Changing the Way We Treat Alcohol Use Disorder, With Joseph R. Volpicelli, M.D., Ph.D.

Joseph R. Volpicelli, M.D., Ph.D.

Credit: Volpicelli Center for Addiction Treatment

In an interview with The Educated Patient, Joseph R. Volpicelli, M.D., Ph.D., executive director of the Institute of Addiction Medicine, breaks down the lingering stigma surrounding alcohol use disorder (AUD) and why so many people still hesitate to seek help. He discusses how stigma — rooted in outdated beliefs and reinforced by media stereotypes — can delay treatment, even as evidence-based medications such as naltrexone and promising new drugs like Ozempic (semaglutide) are changing the future of addiction care. His message is clear: alcohol addiction is not a moral failure — it’s a medical condition, and effective treatment exists.

AUD is a medical condition, but it still carries a lot of stigma. Why do you think that is?

Joseph R. Volpicelli M.D., Ph.D.: Despite scientific advances in our understanding of addiction, AUD continues to be burdened by social stigma.

There are several reasons for this stigma. One significant factor is the common misconception that AUD is a moral failing or a lack of willpower rather than a medical condition. This belief is deeply ingrained in many cultures, leading people to view those with AUD as weak or irresponsible. Additionally, the way alcohol addiction is portrayed in the media often reinforces negative stereotypes. People with AUD are considered dangerous, selfish or hopeless. But nothing could be further from the truth, as people with AUD are your friends, neighbors and family members who have yet to find an effective treatment. And effective treatments exist.

Another contributor is that alcohol is a legal, widely used and socially accepted substance. That creates a confusing double standard: drinking is normalized and even celebrated, but when someone loses control over their drinking, they’re often blamed or shamed. The common misconception is that if I can control my drinking, then others should be able to control their drinking as well. This paradox creates a barrier to empathy and makes it harder for people to see AUD as a legitimate medical issue, much like diabetes or hypertension, that deserves treatment and compassion, not judgment.

How does stigma affect whether someone seeks help or sticks with treatment?

JV: Stigma doesn’t just live in society; it becomes internalized. Many people with AUD feel shame, fear or guilt about their drinking, and this can prevent them from even acknowledging that they need help. They may worry that talking to a doctor or therapist will result in being labeled, judged or discriminated against. This fear can delay treatment for years, sometimes until the consequences — physical, emotional, relational or legal — become severe.

This fear is not without merit. A diagnosis of AUD can affect professional licensing, disability insurance coverage and social discrimination. For example, a study from Johns Hopkins Bloomberg School of Public Health found that discrimination against those with a drug addiction was much higher than discrimination for people with mental disorders.

The study showed that:

• 90% of respondents didn’t want someone with an addiction to marry into their family
• 78% didn’t want them as coworkers
• 64% supported denying employment
• 54% supported denying housing

While these percentages are for drug addiction in general, they apply to people with AUD as well.

Even once someone enters treatment, stigma can still undermine progress. If they feel judged by a provider or misunderstood by their family or employer, they may disengage or drop out. That’s why it’s crucial to create treatment environments that are supportive and nonjudgmental. Programs are most effective when employing approaches that emphasize empathy, collaborative problem-solving and patient-driven goals, which help reduce shame and foster motivation, trust and treatment adherence.

What does treatment for alcohol use disorder look like today, and how do medications like naltrexone or Vivitrol help?

JV: Today, we know more than ever about how to treat AUD effectively. The gold standard is an integrated approach that combines medication, and psychosocial support. Psychosocial support can include individual counseling, group support, peer recovery services and tools such as motivational interviewing, mindfulness and cognitive behavioral therapy.

While psychosocial support is often helpful, the use of medications plays a crucial role. Oral naltrexone and extended-release naltrexone [Vivitrol] help by reducing alcohol cravings and blocking the pleasurable effects of alcohol in the brain. Essentially, they help "turn down the volume" on the urge to drink. Studies have shown that patients on naltrexone are significantly less likely to relapse and tend to drink less even if they do have a slip. A core feature of addiction is the impaired ability of someone to control their drinking once they start drinking. Medications such as naltrexone help people regain control and can limit drinking to moderate levels.

Importantly, recent research has confirmed that naltrexone is safe for people with liver disease, which is a population often excluded from treatment due to outdated fears about liver toxicity. This is a game changer in reaching more people who have advanced AUD.

We’re hearing more about GLP-1 medications like Ozempic being explored for AUD. What’s the science behind that idea, and how close are we to real treatments in that area?

JV: GLP-1 receptor agonists like Ozempic and Wegovy are medications originally developed for diabetes and obesity. Interestingly, they also affect the brain’s reward and impulse control systems — areas closely linked to addiction. The mechanisms aren’t fully understood yet, but it seems GLP-1 medications may reduce the dopamine-driven “reward” that alcohol provides.

Early research, mostly in animal studies and small human trials, has shown that these medications may reduce alcohol cravings and consumption.

We are still in the early days. These medications are not FDA-approved for AUD, and larger, well-controlled clinical trials are needed to confirm their safety and effectiveness in this context. But the potential is exciting. If proven effective, GLP-1 medications could become a new class of treatment, especially for people who may not respond to traditional options like naltrexone.

What advice do you have for someone who’s struggling with alcohol but is scared to talk to a doctor about it?

JV: First and foremost, you are not alone. Millions of people struggle with alcohol, and reaching out for help is a sign of strength, not weakness. It’s completely normal to feel scared or uncertain. It takes courage to confront something that may have been a private struggle for a long time.

You don’t have to have it all figured out to start the conversation. You could simply say, “I’ve been drinking more than I’d like, and I’m worried about it,” or “I think alcohol might be affecting my health, and I want to talk about some options.” A good doctor will meet you with empathy and respect, not judgment. If that’s not your experience, keep going — some providers specialize in addiction medicine and will support you with compassion and evidence-based care.

You deserve to feel better, to be healthier and to live a life that feels more in control. And treatment can help you get there. Know there is hope and treatment works.

If someone is ready to seek help, what should their first step be, especially if they’re not sure where to turn?

JV: The first step is simply reaching out — whether that’s to a primary care provider, a mental health professional, or even a confidential helpline, such as the Substance Abuse and Mental Health Services Administration's National Helpline (1-800-662-HELP). There are virtual and in-person communities that can offer support and guidance.

From there, you can explore various treatment options, including medications, outpatient or residential programs, individual therapy and support groups, both virtual and in-person. Many people benefit from a flexible approach that combines medical and psychosocial treatment.

If you’re not sure what’s right for you, that’s OK — your provider can help guide you based on your goals, preferences and medical history. You don’t need to be ready to quit completely; you need to be ready to start the conversation. That’s the beginning of real change.