Loosening the Grip: a handbook of Alcohol Information 9th

Chapter 4 Alcohol Dependence

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Chapter 4 Alcohol Dependence

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised. Washington, DC: American Psychiatric Association, 1987.

American Psychiatric Association. Diagnostic and Statistical Manual, 4th ed., TR (text revision). Washington, DC: American Psychiatric Association, 2000.

Basu D, Ball SA, Feinn R, Gelernter J, Kranzler HR. Typologies of drug dependence: Comparative validity of a multivariate and four univariate models. Drug and Alcohol Dependence 73(3): 289–300, 2004. (57 refs.)

Data from a longitudinal cohort study were used to directly compare the concurrent and predictive validity of four univariate typologic approaches with a multivariate approach in subtyping drug dependence. The four univariate typologies were based upon: (a) age-of-onset of drug abuse/dependence, (b) presence of drug abuse in first-degree relatives, (c) presence of antisocial personality disorder, and (d) sex. The multivariate typologic approach was based on indices of vulnerability, chronicity, consequences, and psychopathology, yielding the Type A/B dichotomy first demonstrated in alcohol dependence. Subtypes generated from the univariate typologies were then each compared with the multivariate typology on measures of concurrent and predictive validity, and the strength of association was compared statistically. There was evidence of significantly greater concurrent validity of the Type A/B typology compared with the univariate typologies across all the domains of validation (risk, substance use, psychopathology, personality, and overall functioning). The multivariate typology also fared better than the univariate ones in all three domains on which predictive validity was evaluated: substance use, psychopathology, and overall functioning, as well as the degree of change in several composite scores (drug, medical, legal, and psychiatric) and the global psychiatric symptom index. This direct method of comparison seemed to demonstrate the superior validity of the multivariate cluster-analytic approach over the univariate approaches to classifying subjects with drug dependence. (Copyright 2003, Elsevier Science)

Criteria Committee, National Council on Alcoholism. Criteria for the diagnosis of alcoholism, American Journal of Psychiatry 129(2): 41–49, 1972.

Dundon W, Lynch KG, Pettinati HM, Lipkin C. Treatment outcomes in type A and B alcohol dependence 6 months after serotonergic pharmacotherapy. Alcoholism: Clinical and Experimental Research 28(7): 1065–1073, 2004. (33 refs.)
Background: Evidence supporting the use of serotonergic medications for the treatment of alcohol dependence is available from studies where pharmacotherapy targeted specific alcoholic subtypes. We previously established with Babor's alcohol typology that type A "lower risk/severity" alcoholics (n = 55) had better treatment response to 14 weeks of sertraline (200 mg/day) than placebo, and this was not found for type B "higher risk/severity" alcoholics (n = 45). The purpose of this study was to assess in this original study group whether treatment gains in the type A alcoholics were maintained or whether treatment outcomes changed for the type B alcoholics after discontinuing pharmacotherapy. Methods: After the end of a 3-month course of 200 mg/day sertraline, the, subjects were interviewed at several time points about their alcohol drinking, if any, using the timeline follow-back method. For 90% of the original study group, mixed effects and generalized estimating equation models were used to compare monthly drinking amounts over a 6-month posttreatment period with drinking amounts in the last month of treatment. Results: We found that type A alcoholics who had been treated with sertraline, in contrast to placebo, maintained the good outcomes they had achieved during treatment for at least 6 months after pharmacotherapy. We found that type B alcoholics who had been treated with sertraline, in contrast to placebo, continued to show no advantage for pharmacotherapy in the 6 months after completing treatment. In addition, heavy drinking in type B alcoholics increased over the 6 months postpharmacotherapy in those initially treated with sertraline compared with placebo. Conclusions: These data support the importance of considering alcohol subtype when pharmacologically treating alcohol dependence. (copyright 2004, Research Society on Alcoholism)

Finch E, Welch S. Classification of alcohol and drug problems. Psychiatry 5(12): 423–426, 2006. (16 refs.)

