Dear Dr. Roach: Are there any supplements that can help reduce alcohol use disorder?
B.S.
Alcohol use disorder is an enormous problem, affecting over 100 million people worldwide in any given year, with three million deaths a year — for which there is no single solution. Recognizing that one has a problem is a critical, necessary first step, and one that is often never taken.
Once a person recognizes they have a problem, whether they realize it themselves, a friend or family member helps them to, or a clinician recognizes it for them, then there are many options for treatment. These can involve psychosocial treatments (including brief physician intervention, help from a mental health professional, and mutual-help groups like AA), medication treatment, or both.
Many people benefit most from combined behavioural interventions, and some people benefit from medication treatment on top of combined psychosocial treatments.
There are many medications that have been used for that group of people with problem-drinking who have not had a good response to psychosocial interventions alone. The best evidence is with naltrexone or acamprosate, both of which seem to target the underlying mechanisms of addiction. Certain anti-seizure and antidepression medicines have shown effectiveness, probably outside of their primary mechanism of treating seizures or depression.
I’m not aware of any over-the-counter supplements that have good evidence to support their use in helping people reduce problem-drinking. Recent evidence showing that psilocybin (a hallucinogen found in certain mushrooms) may help with problem-drinking deserves further study before it could possibly be used clinically.
Your regular doctor is a good place to start with getting help in reducing problem-drinking, but an addiction specialist is likely to have more expertise in this area.
Dear Dr. Roach: I take blood pressure medications in the morning and monitor my blood pressure at home once a week. Should I take the readings first thing in the morning before my meds or later in the morning after the meds have started working?
H.C.
Blood pressure readings from home are very valuable in determining the right regimen and dose of medication. The more readings, the better, so I recommend getting them at different times of the day. When my patients come in, I look at the average readings and look for any patterns of when the readings are the highest. While readings don’t have to be taken every day, multiple readings per week provide better information.
Most modern blood pressure medicines work pretty much all day. Shorter-acting medicines did not reduce heart disease and stroke risk as well as long-acting ones. So, they have been largely replaced by those that are inherently longer-acting (like amlodipine) or put into formulations that allow them to last for a longer time (any medicine ending in -sr or -er is a long-acting formulation).
Most people have a “dip” in their blood pressure at night, which is why we have traditionally recommended taking medicines in the morning. A 2020 study suggesting much better results by taking medicine in the evening has not been confirmed by further trials. Most of the studies on blood pressure control have used morning-dosed medication, and diuretics in particular can be inconvenient when taken in the evening.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu
