In recent years, sports gambling has exploded in popularity, with mobile apps and online platforms making it easier than ever to place bets on everything from football to tennis. While sports betting can be an exciting pastime, research is beginning to reveal a concerning link: frequent sports gambling is positively correlated with alcohol-related problems over time.
The Research Behind the Connection
A recent survey study found that individuals who frequently engage in sports gambling are at a higher risk of developing alcohol-related problems. The study tracked gambling habits and alcohol consumption over time, revealing a strong correlation between increased betting frequency and worsening alcohol-related consequences.
But why does this connection exist? Several factors could be at play:
The Social Environment – Many sports gambling settings, such as bars, casinos, or watch parties, encourage alcohol consumption. Betting while drinking can lead to impaired decision-making and increased risk-taking.
Impulse Control and Addiction – Both gambling and alcohol can activate the brain’s reward system, leading to compulsive behaviors. Someone prone to impulsive gambling may also struggle with moderating alcohol intake, and vice versa.
Coping Mechanisms – For some, gambling and alcohol serve as escape mechanisms from stress, anxiety, or financial difficulties. Unfortunately, these behaviors can reinforce each other, creating a cycle that’s hard to break.
Why This Matters
With the rise of legalized sports betting, it’s crucial to understand the potential risks. Problem gambling and alcohol misuse can lead to financial hardship, strained relationships, mental health struggles, and long-term health consequences. Awareness is key to preventing these issues before they spiral out of control.
Responsible Gambling and Drinking: What Can You Do?
If you enjoy sports betting and drinking, consider these tips to keep things in check:
✅ Set Limits – Establish a gambling budget and a drinking limit before you start. Stick to them.
✅ Avoid Drinking While Betting – Alcohol impairs judgment, which can lead to reckless betting decisions.
✅ Recognize Warning Signs – If you find yourself gambling or drinking more than you intended, or if these habits are negatively affecting your life, it may be time to take a step back.
✅ Seek Support – If you or someone you know is struggling, reach out for help. Resources like gambling helplines and alcohol support groups can provide guidance and support.
Final Thoughts
Sports gambling and alcohol can both be enjoyed responsibly, but it’s important to be aware of their potential risks. As research continues to uncover the connection between these two behaviors, taking a mindful approach can help ensure they remain entertainment rather than a problem.
What are your thoughts on this issue? Have you noticed a link between gambling and alcohol in your own experiences? Share your insights in the comments! ⬇️
📉 In a randomized trial with 48 patients diagnosed with #AlcoholUseDisorder, semaglutide significantly lowered alcohol intake in a controlled lab setting.
🚬 Interestingly, nicotine consumption also decreased.
💉 Low doses (0.25-1 mg/week) were used over 9 weeks—much lower than standard obesity or diabetes dosing.
🔬 More research is needed, but this adds to growing evidence that GLP-1 agonists may impact addictive behaviors.
Recent research in JAMA and JCI Insight on repurposing GLP-1 receptor agonists, particularly semaglutide and liraglutide, for Alcohol Use Disorder (AUD) shows promise.
Mechanism of Action: Semaglutide and liraglutide, commonly used to manage diabetes and obesity, activate the GLP-1 receptor, which plays a role in satiety and reward pathways. This activation has shown to suppress the rewarding effects of alcohol, aligning with existing data on the overlap between mechanisms regulating food intake and addictive behaviors.
Preclinical Findings: In rodent models, semaglutide reduced alcohol intake in a dose-dependent manner, with promising results across both binge drinking and alcohol-dependent models. Compared to other GLP-1 agonists, semaglutide’s potent binding and prolonged action make it a strong candidate for further study.
Clinical Potential: The findings provide a foundation for testing semaglutide in clinical trials for people with AUD, where it could potentially serve as an alternative to traditional treatments by targeting alcohol cravings and reducing consumption patterns in those with AUD.
The promising preclinical data suggests that further investigation could potentially lead to semaglutide as a viable treatment for AUD, adding to the treatment options for substance use disorders that overlap with metabolic disorders. This research is ongoing, and clinical trials may help solidify its role in AUD treatment in the future.
