Henri Begleiter - 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.

The previous volume, The Pathogenesis of Alcoholism: Psychosocial Factors, attempted to describe the interaction of biological, psychological, and social factors that lead to the initiation and perpetuation of alcoholism. The preface to that volume presented our particular view of the bio-. psycho-social interaction as a progressive process in which earlier developments produce new pathogenetic mechanisms, which in turn lead to still other cyclical feedback activities. Although influences from each of the three phenomenologic levels are at work during each stage of the clinical course, it would appear that social factors are most significant in the early phase, psychological factors at the intermediate level, and biological ones toward the end. These differences are only relative, however, for influences of all three types surely are operative during all stages of the syndrome. This appears to be particularly true for the biological parameters of activity. Don Goodwin (1976), who has supplied much of the data that support the role of hereditary factors in alcoholism, is wont to say that all living behavior is biological-by definition. The operational evidence for this is perhaps more evident in alcoholism than in other syndromes. For example, the general social indifference of many Asians to alcohol may reflect the presence of an atypical isoenzyme of alcohol dehydrogenase rather than some independently derived cultural norm.

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.

This volume is the second in "The Downstate Series of Research in Psychiatry." It is aseries devoted to the presentation of sig­ nificant research with relevance for both clinicians and researchers in the multiple subfields of psychiatry. This book focuses on the interactions between psychic phenomena and physical processes as studied by evoked brain potentials. It presents material concerned with physiological and psychological unifying processes, as weIl as research concerning technology and methods of obtaining meaningful measurements. As such it is representative of biological psychiatry at its best. Thus, it represents another step in new directions in psychiatric research but not an unanticipated direction. Scientific investigation into the human psyche took an unex­ pected turn when Sigmund Freud in the last part of the 19th Century turned his attention from neurological concerns to those of psychol­ ogy. His first attempts at explanations as noted in the "project," included a heavy emphasis on the biological substrate of behavior.