Benjamin Kissin - Böcker

The Genetics of Alcoholism is the first book to provide comprehensive coverage of this controversial subject.The book is divided into three main sections. Part I on Genetic Epidemiology contains five chapters on different types of studies which when considered together define many of the issues to be addressed in Part II: Laboratory Studies in Animals and Humans of Genetic Influences in Alcoholism. The chapters in this section in turn provide the main themes for Part III - Strategies for Genetic Research in Alcoholism. The book also details those genetic factors that reduce the risk of alcoholism as well as those that increase vulnerability. This integrated approach provides the reader with a thorough and critical overview of the subject and as such is a challenging reference resource for every physician interested in alcohol abuse.

This is a comprehensive review of the pharmacological effects of alcohol and the mechanisms underlying the pathogenesis of alcoholism. The book draws on general pharmacology, neuropharmacology, and alcohol studies to explore its theme. The second volume in the ALCOHOL AND ALCOHOLISM series, it focuses on the pharmacologic mechanisms underlying the development of alcoholism. The first section on basic pharmacology is concerned with those aspects that are common to all of alcohol's effects. These include pharmacokinetics, general metabolism, and cross-tolerance. The second section on neuropharmacology describes the effects of alcohol on various brain functions, including circulation and metabolism. The third section provides an in-depth review of the neurobiology of physical dependence, withdrawal, and physiological tolerance. The book as a whole gives a comprehensive and authoritative picture of the complex pharmacologic actions of alcohol, particularly on the nervous system. For clinicians and researchers in the field of alcohol and alcoholism, it will serve as a fundamental reference.

The first three volumes of this series have dealt with materials which generally justify the title, The Biology of Alcoholism. This is only remotely true of the present volume, Social Aspects of Alcoholism, or of the final volume to come, Treatment and Rehabilitation. Except for small portions of the treatment section which involve pharmacotherapy, much of these last two volumes deals with the psychological aspects of alcoholism and still more with the social. It is interesting to review the evolution of this new pattern over the past seven years, a pattern which, had it existed initially, would have resulted, if not in a dif­ ferent format, at least in a different title. Our initial selection of areas to be covered was influenced by our desire to present as "hard" data as possible, in an attempt to lend a greater aura of scientific rigor to a field which was generally considered as "soft. " When we completed our review of this material in volumes 1-3, we recognized that what we might have gained in rigor, we had more than lost in completeness. These volumes presented a picture of a biological disease syndrome for which the remedies and preventive measures were presumably also biological. And yet, most workers in the field readily accept the significant contributions of psychological and social factors to the pathogenesis and treatment of alcoholism.

For almost a century now, since Freud described the basic motivations and Pavlov the basic mechanisms of human behavior, we have had a reasonable concept of the forces that drive us. Only recently have we gained any real insight into how the brain really works to produce such behavior. The new developments in cognitive psychology and neuroscience have taught us things about the function of the brain that would have been inconceivable even ten years ago. Yet, there still remains a tremendous gap between the two studies-human behavior and brain function-a gap which often seems irrec­ oncilable in view of the basic differences in the methodologies and approaches of the two fields. Students of behavior are frequently disinterested in the underlying neu­ rophysiology while neurophysiologists tend to consider the concepts of psychiatrists and clinical psychologists too vague and theoretical to be applicable to their own more limited schemata. Several valiant attempts have been made by experimentalists to develop a theoretical context in which behavior is described, not separately from brain function but rather as its direct outgrowth. This present work is still another attempt to develop a theoretical system which, given the limitations of our present knowledge, as completely as possible, the underlying brain mechanisms that influ­ will describe ence and determine human behavior. The main emphasis of this work, however, will be not on normal behavior but rather on more neurotic manifestations.

