

  The article underscores a significant gap in health coverage related to AUD treatment. It states that despite the existence of three effective, FDA-approved medications, “less than 2 percent of people with AUD take them.” The discussion about overcoming barriers to access through innovations like “telehealth,” “direct-to-patient sales model,” and making naltrexone available “over-the-counter (OTC)” directly addresses the goal of improving access to essential medicines for all who need them.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicator: Coverage of treatment interventions for substance use disorders.

  The article provides a stark and specific metric for this indicator. It states, “Yet

• Indicator: Rates of abstinence and reduction in harmful use.

  The article implies this indicator by discussing the effectiveness of various treatments. It mentions that naltrexone “reduces relapse risk and heavy drinking days,” acamprosate “supports abstinence maintenance,” and disulfiram leads to “among the highest abstinence rates.” A phase 2 trial of psilocybin also measured its effect on “heavy drinking days.” These outcomes are key metrics for evaluating the success of treatment interventions for substance abuse.

• Indicator: Relapse rates for substance use disorders.

  The article explicitly mentions that for AUD, “relapses approach 60-70 percent within a year of treatment cessation.” This high rate is an indicator of the challenges in providing effective, long-term treatment and recovery support. A reduction in this relapse rate would signify an improvement in the quality and effectiveness of care.

• Indicator: Accessibility of essential medicines.

  The article implies this indicator by discussing strategies to overcome barriers to access. The implementation of “telehealth,” “direct-to-consumer models,” and the potential for “over-the-counter (OTC)” availability of naltrexone are all measurable actions. Tracking the adoption of these models and the availability of OTC options would serve as an indicator of progress in making essential medicines more accessible, in line with Target 3.8.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

Source: psychologytoday.com