Introduction to the special section: research on the nature and treatment of alcoholism--does one inform the other?

Although the 2 topics of the nature and treatment of alcoholism have both been investigated for years, they are just recently beginning to interface with and complement one another. This special section addresses the interface from both perspectives and covers content areas that touch on current issues, research and treatment trends, and controversies in the alcohol field. The first 2 articles focus on the nature of alcoholism with commentary on implications for treatment, and the second 4 articles shift to examine research on treatment of alcohol problems, with implications for understanding the nature of alcoholism. This introductory article describes the special section, summarizes the articles in the section and integrates the information to discuss areas of increasing interface between research on the nature and treatment of heterogeneous substance abuse problems.     

Bridging the gap between alcoholism treatment research and practice: Identifying what works and why.

Despite the proliferation of alcoholism treatment research over the past 2 decades, there is a continued gap between what has been shown to be promising in the extant literature and what is commonly practiced by clinicians in the alcohol treatment field. The present article is an effort to bridge this gap by examining findings from the broad body of alcoholism treatment outcome research to determine how these findings may optimally be used by treatment providers. To this end, the authors provide clinicians with a succinct review of the current alcoholism treatment outcome literature and identify hallmarks of the most empirically supported treatments. Clinical implications of this literature for practitioners working with client with alcohol use disorders are discussed, with a focus on factors underlying effective treatments and on how these factors can be transferred from research to practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Length of stay and program component effects in the treatment of alcoholism: A comparison of two techniques for process analyses.

Evaluated the effects of length of treatment and specific treatment components (therapy sessions, Alcoholics Anonymous meetings, and films and lectures on alcoholism) of 3 residential alcoholism programs. Two statistical techniques—partial correlation and treatment-effect correlation—were compared for their estimates of treatment effects after controlling for patient background characteristics and functioning at intake. Longer periods of treatment were associated with better outcome for the 59 residents of a halfway house but not for the 92 patients at a milieu-oriented program or the 97 males at a Salvation Army center. Evidence suggest that the 3 program components tended to have moderately beneficial effects on outcome, although the results varied in some cases, depending on whether partial or treatment-effect correlation was used in the analysis. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cultural context of psychological approaches to alcoholism: Can we control the effects of alcohol?

Argues that the unique history of alcohol use in the US has led to the ascendance of disease theory as the dominant conception of alcoholism. Social-scientific research has consistently conflicted with disease theory, but psychological and other nondisease conceptions of alcoholism are not well-represented in the public consciousness, in treatment programs, or in policies for affecting nationwide drinking practices. Conflict in the field has intensified in the last decade, most notably surrounding the issue of controlled drinking in alcoholism treatment. It is suggested that the current cultural attitude toward alcoholism in the US, one strongly influenced by disease notions, has not led to an improvement in society's drinking problems and that there continues to be a need for psychologists to present alternative views of alcoholism. The concepts of dependence and addiction as related to alcohol and to drugs are discussed. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family systems and alcohol misuse: Research on the effects of alcoholism on family functioning and effective family interventions.

This article reviews the most prominent research at the interface between studies of alcohol addiction and family systems psychology. The review addresses the general effects of alcohol misuse on family functioning as determined in empirical studies comparing healthy families, alcohol afflicted families, and otherwise troubled families. Three factors ("dry" vs "wet" families, family development and the progression of alcoholism, and family structure) are identified as particularly relevant to understanding the treatment needs of families affected by alcohol misuse. Research examining the general efficacy of family interventions in the treatment of alcoholism and specific treatment considerations unique to treating families coping with alcohol misuse are reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholism and alcohol abuse among women: report of the Council on Scientific Affairs. American Medical Association

We describe characteristics of women alcohol abusers, risk factors for alcoholism in women, barriers to treatment, and implications and strategies for physicians dealing with alcohol abuse in women patients, including risk assessments and intervention strategies. Alcohol abuse and alcoholism have a different physiologic effect on women than on men. Societal attitudes about women and alcohol and internal (self-perception) and external (environmental) factors can create barriers to the detection and treatment of female alcohol abusers. Physicians are in an excellent position to address the medical, psychologic, and social concomitants of alcoholism and alcohol abuse. The Council on Scientific Affairs recommends that physicians become more active in the prevention, diagnosis, and treatment of alcohol-related problems in women, including the diseases that may be associated with chronic alcohol abuse and the effect of alcohol on the developing fetus. Specific American Medical Association policy and recommendations for physician practice are included.     

Outcomes of treatment for alcohol problems: Current methods, problems, and results.

