Gut Microbiomics and Alcohol Use Disorder: Mechanisms and Therapeutic Interventions

Alcohol use disorder (AUD) is a chronic, relapsing condition that imposes a substantial health and socioeconomic burden worldwide. Despite the availability of behavioral and pharmacological treatments, relapse rates remain high, underscoring the need for innovative therapeutic strategies. Recent evidence highlights the gut microbiome as a critical player in AUD pathophysiology. Alcohol consumption disrupts microbial diversity, promotes pathogenic species, and compromises gut barrier integrity, leading to systemic inflammation and impaired gut–brain axis signaling. These changes contribute to neurotransmitter imbalances, neuroinflammation, and reinforcement of addictive behaviors. This review synthesizes current preclinical and clinical findings on alcohol-induced gut dysbiosis and its impact on neural, immune, and endocrine pathways. It also evaluates microbiome-targeted interventions—including dietary modification, probiotics, prebiotics, synbiotics, and fecal microbiota transplantation—while discussing their mechanisms, efficacy, and limitations. Targeting the gut microbiome represents a promising adjunct to conventional AUD therapies. Future research should focus on standardized methodologies, multi-omic integration, and personalized approaches to enhance clinical translation.