Systems of classifying alcohol and drug problems have developed through the disease model of the 19th century, which allows categorical diagnosis and facilitated the 12-step approach to behavioural models and to socioeconomic models where substance use is seen as part of the environment in which an individual functions. DSM and ICD classified drug and alcohol use separately in their early versions, although they are now subject to the same criteria and both systems make a distinction between dependant and non-dependant use. DSM-IV and ICD-10 classify dependence as a cluster of cognitive, behavioural and physiological systems applicable across all substances. The criteria are broadly tolerance and withdrawal, impaired control and compulsion and salience and continued use despite harm. Dependence symptoms, substance-related problems and consumption form separate but related axes. Both DSM-IV and ICD-10 contain categories of abuse and harmful use respectively for substance users who do not meet the criteria for dependence. ICD-10 has a greater emphasis on the physical and psychological consequences of substance abuse. A substantial body of work on the validity of the dependence syndrome has generally found the dependence abuse model to be useful across the range of substances, although for cannabis the there are problems defining the withdrawal syndrome. Recent work to define DSM-V may change classification systems. Other forms of typology which are clinically useful also exist; for instance, the distinction between injecting and non-injecting drug users, and systems that detect substance-related problems rather than diagnostic criteria. (Copyright 2006, Elsevier Science)

Hasin DS, Grant B, Endicott J. The natural history of alcohol abuse: Implications for definitions of alcohol use disorders. American Journal of Psychiatry 147(11): 1537–1541, 1990. (15 refs)

Is the DSM-III-R category of alcohol abuse validly differentiated from the DSM-III-R category of alcohol dependence, or is abuse primarily a mild, prodromal condition that typically deteriorates into dependence? A 4-year longitudinal epidemiologic study of male drinkers provided data to answer this question. The study used identical questions at baseline and follow-up. At follow-up, 70% of the subjects who were initially classified as alcohol abusers were still abusers or were classified as remitted. This contrasted significantly with outcome in the subjects who initially reported alcohol dependence. Although additional research is needed, these results indicate that alcohol abuse often has a course distinct from that of alcohol dependence. Copyright 1990, American Psychiatric Association..

Hasin DS, Liu XH, Alderson D, Grant BF. DSM-IV alcohol dependence: A categorical or dimensional phenotype. Psychological Medicine 36(12): 1695–1705, 2006. (37 refs.)

Background. Etiologic research on complex disorders including alcohol dependence requires informative phenotypes. Information is lost when categorical variables represent inherently dimensional conditions. We investigated the validity of DSM-IV alcohol dependence vs a dimensional phenotype by examining evidence for linearity and thresholds in associations with validating variables. Method. Current drinkers in the National Longitudinal Alcohol Epidemiologic Survey (NLAES) (n = 18 352) and National Epidemiologic Survey of Alcohol and Related Conditions (NESA RC) (n=20836) were analyzed. Validating variables included family alcoholism, early-onset drinking, and alcohol treatment. Logistic or Poisson regression modeled the relationships between the validating variables and dependence in categorical, dimensional or hybrid forms, with severity defined as number of current DSM-IV alcohol-dependence criteria. Wald tests assessed differences between models. Results. No evidence was found for boundaries between categories. Instead, the association of alcohol dependence with the validating variables generally increased in linear fashion as the number of alcohol-dependence criteria increased. For NLAES models of family alcoholism, early-onset drinking and treatment, the lines had zero intercepts, with slopes of 0-18, 0-27, 0-70, respectively. For NESARC models of family history and early-onset drinking, the zero intercept lines had slopes of 0(.)20, 0(.)33, and 0(.)77, respectively. Wald tests indicated that models representing alcohol dependence as a dimensional linear predictor best described the association between dependence criteria and the validating variables. Conclusions. The sample sizes allowed strong tests. Diagnoses are necessary for clinical decision-making, but a dimensional alcohol-dependence indicator should provide more information for research purposes. (Copyright 2006, Cambridge University Press)

Jellinek EM. Phases of alcohol addiction. Quarterly Journal of Studies on Alcohol 13:673–684, 1952.

Jellinek EM. The Disease Concept of Alcoholism New Haven CT: Hill House Press, 1960.

Penick EC, Nickel EJ, Powell BJ, Liskow BI, Campbell J, Dale TM, Hassanein RE, et al. The comparative validity of eleven alcoholism typologies. Journal of Studies on Alcohol 60(2): 188-202, 1999. (75 refs.)