This overview of current methods, problems, and results of psychological treatment for alcohol abuse, including alcoholism, begins by considering three common and troublesome assumptions about such treatment. A discussion of external and internal validity problems that are specific to alcoholism treatment research follows, and promising solutions are reviewed. Current data are discussed on who is treated for alcohol problems in this country. Next, detailed consideration is given to factors that predict response to alcoholism treatment, including variables associated with treatment type, setting, and intensity; such factors specific to patients as age, gender, ethnicity, socioeconomic status and education, psychopathology, marital and occupational status, and motivation for change; and environmental and other extratreatment factors. The article concludes with a review of current data on nonproblem-drinking treatment goals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of From denial to recovery: Counseling problem drinkers, alcoholics, and their families.

Reviews the book, From denial to recovery: Counseling problem drinkers, alcoholics, and their families by Lawrence Metzger (see record 1987-98723-000). This book admirably complies with the author's stated reason for writing it: "A compelling reason for writing this book is to aid care givers who may have avoided or been baffled by alcoholic clients in the past. Their lack of training and expertise in dealing with this problem has meant that alcoholics and their family members...have been neglected to the point where the problem simply becomes self-perpetuating and expands generationally." To this end, this book can serve as an excellent introduction to the field of alcoholism treatment for practitioners trained in the behavioral sciences. Unlike many works in the alcoholism literature, this book is properly annotated and, to a large degree, research based. As such, it will appeal to practitioners with a scientific background. The author proceeds to give an excellent overview of the current state of the art in alcoholism treatment. None of the particular criticisms noted should detract from these general observations. Overall, the major strength of this work is its explication of the details of alcoholism treatment in a format which will be palatable to students of the behavioral sciences. It would be an excellent addition to courses on addictions treatment. The most specific strengths of this work are in the diagnostic formulation for differentiating levels of alcohol abuse and the explication of a very thorough alcoholism diagnostic interview. In my view, if the reader can remember that (a) alcoholism is not caused by bad genes, (b) patients who have blackouts must abstain from alcohol, and (c) the self-help movements are the primary treatment modalities for addictions, then this work will be an excellent addition to any library on alcoholism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contributions of behavioral science to alcohol research: Understanding who is at risk and why.

Behavioral science has been an active participant in alcohol research progress over the past 30 years, particularly in the areas of prevention and treatment methodology. However, alcoholism results from the interaction between complex biological and behavioral systems, and in recent years, combined behavioral and biological studies, primarily of alcohol effects on the brain and of the genetics of alcoholism, have begun the much more complex process of elucidating the links between biology and specific alcohol use behaviors. It is this combined research that ultimately will produce the pharmacological and behavioral interventions that will improve the efficiency and effectiveness of alcohol prevention and treatment methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New drugs in the treatment of alcoholism

Pharmacotherapy of alcoholism is improving rapidly with the introduction of new agents. New knowledge about the neurobiology of alcoholism is necessary for the clinician, who has to establish the diagnosis. Useful pharmacological agents for the treatment of alcohol dependence can be classified into four groups: (1) agents for the treatment of the withdrawal syndrome, (2) aversive agents, (3) therapeutic agents for comorbidity, (4) new agents to reduce craving for alcohol or prevent relapse. These new agents derive from research in four directions, based on neurobiological hypotheses: (a) the glutamatergic hypothesis with acamprosate, (b) the opioid hypothesis with naltrexone, (c) the serotonergic hypothesis with the new antidepressants, and (d) other hypotheses, including dopaminergic, peptidic etc. Of these new agents, acamprosate has undergone most study in controlled clinical trials around Europe. Its efficacy has been demonstrated statistically, it is well tolerated and does not interact with alcohol. Acamprosate can be associated with disulfiram therapy. Future perspectives for treatment and research are discussed, in particular with regard to therapeutic associations.     

Review of The diagnosis and treatment of alcoholism (second edition).

Reviews the book, The diagnosis and treatment of alcoholism (second edition) edited by Jack H. Mendelson and Nancy K. Mello (1985). This text is designed to be an authoritative handbook for practitioners in the field of alcohol abuse or a comprehensive textbook for graduate students. The target audience is physicians, nurses, psychologists, alcoholism counselors, social workers, and others involved in assessing and treating alcohol abuse. One way in which this text differs from many on the market is in its reliance on methodologically sound research as the basis for the recommendations and conclusions in most of the chapters, including objective discussions of controversial issues where the research data challenge commonly accepted assumptions in the alcohol field. The second edition of this volume provides valuable updating and expansion of the information presented in the widely used first edition. Overall, the second edition of this volume remains a leader in the field and will be valuable as a handbook for the clinician or textbook for the graduate seminar. The strengths of this volume are in the chapters that rely on a thorough knowledge of methodologically sound research, presented in a way that will be acceptable to clinical practitioners. Paraprofessionals may find this hard to read but advanced professionals will find the text useful. This edition remains superior to any other single resource which I can think of in the field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Co-morbidity and familial aggregation of alcoholism and anxiety disorders