Many people enjoy a drink without a second thought, but did you know that excessive alcohol consumption can significantly increase your risk of developing several types of cancer? It’s a hidden danger that often goes unnoticed. Here’s a breakdown of the various forms of cancer linked to heavy drinking:
1. Mouth and Throat Cancer (Oral and Pharyngeal)
Alcohol irritates the cells in your mouth and throat, making them more susceptible to carcinogens. Heavy drinkers are at much higher risk of developing cancers in these areas, especially when combined with smoking.
2. Esophageal Cancer
Drinking alcohol can damage the cells lining the esophagus, leading to DNA mutations over time. Certain genetic factors, such as deficiencies in alcohol metabolism, can further increase this risk.
3. Liver Cancer
Your liver is responsible for breaking down alcohol, and chronic drinking leads to inflammation, cirrhosis, and eventually liver cancer. Hepatocellular carcinoma is the most common type of liver cancer linked to alcohol abuse.
4. Breast Cancer
Alcohol affects hormone levels, particularly estrogen, which can contribute to an increased risk of breast cancer. Even moderate drinking can elevate this risk in women.
5. Colon and Rectal Cancer
Excessive alcohol consumption is linked to cancers of the colon and rectum. Alcohol disrupts the way your body processes nutrients, leading to inflammation and other conditions that promote cancer development.
6. Pancreatic Cancer
Chronic alcohol use can inflame the pancreas, increasing the risk of pancreatic cancer. Since this cancer is notoriously difficult to detect early, the connection to alcohol makes prevention even more critical.
Reduce Your Risk
The more alcohol you consume, the higher your risk of developing cancer. While occasional drinking in moderation might not significantly raise your risk, chronic and heavy drinking has been strongly linked to these cancers. To lower your risk:
Limit alcohol intake
Stay informed about the impact of alcohol on your body
Get regular health check-ups, especially if you drink often
The article “Major Psychiatric Disorders, Substance Use Behaviors, and Longevity” explores the complex relationships between psychiatric disorders, substance use, and life expectancy. The authors examine how conditions like schizophrenia, bipolar disorder, and major depression affect longevity, often leading to reduced lifespans. This is largely due to increased risk factors, such as poor physical health, unhealthy lifestyles, and increased rates of suicide.
Substance use behaviors, including alcohol, tobacco, and drug use, often co-occur with psychiatric disorders, compounding the negative effects on longevity. The article emphasizes the need for better integration of mental health and substance use treatment into healthcare systems. It also advocates for targeted interventions to reduce mortality rates, improve the quality of life, and enhance access to comprehensive care for individuals with psychiatric disorders.
When it comes to treating addiction, the prevailing idea is that it’s simply a chronic brain disease. But in reality, few experts fully subscribe to this view in isolation. We understand that not everyone who uses drugs, alcohol, or gambles ends up with a life-destroying addiction. Many individuals manage to engage with substances or behaviors without it overtaking their lives—they maintain jobs, care for their families, and function in society. This suggests that addiction is much more than a biological condition; it’s an intricate interplay of biology, social influences, environmental factors, and personal choices.
It’s worth pausing to consider what labeling addiction as a chronic disease implies. On one hand, it suggests that even if you strive for change, addiction remains a lingering presence—one that can pull you back into destructive patterns at any moment. This can foster a disheartening and pessimistic outlook, as it positions addiction as an inescapable burden. The concept of a chronic disease also reinforces the idea that ongoing, lifelong treatment is necessary, often with medications like buprenorphine, which may be prescribed for years, or even indefinitely, to prevent relapse.
While I absolutely recognize the biological underpinnings of addiction and the life-saving role medications like buprenorphine play, we must look beyond just biology to truly understand and address addiction. The motivations behind substance use and the social contexts in which it occurs are equally important. Humanity’s long history of seeking altered states of consciousness suggests that drug use is often a response to emotional pain or difficult circumstances. People frequently use substances as an escape, and understanding these personal and social factors is key to effective treatment.
At its core, successful addiction therapy must focus on uncovering the reasons behind substance use and helping individuals develop healthier coping strategies. Treatment that focuses solely on the biological side—without considering the psychological and social aspects—often falls short. It’s critical to provide not just medical interventions but also hope and optimism, which are fundamental to any healing process. Addiction may not be a simple choice, but it certainly involves choices, and it emerges from a complex web of circumstances in a person’s life.
In the end, we should avoid oversimplifying addiction as merely a chronic brain disease. True treatment requires a holistic approach, considering all the elements—biological, social, environmental, and personal—that create the conditions for addiction to thrive. Only then can we offer meaningful, lasting solutions for those struggling with addiction.