Objective: This study directly compared the clinical validity of 11 empirically defined alcoholism typologies to determine whether some typologies are clinically more valid than others. Method: A sample of 360 hospitalized alcoholic men were extensively evaluated at entry into the study and again 1 year later. Twenty-three measures of clinical validity were employed; 15 were postdictive and 8 were predictive. Postdictive retrospective measures obtained at entry into the study included family history, age of onset and lifetime course characteristics associated with alcoholism severity, general psychopathology and psychosocial functioning. Predictive outcome measures drawn from information obtained during the 1-year follow-up included: abstinence, alcoholism severity and clinician ratings of outcome. The measures were subjected to various statistical analyses, including factor analysis. Results: We found that all of the alcoholism typologies met at least 7 of the 23 a priori measures of clinical validity. The correlations between these conceptually and methodologically disparate typologies were often striking. Exploratory factor analysis, which explained 35% of the variance. suggested three possible underlying dimensions to account for the overlap among typologies: (1) age and its correlates, including age- of-alcoholism onset; (2) "pure" alcoholism versus psychiatrically heterogeneous alcoholism that encompassed antisocial personality disorder; and (3) current severity of psychiatric distress, impairment and dysfunction. Conclusions: No single method of subtyping alcoholics clearly emerged as superior. All demonstrated some degree of predictive and postdictive clinical validity. Most methods of subtyping correlated positively with each other at moderate, but typically significant, levels. Copyright 1999, Alcohol Research Documentation, Inc.

Rinaldi RC, Steindler EM, Wilford BB, Goodwin D. Clarification and standardization of substance abuse terminology, JAMA. Journal of the American Medical Association 259(4): 555–557, 1987. (9 refs.)

A four-stage Delphi survey of substance abuse experts was conducted to help achieve greater clarity and uniformity in terminology associated with alcohol and other drug-related problems. This multidisciplinary group of experts was asked to reach a consensus on alcohol and other drug-related terms and definitions. Results produced a list of 50 substance abuse terms deemed important, along with the most agreed on definition for each term. Copyright 1987. American Medical Association.

Satel SL. Is drug addiction a brain disease? IN: Heymann PB, Brownsberger WN, eds. Drug Addiction and Drug Policy: The Struggle to Control Dependence. Cambridge MA: Harvard University Press, 2001. pp. 118-143. (35 refs.)

The chapter recounts the emergence of "addiction is a brain disease" a slogan and position of the National Institute on Drug Abuse, one which was 'blessed' by a conference convened in Chantilly Virginia, in 1995, which convened a group of national experts. The impetus is suggested to have been the effort to reduce the stigma of addiction. However, the author suggests that this slogan is a gross over-simplification, fails to recognize the role of volition, and tends to turn attention to drug therapies and allow overlooking the newer behavioral therapies. The author reviews some of the treatment outcome literature and epidemiology studies which demonstrate that remission is not that uncommon. Among the promising approaches are therapies that use contingency management or elements of coercion as are evident through in drug courts. Copyright 2004, Project Cork

Saunders JB; Schuckit MA, eds. Diagnostic issues in substance use disorders. Addiction 101(Supplement 1): entire issues, 2006.

The special supplement on Diagnostic Issues in Substances Use Disorder has 18 articles ranging from considering diagnostic criteria, comparing diagnostic criteria of the APA's Diagnostic and Statistical Manual and the International Classification of Disease, to examining the whether addiction disorders should include non-substance related conditions, such as gambling. (Copyright 2006, Project Cork)

Stepney R. The concept of addiction: Its use and abuse in the media and science Human Psychopharmacology 11(Supplement 1): S15–S20, 1996. (18 refs.)

Since it relates to common and frequently troublesome aspects of human behaviour, the concept of addiction is of considerable interest to the media, as it is to the health sciences and medicine. With some exceptions, the problems that emerge from the media's use of the concept are similar to those evident in the scientific literature. The term is sometimes used simply to draw attention to a behaviour which evokes disapproval, and the concept may be applied so broadly that sight of its core meaning is lost. However, the fact that there are problems in the way we employ the concept of addiction does not mean that there is no problem of addiction. Important aspects of human experience are well captured by much lay and scientific usage of the term. These experiences involve a range of appetitive behaviours (frequently but not exclusively drug-related) which the person concerned finds genuinely difficult to control and which are the source of conflict both within and between individuals. Among drug-related behaviours, opiate use can be considered the paradigm of addiction; and it is meaningful, even if not always appropriate, to consider the addictive potential of other psychoactive drugs in relation to this standard. Copyright 1996, John Wiley & Sons, Ltd.