BACKGROUND: This study examined the patterns of familial aggregation and co-morbidity of alcoholism and anxiety disorders in the relatives of 165 probands selected for alcoholism and/or anxiety disorders compared to those of 61 unaffected controls. METHODS: Probands were either selected from treatment settings or at random from the community. DSM-III-R diagnoses were obtained for all probands and their 1053 first-degree relatives, based on direct interview or family history information. RESULTS: The findings indicate that: (1) alcoholism was associated with anxiety disorders in the relatives, particularly among females; (2) both alcoholism and anxiety disorders were highly familial; (3) the familial aggregation of alcoholism was attributable to alcohol dependence rather than to alcohol abuse, particularly among male relatives; and (4) the the pattern of co-aggregation of alcohol dependence and anxiety disorders in families differed according to the subtype of anxiety disorder; there was evidence of a partly shared diathesis underlying panic and alcoholism, whereas social phobia and alcoholism tended to aggregate independently. CONCLUSIONS: The finding that the onset of social phobia tended to precede that of alcoholism, when taken together with the independence of familial aggregation of social phobia and alcoholism support a self-medication hypothesis as the explanation for the co-occurrence of social phobia and alcoholism. In contrast, the lack of a systematic pattern in the order of onset of panic and alcoholism among subjects with both disorders as well as evidence for shared underlying familial risk factors suggests that co-morbidity between panic disorder and alcoholism is not a consequence of self-medication of panic symptoms. The results of this study emphasize the importance of examining co-morbid disorders and subtypes thereof in identifying sources of heterogeneity in the pathogenesis of alcoholism.     

The federal role in research, treatment, and prevention of alcoholism.

Outlines the dimensions of the alcohol abuse problem in the US, federal legislation related to the treatment and prevention of alcohol and drug abuse, and priorities for future government involvement in research and treatment. It is argued that the government should play a greater role in the dissemination of research results; fund demonstration projects targeted at improving the effectiveness of alcoholism treatment; coordinate employee assistance programs in the workplace; and ensure that services are extended to currently underserved populations such as the elderly, minorities, and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholic patients' experience and attitudes on pharmacotherapy for alcoholism

Clinical studies have demonstrated that pharmacotherapies may improve alcoholism treatment, when combined with traditional psychosocial therapies. Recently, the opioid antagonist, naltrexone, has been approved as an adjunct in alcoholism treatment, and several other pharmacotherapies for alcoholism are under development. Because of the abstinence orientation of many patients, we assessed attitudes regarding medications, and explored whether alcoholic patients would consider taking medication as part of their alcoholism treatment. Active patients (n = 127) in three alcohol treatment settings were surveyed with an anonymous questionnaire which asked demographics, personal alcoholism history and questions about medication use. They were asked whether they felt disulfiram and naltrexone were helpful for alcoholics and whether they would take the medications. The findings indicate that the patients were divided about the use of pharmacotherapy for the treatment of alcoholism. The strongest predictor of willingness to take medication was a belief that the medication would be helpful.     

Review of A history of alcoholism.

Reviews the book, A history of alcoholism by Jean-Charles Sournia (1990). This book was first published in French in 1986, and this English translation was published in 1990. The book consists of 12 chapters divided into 3 parts. The first 3 chapters cover a period of 19 centuries, ending at approximately 1850. Included in these 3 chapters are materials pertaining to alcohol use and drunkenness in antiquity and drinking throughout Europe and in the United States during the 1700s and into the mid-1800s. The second part of the book, composed of 5 chapters, covers the following 100 years. It includes chapters on the Swedish physician Magnus Huss, the evolution of drinking patterns in several European countries (with a particular focus on France), alcohol and medicine, and the development and activities of temperance societies. The third and final part includes 4 chapters and covers the years since 1950, a period that has witnessed many advances in research on alcohol effects, risk markers, treatment, and prevention. The strongest section of the book is the first part, which provides an overview on the history of alcoholism. This section also provides a variety of interesting notions about alcohol use from the Ancient Greek world, in which wine played an important role. The book starts out strong and provides an interesting and readable perspective on the history of drunkenness and alcoholism. The last third of the book loses steam, direction, and focus, though. However, for the reader interested in a historical overview, the first two thirds of this volume are enjoyable and recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Etiology, personality and alcoholism.