Have you ever noticed that hand sanitizer is sometimes locked up in certain areas of the hospital? The reason for this is that individuals with severe alcohol use disorder may attempt to drink it. One of the highest blood alcohol levels (BAL) I’ve ever encountered came from a patient who found an unlocked dispenser, opened it, and consumed an entire bottle of sanitizer. Their BAL was an alarming 600 when we tested them. This highlights the dangers and societal impact of risky alcohol consumption—something I’ve witnessed firsthand in the inpatient setting.
While alcohol is widely accepted in social settings and deeply embedded in many cultures, it’s important to recognize that its social acceptance does not make it harmless. In fact, alcohol has caused far more harm than many illegal substances that are often perceived as more dangerous.
Alcohol is linked to numerous health problems, including liver disease, heart issues, and various forms of cancer. It’s also a leading contributor to accidents, violence, and fatalities, with drunk driving being one of the most deadly consequences. Beyond physical health, alcohol abuse can devastate relationships, contribute to domestic violence, and exacerbate mental health conditions like depression and anxiety.
Alcohol’s normalized presence in society often downplays the risks of dependency and addiction. Many people who drink don’t realize how easy it can be to develop problematic drinking, which can lead to a host of long-term issues, both physically and emotionally.
Despite its legal status and social acceptance, alcohol has proven to be one of the most harmful substances in terms of both individual and societal impact. Recognizing the risks and encouraging more mindful consumption can help reduce the extensive harm caused by this seemingly benign substance.
Gabapentin is approved by the FDA for three specific indications to prevent and control partial seizures, relieve nerve pain following shingles (post herpetic neuralgia), and to treat moderate to severe restless leg syndrome. Unfortunately, less than 1% of the prescriptions written for gabapentin are for the above listed FDA approvals. In fact, much of the off-label prescribing of gabapentin is done for the treatment of psychiatric and substance use disorders.
We were first alerted to the misleading marketing practices when Pfizer paid a $2.3 billion dollar fine for misleading clinicians through their marketing campaigns. Gabapentin is often thought of as a benign medication that can address symptoms in several common disorders including migraine, chronic pain, fibromyalgia, opioid use disorder, anxiety, and mood disorders. There is now mounting evidence that this medication is not as safe as people once assumed yet many of these prescribing practices continue despite a lack of quality data. Today we will review the safety and efficacy of gabapentin in psychiatric disorders.
How Does Gabapentin Work?
Gabapentin functions by binding to the alpha-2-delta subunit of voltage gated calcium channels theoretically offering antipain, anticonvulsant, and anxiolytic properties. Although it’s structurally related to the GABA neurotransmitter, there is no direct interaction at GABA A or B receptors.
Why is there such an increase in Gabapentin prescribing?
In the United States the opioid epidemic drove much of the 64% increase in gabapentin prescriptions 2012 to 2016 as policy makers searched for safer alternatives for pain management. Although lacking any data for the treatment of chronic pain, gabapentin was elevated into this role because of several factors cost, non-controlled status at the federal level, evidence in neuropathic pain, and benign side effect profile.
However, the risk for gabapentin abuse became apparent as more prescriptions were written. The risk of adverse effects was prevalent when combined with other CNS depressants such as opioids, the exact thing gabapentin set out replace. Approximately 15%-22% of people with an existing substance use disorder abuse gabapentin. Those who overused gabapentin were found to be at increased risk of all-cause or drug-related hospital stay and emergency visits for altered mental status and respiratory depression.
The off-label prescribing of gabapentin comes with risk.
Evidence For Use in Anxiety Disorders
The evidence for gabapentin’s use in anxiety disorders comes from only two industry sponsored studies with a total of 172 participants. These are relatively small but well-designed studies that provide limited evidence for the use of gabapentin in anxiety disorders. The first study was in 1999 and looked at the use of gabapentin in social anxiety disorder. 69 participants were randomized to placebo or gabapentin 900-3600 mg/day for 14 weeks. A significant reduction in social anxiety was observed over the 14 weeks and the conclusion was more studies were needed to confirm the results. The other study looked at panic disorder with the same study design and doses of gabapentin, only this time the study lasted 8 weeks. The results indicated gabapentin was effective for severe panic disorder. One thing we notice is neither of these studies focused on generalized anxiety disorder. These results have not been replicated in other studies.