Vaillant GE. The Natural History of Alcoholism, revisited. Cambridge MA: Harvard University Press, 1996. (563 refs)

This volume represents both a "re-printing", as well an up-dating and reflection on a now classic work in the alcohol field, one published fifteen year ago. Drawing upon the analysis of two major longitudinal studies, that work described the natural history of alcoholism (alcohol dependence.) The "new" edition is structured as a "reprint" of the previous edition, with new sections interspersed -- clearly denoted -- providing a commentary on the earlier work, drawing upon new research in the field, further follow-up of subjects, and the author's reflections. Copyright 1996, Project Cork Institute

Woody G, Schuckit M, Weinrieb R, Yu E: A review of the substance use disorder section of the DSM-IV, Psychiatric Clinics of North America 16(1): 21–32, 1993.

In 1988 the Board of Trustees of the American Psychiatric Association (APA) appointed as Task Force on DSM-IV to revise the Diagnostic and Statistical Manual (DSM) to be compatible with the World Health Organization's (WHO) International Classification of Diseases tenth edition. The Substance Use Disorders work group was formed to assist in the effort. A three-step process included literature reviews on selected topics; re-analysis of several pre-existing data sets, and conduct of field trials in America and Europe to determine the best way to diagnose abuse and dependence. Reports from the work group suggested significant alterations to DSM-IV in several areas: the optimal criteria for abuse; modifications in the criteria for dependence; diagnostic guidelines for dealing with psychiatric syndromes in individuals with substance use disorders; further scrutiny for diagnostic criteria for remission; the need to define severity more clearly; reorganization in the notation of some substance use disorders; handling of nicotine withdrawal; and inclusion/exclusion of alcohol idiosyncratic intoxication. In addition, other reports suggested no change for DSM-IV with regard to inclusion of caffeine abuse and dependence; highlighting anabolic steroid dependence; relevance of protracted abstinence (withdrawal) syndromes; a new subtype of dependence based on familial pattern of the disorder; and combination of amphetamines and cocaine into a large category, stimulants. Copyright 1993, Project Cork Institute

Chapter 5 Etiology of Alcohol Dependence

Note: Some of these references may appear dated. However, those included are original primary sources—that is, the articles in which the ideas or findings set forth were first introduced in the scientific literature.

Alcohol Epidemiology Program, Wagenaar AC. Alcohol Policies in the United States: Highlights from the 50 States. Minneapolis, MN: University of Minnesota, 2000. (40 refs.)
This volume provides information on patterns and trends of selected alcohol policies around the country across several decades, from 1968 - 2000, and on policies in each state as of January 1, 2000. It describes (1) Distribution systems, how the sale and distribution of alcohol are controlled; (2) Purchase and sales, i.e. related to beer keg registration and alcohol server training; (3) Taxation, the changes in excise taxes on beer, spirits/liquor, and wine; (4) Drinking and driving, the legal limits on BAC levels, for different populations and penalties for violating them. Information is organized by state. Among the significant findings are that a quarter of states have keg registration. Accounting for inflation, the value of beer taxes has declined dramatically over the past three decades, with the average tax only one-third of what it was in 1958. The trend in drinking driving laws includes an increase in the number of states with a very low BAC (0.0 or .02) for those under the legal drinking age; the reduction in BAC for all drivers to .08 by 29 states. All states now have BAC limits for motor boats, but only a few have such limits for snowmobile drivers. There has also been an increase in the portion of states that require server training. Copyright 2001, Project Cork

Bales R. Cultural differences in rates of alcoholism. Quarterly Journal of Studies on Alcohol 6:489–499, 1946. (16 refs)

This classic work describes four different cultural orientations toward alcohol use: total abstinence, ritual, convivial, and utilitarian uses and the influence of these orientations upon a culture's rate of alcoholism. The effects of a cultural attitude as set forth in this work continues to influence the understanding of the origins of alcohol and other drug problems, and thereby influences public policy and program development. Copyright 1989, Project Cork

Bassett JF, Dabbs JM Jr. Eye color predicts alcohol use in two archival samples. Personality and Individual Differences 31(4): 535–539, 2001. (12 refs.)

