Alcohol use disorder: who thinks about addiction? The role of mutual-self-help

In this narrative review, some main points have been addressed. This is to better understand the daily clinical reality. The points are the following: alcohol use disorder (AUD) is not a "self-inflicted disease" but a clinical problem that derives from an incorrect lifestyle; possible presence of psychiatric pathology; possible presence of previous traumas; link with the substance (addiction).

This review is based on a detailed analysis of the scientific literature published before January 31, 2025 and examining the most recent guidelines or position papers on alcohol use disorder treatment (PubMed, Web of Science, Scopus, Google Scholar).

The alcohol problem is identified with addiction, ignoring that the close "bond" with the substance is acquired through a continuum that slips into slavery. The starting points of consumption are innumerable: pure pleasure, self-medication (psycho pathology, traumas, etc.), improvement of the relationship, etc. Also, for neuro-physio-pathological reasons, the concept of "self-inflicted disease" ceases to exist, especially when the onset of substance use is promoted and favored by society itself. During AUD, previous traumas, individual or social stresses favor, support and create the conditions to "defend" alcohol consumption. However, the self-referential release of alcohol represents the rule and if the primum movens is removed, the addictive experience is unlikely to end. Furthermore, the pharmacodynamic profile of alcohol is able to cause the phenomenology of the main psychotic symptoms in a way that is completely superimposable to that presented by subjects without a history of alcohol use disorder. We do not know whether the chicken or the egg came first. The distinction between use and induced disorders is fundamental but, in fact, not always practicable because, often, the induction of symptoms by the substance cannot be excluded, given that there is not a sufficient period of abstinence. Therefore, it is possible to confuse an induced disorder with a phenomenon of comorbidity, and therefore overestimate the dual diagnosis. It is important to understand whether or not a psychiatric problem is present, define the diagnosis and use the right pharmacological therapy at the lowest possible dosage. Neglecting it means undermining the therapeutic-rehabilitative path.

In light of the scientific evidence presented in the present narrative review, it is possible to draw some conclusions. Firstly, AUD should not be considered as a "self-inflicted disease" but a clinical problem that derives from an incorrect lifestyle. Secondly, the possible presence of psychiatric pathology (primary or secondary) must be evaluated after a prolonged period of abstinence. Thirdly, psychotherapeutic activity is effective for the resolution of problems from post-traumatic stress and in helping the patient in motivation and change. Moreover, the treatment of psycho-pathological problems and those related to traumatic/stressful factors facilitates the maintenance of sobriety, but does not represent the key to interpretation. As already stated, "the self-referential release of alcohol and other psychotropic substances represents the rule and it is difficult to conclude the additive experience if the primum movens is removed." The key treatment to significantly address the "pathological bond with the substance" is the frequency and full adherence to self-help groups. The effectiveness is independent of routine pharmacological/psychotherapeutic treatments. Lastly, the number of subjects and family members who currently attend is negligible. For this reason, it is appropriate that services provide themselves with self-help facilitators and train informal caregivers.