There is far more evidence for the use of pregabalin in anxiety disorders. In Europe it does have regulatory approval for generalized anxiety disorder.
Evidence For Use in Bipolar Disorder
I’m going to burst this bubble and maybe a few other bubbles up front. While some believe all anticonvulsants are “mood stabilizers” they are wrong. Gabapentin has never proven in RCTs to treat mania or any other aspect of bipolar disorder. Likewise, Topiramate and oxcarbazepine have performed poorly in studies assessing their efficacy in bipolar disorder. Simply put, if you are on any of the three medications as primary mood stabilizers it’s best to consider other options such as lithium.
Evidence For Use In Alcohol and Cannabis Use Disorder
While addiction treatment is part of the reason we are in this mess with gabapentin, it does have a role in alcohol use disorder (AUD) and cannabis use disorder. The APA added gabapentin as a second line option for AUD because patients who take it for this indication report fewer heavy drinking days with an effect size in the moderate range. There is also some indication that sleep quality improves with gabapentin when patients are cutting back or stopping alcohol use. Alcohol is known to worsen sleep with more frequent nighttime awakenings. The dose range is 300-3600 mg/day in divided doses with many using an average of 900 mg/day.
Gabapentin is sometimes used for alcohol withdrawal in place of benzodiazepines or phenobarbital. There were a few seizures in the gabapentin groups raising some questions about its use in severe alcohol withdrawal. It’s probably best left for those with less severe dependence.
Typical Taper for Alcohol Withdrawal
-Start with 1200-2400 mg/day in three divided doses
-Taper to 600 mg/day over the course or 4-7 days watching for objective signs of alcohol withdrawal and have Ativan available should a seizure develop.
-Taper by 300 mg/day over the next 2-3 days until the medication is completely off.
In cannabis use disorder there is limitted data. A single study showed improvement in withdrawal symptoms, reduced cannabis use, and improved executive function but this is not enough to recommend gabapentin on a regular basis in clinical practice.
It’s important to note gabapentin failed in controlled trials for cocaine, methamphetamine, benzodiazepine, and opioid use disorder. It’s dangerous to combine gabapentin and opioids as discussed earlier in the video.
A Quick Note on Gabapentin for Chronic back pain
There are 8 total studies including a systematic review and meta-analysis to assess pain relief in patients with chronic lower back pain a reason many patients tell me they are taking gabapentin for. When you pool this data together, gabapentin demonstrated minimal improvement in pain compared to placebo and had an increase in adverse effects including dizziness, fatigue, and visual disturbances.
Adverse Effects
The most common side effects include sedation, fatigue, dizziness, imbalance, tremor, and visual changes.
Dosing
Gabapentin has a short half-life of 6 hours and will need to be dosed three times per day. The kinetics of gabapentin are not linear which means levels in the blood do not rise consistently. For a 900 mg dose, only 540 mg is absorbed. This has to do with the transporters responsible for gabapentin absorption becoming over saturated limiting the amount of medication absorbed.
Conclusion
While there are very good reasons to consider the use of gabapentin many of the common reasons cited in clinical practice lack the appropriate evidence to support using the medication. It’s best to stick with FDA approved indications and if you are prescribing it off-label consider only using it for the disorders with the most evidence in my opinion that is alcohol use disorder when other treatments have failed.
MOA: mu opioid receptor antagonist which prevents exogenous opioids from binding blocking the pleasurable effects of opioid use. Reduces alcohol consumption through modulation of the opioid system, blocking the reinforcing effects of alcohol.
FDA Indications: alcohol use disorder (oral or injectable), Prevention of relapse to opioid dependence (injection)
Oral Dose: 50 mg/day
Injection Dose: 380 mg/month
Caution: patient must be opioid free for 7-10 days prior to starting, conformed with a negative urine
For alcohol use disorder start with 50 mg/day or 380 mg/month for IM formulation (injection may be preferred because it eliminates the daily decision to take the medication)
Side effects: nausea, vomiting, decreased appetite, dizziness, injection site reaction, life-threatening side effect is hepatocellular injury in overdose
Who is it good for?: Those ready to abstain completely from alcohol and for binge drinkers. Good evidence for reducing heavy drinking days. There is some risk of apathy or loss of pleasure with chronic use. The combination of naltrexone and bupropion has been used as a treatment for obesity.