The present study used data from two archival samples to test the hypothesis, derived from Worthy, M. (1999), Eye colour: a key to human and animal behaviour. Lincoln, Nebraska: to Exel (originally published 1974) that light-eyed individuals would be more likely than dark-eyed individuals to abuse alcohol. Sample I consisted of 10,860 Caucasian male prison inmates, and Sample 2 consisted of 1862 Caucasian women respondents in a national survey. In both samples, individuals with light eyes had consumed significantly more alcohol than individuals with dark eyes. These results are consistent with previous findings that dark-eyed people exhibit more physiological arousal and more sensitivity to some medications than light-eyed people. The results may indicate that greater sensitivity to alcohol in dark-eyed individuals prevents them from drinking the large quantities of alcohol needed for development of physical dependence. Alternatively, greater behavioral inhibition may motivate light-eyed individuals to engage in alcohol consumption to achieve harm avoidance. Copyright 2001, Pergamon Press

Bateson G. The cybernetics of “self”: A theory of alcoholism. American Journal of Psychiatry 34:1–18, 1971. (16 refs)

This chapter is one of several that deals with self psychological formulations. The author brings the perspective of a social anthropologist and information theorist to the dilemma of self destruction through drinking. The author sees the alcoholic as suffering from an exaggerated version of the characteristic epistemological error of Western culture, which sees such radical disjunction between subject and object that it leaves no possibility for a nonexploitive relationship between humanity and its environment or between people. The author sees alcoholism as an attempt to correct this false epistemology through drinking; tragically, the pharmacology of alcohol exacerbates that which it attempts to cure. The author sees AA's Twelve Steps as a vehicle for correcting this epistemology through the surrender experience. The author also sees the key transformation in recovery as a shift in self-perception from an isolated self doing battle with an externalized addiction to a noncombatant self that is part of an interactive interpersonal feedback loop. Copyright 1995, Project Cork Institute.

Berman M, Hull T, May P. Alcohol control and injury death in Alaska native communities: Wet, damp and dry under Alaska’s local option law. Journal of Studies on Alcohol 61(2): 311–319, 2000. (24 refs.)

Objective: This article tests whether different forms of community-level alcohol control significantly affect injury deaths in a population with extremely high injury mortality. Method: The 1981 Alaska local option law provides a natural experiment for studying how implementation of community level controls may be associated with changes in injury deaths, most of which are alcohol-related, among Alaska Natives living in small communities. The study compares population and community-specific death rates under different levels of alcohol control for the 97 communities that passed restrictions between 1980 and 1993 with the death rates in the same communities during periods when no restrictions were in place. Results: Injury death rates were generally lower during periods when alcohol sales, importation or possession were restricted than when no restrictions were in place (wet). More restrictive controls (dry) significantly reduced homicides; less restrictive control options (damp) reduced suicides. Accident and homicide death rates fell, on average, by 74 and 66 per 100,000, respectively, for the 89 communities that banned sale and importation or possession. A control group of 61 small communities that did not change control status under the law showed no significant changes over time in accident or homicide death rates. Conclusions: The changes in accidental and homicide death rates are statistically significant, although these reduced rates remain 2.5 to 7 times national death rates. The isolated nature of Alaskan villages may explain why alcohol control has more effect in Alaska than has been found in studies of Native Americans living in other states. Copyright 2000, Alcohol Research Documentation, Inc. Used with permission

Bierut LJ, Dinwiddie SH, Begleiter H, Crowe RR, Hesselbrock V, Nurnberger JI Jr., et al. Familial transmission of substance dependence: Alcohol, marijuana, cocaine, and habitual smoking: A report from the Collaborative Study on the Genetics of Alcoholism. Archive of General Psychiatry 55(11): 982–988, 1998. (28 refs.)