The present volume contains a large variety of treatment approaches to the long-term rehabilitation of the alcoholic, ranging from the biological to the physiological to the psychological to the social. The multiplicity of proposed therapies, each of which has its strong proponents, suggests that alcoholism is either a complex medical-social disease syndrome requiring a multipronged treatment approach or a very simple illness for which we have not yet dis­ covered the remedy. The latter may, indeed, be true, but we cannot use what we do not know and must use what we do know. We do, however, have the obligation to be responsible in our treatment, to provide the best that is known at this time, and to be discriminating in our prescription of appropriate treat­ ment for individual patients. If there is one conclusion we would like to offer in our preface, it is that alcoholics constitute a markedly heterogeneous popula­ tion with widely disparate needs, for whom, at least at our present level of knowledge, a broad spectrum of treatment modalities is necessary. If this is true, then probably most of this book has validity. With this volume on the treatment and rehabilitation of the chronic alco­ holic, we bring to completion our five-volume series, The Biology of Alcoholism. As the title of the present volume indicates, we have departed from our original intention to deal solely with biological aspects of the syndrome and have attempted rather to produce a more comprehensive work.

Alcoholism is a uniquely human condition. Although some forms of alcohol dependence can be induced experimentally in a variety of laboratory animals, the complete spectrum of alcoholism with all of its physical, psychological, and social implications occurs only in man. The special quality of this relationship becomes more significant when one considers that the manifestations of most physical disease syndromes in animals and man are more similar than they are different. The uniqueness of alcoholism lies in the fact that it is one of the few physical diseases which reflects at all levels the problems of individuals coping with the complexities of human society. In order to present a more coherent picture of these complex relationships, we have attempted to impose a logical sequence upon the material. This sequence lies along a dual parameter-from the physical to the social and from the theor­ etical to the empirical. Consequently, it was natural for the first volume in this series to deal with biochemistry, the most basic and physical aspect of the inter­ action of alcohol and man. It is equally natural for this, the second volume, to deal with physiology and behavior, for these levels of phenomenology-partic­ ularly the latter-are already more empirical and psychological in their mani­ festations. Finally, the third volume, clinical pathology, describes the disease itself, with all of the medical and social implications carried in the word "alcoholism.

In this volume, the third of our series, the emphasis has shifted from the theoretical and experimental to the more clinical and practical aspects of alcoholism. Where, in the earlier volumes, more attention was directed to animal than human studies, in this volume, almost all material deals with the human condition. The clinical manifestations of alcoholism may be divided into two major aspects, that of the disease itself and that of its complications. This separation is to some extent artificial since, in a sense, the natural history of the disease is a function of the development of certain complicating mechanisms. These mechanisms in turn either become part and parcel of the underlying condition -alcoholism-or give rise to a new set of clinical variables characterized as "medical complications. " At this point, the dichotomy becomes real. The disease alcoholism tends to be seen as a distinct psychosocial entity and to be treated with psychosocial techniques. The "medical complications" are more clearly envisioned as being within the legitimate domain of medical practice and are treated by physicians who often tend to ignore the underlying alcoholism. The "patient" is sometimes lost in between. The major thrust of this volume is an attempt to describe the mechanisms of alcoholism as they are now known, in such a way as to establish a continuum between the disease alcoholism and its "medical complications.

Pathogenesis is defined in Blakiston's Medical Dictional), as "the course of development of disease, including the sequence of processes or events from inception to the characteristic lesion or disease. " The central position of the word "pathogenesis" in the titles of Volumes 6 and 7 in itself connotes a bias on the part of the editors in favor of the disease concept of alcoholism, inasmuch as the end product of the pathogenetic process is presumed to be a disease. But the disease model as here conceptualized is vastly different from that of Jellinek, or of Alcoholics Anonymous, or of psychoanalysis. In those theories, alcoholism is seen as the inevitable consequence of some specific flaw in the heredity or the experience of the afflicted individual that inexorably leads to alcoholism. In these present volumes, the alcoholic syndrome is viewed rather as the outgrowth of the interaction of a variety of biological, psychological, and social influences which, depending on the predom­ inance of one or another, may lead to different types of alcoholism. This view, which has been labeled the bio-psycho-social perspective, encompasses a larger view of the dynamics of the development of alcoholism, incorporating data from each of the phenomenologic levels involved. An additional complication arises from the fact that the physiolog­ ical and psychosocial stigmata of alcoholics, which are probably most often the result of prolonged drinking, frequently have come to be considered as causes of the disease.