Microbiota & Alcohol: toward a new treatment?

By Ana Espino | Published on January 13, 2026 | 3 min read


Alcohol dependence (or alcohol use disorder – AUD) is a major public health problem, responsible for millions of deaths each year. It is frequently comorbid with psychiatric disorders (anxiety, depression) and physical conditions (notably alcoholic liver disease). Despite the availability of medical treatments (disulfiram, naltrexone, acamprosate) and psychotherapeutic approaches, their effectiveness remains limited, particularly in terms of relapse prevention.  

A major unresolved issue concerns the interaction between alcoholism, the gut microbiota, and neurocognitive complications (such as Wernicke–Korsakoff syndrome). Several potential mechanisms have been proposed: impairment of the intestinal barrier, systemic inflammation, dysbiosis, thiamine deficiency, etc. In this context, this review was undertaken to explore the links between alcohol, the gut microbiota, the brain, and the liver, and to identify potential new therapeutic targets.  

What if everything started in the gut?  

This review examines:  

1. The impact of alcohol on the gut microbiota and intestinal barrier permeability;
2. The metabolic and neuroinflammatory consequences of dysbiosis, as well as emerging therapeutic approaches such as probiotics, thiamine supplementation, and gene therapy techniques like CRISPR.

 
The data show that chronic alcohol consumption disrupts the intestinal barrier, facilitating bacterial translocation and inducing systemic inflammation, which may worsen cognitive and psychiatric disorders. Gut dysbiosis, characterized by a reduction in bifidobacteria and an overgrowth of pathogenic species, is associated with worsening liver disease and deterioration of mental health. Certain microbiota-modulating interventions, such as probiotic administration or fecal microbiota transplantation, have shown positive effects on liver markers and depressive symptoms.

Thiamine deficiency, common in alcoholism, contributes to neurological damage, particularly Wernicke–Korsakoff syndrome. Finally, innovative tools such as CRISPR could eventually target key enzymes involved in alcohol metabolism (ADH, ALDH), opening new therapeutic perspectives.    

Toward a new therapeutic era?  

Alcohol dependence is a complex disorder, often exacerbated by hepatic, cognitive, and inflammatory damage. The main therapeutic challenge is preventing relapse while accounting for the systemic and neuro-immune dimensions of the disorder.  

This review aimed to improve understanding of the role of the gut microbiota in alcoholism and its complications. It suggests that combined strategies (microbiota modulation, correction of thiamine deficiency, conventional treatments, and potentially gene therapy) could offer new therapeutic avenues.  

However, limitations remain and justify further research. Future work should include well-controlled clinical trials, standardization of interventions (probiotics, CRISPR, etc.), and better characterization of patient subgroups that respond to treatment. Integrating the gut microbiota into the management of alcoholism still requires robust evidence, particularly at the clinical and functional levels.

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