Background: Alcoholism and substance dependence frequently co-occur. Accordingly, we evaluated the familial transmission of alcohol, marijuana, and cocaine dependence and habitual smoking in the Collaborative Study on the Genetics of Alcoholism. Methods: Subjects (n = 1212) who met criteria for both DSM-III-R alcohol dependence and Feighner definite alcoholism and their siblings (n = 2755) were recruited for study. A comparison sample was also recruited (probands, n = 217; siblings, n = 254). Subjects were interviewed with the Semi-Structured Assessment for the Genetics of Alcoholism. The familial aggregation of drug dependence and habitual smoking in siblings of alcohol-dependent and non-alcohol-dependent probands was measured by means of the Cox proportional hazards model. Results: Rates of alcohol, marijuana, and cocaine dependence and habitual smoking were increased in siblings of alcohol-dependent probands compared with siblings of controls. For siblings of alcohol-dependent probands, 49.3% to 50.1% of brothers and 22.4% to 25.0% of sisters were alcohol dependent (lifetime diagnosis), but this elevated risk was not further increased by comorbid substance dependence in probands. Siblings of marijuana-dependent probands had an elevated risk of developing marijuana dependence (relative risk [RR], 1.78) and siblings of cocaine-dependent probands had an elevated risk of developing cocaine dependence (RR, 1.71). There was a similar finding for habitual smoking (RR, 1.77 in siblings of habitual-smoking probands). Conclusions: Alcohol, marijuana, and cocaine dependence and habitual smoking are all familial, and there is evidence of both common and specific addictive factors transmitted in families. This specificity suggests independent causative factors in the development of each type of substance dependence. Copyright 1998, American Medical Association

Blum K, Braverman ER, Holder JM, Lubar JF, Monastra VJ, Miller D, et al. Reward deficiency syndrome: A biogenetic model for the diagnosis and treatment of impulsive, addictive and compulsive behaviors. Journal of Psychoactive Drugs 32(Supplement): 1–112 (entire issue), 2000. (636 refs.)

The dopaminergic system, and in particular the dopamine D-2 receptor, has been implicated in reward mechanisms. The net effect of neurotransmitter interaction at the mesolimbic brain region induces "reward" when dopamine (DA) is released from the neuron at the nucleus accumbens and interacts with a dopamine D-2 receptor. "The reward cascade" involves the release of serotonin, which in turn at the hypothalmus stimulates enkephalin, which in turn inhibits GABA at the substania nigra, which in turn fine tunes the amount of DA released at the nucleus accumbens or "reward site." It is well known that under normal conditions in the reward site DA works to maintain our normal drives. In fact, DA has become to be known as the "pleasure molecule" and/or the "antistress molecule." When DA is released into the synapse, it stimulates a number a DA receptors (D1-D5) which results in increased feelings of well-being and stress reduction. A consensus of the literature suggests that when there is a dysfunction in the brain reward cascade, which could be caused by certain genetic variants (polygenic), especially in the DA system causing a hypodopaminergic trait, the brain of that person requires a DA fix to feel good. This trait leads to multiple drug-seeking behavior. This is so because alcohol, cocaine, heroin, marijuana, nicotine, and glucose all cause activation and neuronal release of brain DA, which could heal the abnormal cravings. Certainly after ten years of study we could say with confidence that carriers of the DAD2 receptor A1 allele have compromised D-2 receptors. Therefore lack of D2 receptors causes individuals to have a high risk for multiple addictive, impulsive and compulsive behavioral propensities, such as severe alcoholism, cocaine, heroin, marijuana and nicotine use, glucose bingeing, pathological gambling, sex addiction, ADHD, Tourette's Syndrome, autism, chronic violence, posttraumatic stress disorder, schizoid/avoidant cluster, conduct disorder and antisocial behavior. In order to explain the breakdown of the reward cascade due to both multiple genes and environmental stimuli (pleiotropism) and resultant aberrant behaviors, Blum united this hypodopaminergic trait under the rubric of a reward deficiency syndrome. Copyright 2000, Haight-Ashbury Publications

Bowers BJ. Applications of transgenic and knockout mice in alcohol research. Alcohol Research & Health 24(3): 175–184, 2000. (38 refs.)