Personality is a necessary component of an adequate theory of problem drinking/alcoholism. The role of personality in the etiology of alcoholism is examined in terms of prediction, explanation, and causal inference. Issues are reviewed that support multivariate conceptions of alcohol abuse, and the necessity of a multivariate theoretical framework for personality research is emphasized. In the development of theory, it is important to recognize that alcohol abuse is both unique and consistent with other phenomena. Despite conceptual and methodological inadequacies, the literature supports the relevance, in alcohol problems, of dependency, defensive denial, depression, sex-role identity confusion, inadequate impulse control, and subjective dissatisfaction. Reciprocal interaction systems of personality, environment, and behavior are needed for an understanding of the temporally dynamic process of alcohol abuse. (French abstract) (5 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older adult controlled drinkers and abstainers

Little is known about the lifetime course of alcohol problems, especially during late adulthood. Many individuals with a history of alcohol problems achieve remission of their symptoms through abstinence or controlled drinking. This study examined 135 older adults with a prior history of alcohol diagnoses who were symptom free for at least the past year. Two groups were identified based on their alcohol consumption within the past year: abstinent individuals (n = 92) and controlled drinkers (n = 43). The groups did not differ in age, racial composition, education, income, or years since their last alcohol-related symptom, but they did differ in gender composition, indices of alcoholism severity, history of formal and informal treatment, as well as lifetime alcohol consumption patterns. Abstinent individuals had more severe alcohol problems, consumed higher amounts of alcohol on drinking days, had more years of heavy alcohol consumption, and were more likely to have attended alcohol treatment and Alcoholics Anonymous (AA). The controlled drinkers had a longer history of moderate social drinking, and their current consumption habits appeared to be similar to symptom-free older adult drinkers. The results suggest that gender, alcoholism severity, history of formal and informal treatment, and past consumption patterns are associated with whether older adults with histories of alcoholism attain successful outcomes through abstinence or controlled drinking.     

Body mass index and alcohol consumption: Family history of alcoholism as a moderator.

Recent research suggests that excess food consumption may be conceptualized as an addictive behavior. Much of the evidence comes from neurobiological similarities between drug and food consumption. In addition, an inverse relation between alcohol consumption and body mass index (BMI) has been observed. Previous research has hypothesized that this inverse relation is attributable to competition between food and alcohol for similar neurotransmitter receptors. The current study explored this neurobiological hypothesis further by examining the influence of an indicator of biological risk associated with alcohol problems (family history of alcoholism) on the relationship between alcohol and food intake. Data from 37,259 participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were included in the study. BMI, family history of alcoholism, gender, and race/ethnicity were assessed as predictors of typical drinking frequency and estimated blood alcohol concentration (BAC). An inverse relationship between alcohol consumption and BMI was demonstrated. An attenuation of family history effects on drinking behavior was evident for obese compared to nonobese participants. The results suggest a neurobiological link between alcohol use and food consumption, consistent with theories characterizing excess food consumption as an addictive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing comorbid depressive symptomatology in alcohol treatment.

Clinicians often encounter patients who have comorbid alcoholism and depression. The presence of both disorders makes treatment especially challenging. Among individuals seeking treatment for alcohol dependence, depression and depressive symptoms are associated with poorer treatment outcomes, and depressed mood may play an important role in relapse to drinking. Results of a recent study suggest that adding cognitive-behavioral treatment of depression to alcohol treatment can be an effective means of reducing depressive symptoms and improving drinking outcomes in alcoholics with elevated levels of depressive symptoms. This approach may be particularly useful for clinicians seeking a nonmedical intervention to reduce depression during alcohol treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fluoxetine in depressed alcoholics. A double-blind, placebo-controlled trial

BACKGROUND: The selective serotonergic medication fluoxetine has demonstrated efficacy in the treatment of major depression and has suggested efficacy in the treatment of alcoholism. However, no completed trials with any selective serotonergic medication have been reported in patients who display both major depression and alcoholism, despite previous observations that both depression and alcoholism are associated with low serotonergic functioning. METHODS: Fifty-one patients diagnosed as having comorbid major depressive disorder and alcohol dependence were randomized to receive fluoxetine (n = 25) or placebo (n = 26) in a 12-week, double-blind, parallel-group trial. Weekly ratings of depression and alcohol consumption were obtained throughout the 12-week course of the study. RESULTS: The improvement in depressive symptoms during the medication trial was significantly greater in the fluoxetine group than in the placebo group. Total alcohol consumption during the trial was significantly lower in the fluoxetine group than in the placebo group. CONCLUSIONS: Fluoxetine is effective in reducing the depressive symptoms and the alcohol consumption of patients with comorbid major depressive disorder and alcohol dependence. It is unknown whether these results generalize to the treatment of less depressed and less suicidal alcoholics.