All Things Addiction – Alcohol | Understanding Alcohol Use Disorder (AUD)

https://www.youtube.com/watch?v=UXSArhz8w4Y

In this episode, Dr. Fred Rottnek, Chief Medical Officer at ARCA and Program Director of the SSM Health St. Louis University Addiction Medicine Fellowship, joins Percy Menzies, President and Founder of ARCA, to discuss the complexities of alcohol use disorder (AUD)—its history, treatment, and societal challenges.

The conversation opens with the alarming rise in alcohol-related deaths, which nearly doubled during the COVID-19 pandemic—from roughly 90,000 to 178,000 per year in the U.S. Despite alcohol’s status as a socially accepted and legal substance, it remains a leading cause of preventable death and disease.

Dr. Rottnek and Mr. Menzies emphasize how stigma and moral framing continue to hinder progress. Historically, alcohol misuse was viewed as a moral failing rather than a medical condition. This misconception shaped decades of punitive and ineffective treatments—from the use of disulfiram (Antabuse), which induces sickness when drinking, to early, non-scientific intervention

They review the evolution of evidence-based treatments, highlighting three key medications:

• Disulfiram (Antabuse): Early deterrent drug that punished drinking behavior rather than treating its root causes.

• Acamprosate: Helps maintain sobriety post-detox but has adherence challenges due to its three-times-daily dosing.

• Naltrexone (and Vivitrol): Described as the “penicillin of addiction”, it blocks the brain’s reward response to alcohol, reducing cravings and the desire to drink. Naltrexone allows harm reduction—it can help individuals cut down gradually instead of forcing immediate abstinence.

  
  

Despite its effectiveness and affordability (about $1/day for the generic pill), Naltrexone remains underused—a casualty of misinformation, lack of physician training, and persistent stigma.

The discussion also explores the social and policy failures surrounding alcohol. Alcohol remains deeply ingrained in culture and economics, with policies that expand access and reduce taxes instead of promoting prevention and treatment. Dr. Rottnek and Mr. Menzies argue for treating alcohol use disorder like any chronic disease—through accessible, outpatient, evidence-based care rather than moral judgment or institutional punishment.

Finally, they stress the importance of screening, education, and open dialogue. Tools like the CAGE questionnaire (Cut down, Annoyed, Guilty, Eye-opener) can help identify early signs of problematic drinking. Clinicians are encouraged to normalize conversations about alcohol use and offer compassionate, practical solutions.

They conclude with a shared message of hope and urgency: millions can recover if given the right tools, medications, and understanding. Through ARCA and partnerships with SSM Health and St. Louis University, they aim to lead a new wave of compassionate, evidence-based addiction care—where alcohol use disorder is treated as a medical condition, not a moral failure.

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