Multiple genetic and environmental factors contribute to the development of alcoholism. Researchers attempting to elucidate the roles of specific genes in alcoholism risk have benefited from advances in genetic engineering. Two important tools used by researchers include transgenic mice, in which a foreign gene is integrated into an animal's genetic material, and knockout/knock-in mice, in which targeted genes are either rendered nonfunctional or are altered. Both of these animal models are currently used in alcohol research to determine how genes may influence the development of alcoholism in humans. Public Domain

DiCarlo ST, Powers AS. Propylthiouracil tasting as a possible genetic association marker for two types of alcoholism. Physiology and Behavior 64(2): 147–152, 1998. (40 refs.)

The ability to taste 6-n-propylthiouracil (PROP) as bitter is determined genetically. The present study investigated whether this genetic ability was correlated with alcoholism and/or depression. Four groups of community college students (n = 25 each) were constituted based on the presence or absence of alcoholism and/or depression in themselves or their parents. Family history was assessed using the Family History-Research Diagnostic Criteria. Each subject was given a taste rest using paper saturated with PROP. The results showed that subjects who had only alcoholism in their family were more likely to be nontasters of PROP than the control group, whereas subjects with both alcoholism and depression in their family were more likely to be so-called supertasters of PROP; that is, they found it extremely bitter. These findings suggest that PROP tasting might function as a genetic marker for two types of alcoholism. Copyright 1998, Elsevier Science Ltd.

Duncan AE, Scherrer J, Fu Q, Bucholz KK, Heath AC, True WR, et al. Exposure to paternal alcoholism does not predict development of alcohol-use disorders in offspring: Evidence from an offspring-of-twins study. Journal of Studies on Alcohol 67(5): 649–656, 2006. (44 refs.)

Objective: Using an offspring-of-twins design, we tested the hypothesis that exposure to paternal alcoholism during the child's first 12 years will increase offspring risk for subsequent alcohol-use disorders (AUD). Method: Structured psychiatric interviews assessed history of psychiatric and substance-use disorders in Vietnam Era Twin Registry fathers (n = 512), their offspring (n = 877), and mothers of the offspring (n = 507). Exposure was defined as the fathers' endorsement of any Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, AUD symptom, according to the Lifetime Drinking History assessment (administered in 1999), at any time between offspring ages 0-12 years; all fathers had satisfied DSM, Third Edition, Revised (DSM-III-R), criteria for alcohol dependence in a 1992 diagnostic interview. Cox proportional hazards models were fit to predict time to first symptom of abuse/dependence in offspring. Results: Offspring exposed to paternal alcoholism were significantly more likely to develop an AUD when compared with offspring of nonalcoholic fathers (hazard ratio [HR] = 1.51; 95% confidence interval [CI]: 1.10-2.07). Although offspring unexposed to paternal alcoholism did not significantly differ from control offspring (HR = 1.50, 95% CI: 0.93-2.41), the magnitude of association was similar to that in the exposed offspring. There were no significant differences in AUD between offspring of alcoholics who were exposed and those who were not exposed to paternal alcoholism, as long as fathers had satisfied DSM-III-R criteria for alcohol dependence at some point in their lives. Conclusions: There does not appear to be a relationship between exposure to paternal alcoholism during childhood and development of an AUD in offspring. Genetic and high-risk environmental factors that are correlated with lifetime paternal alcoholism may be stronger predictors of offspring AUD than fathers' problem drinking. Future research should be encouraged, using more comprehensive analyses, to examine the role of family genetic influences and other family environmental influences on offspring alcohol outcomes. (Copyright 2006, Alcohol Research Documentation, Inc.)

Elster J, Skog OJ, eds. Getting Hooked: Rationality and Addiction. Cambridge, England: Cambridge University Press, 1999. (Chapter refs.)

The 8 essays in this book, with 10 contributors, discuss the relationship between addiction and rationality. The contributors include philosophers, psychiatrists, neurobiologists, sociologists, and economists. Contrary to the widespread view that addicts are subject to overpowering and compulsive urges, the authors in this volume demonstrate that addicts are capable of making choices and responding to incentives. At the same time there is disagreement with the argument that addiction is the result of rational choice. Essays consider the neurophysiology of addiction; a critical examination of Gary Becker's theory of rational addiction; an argument for a "visceral theory of addiction;" a discussion of compulsive gambling as a form of addiction, and discussion of George Ainslie's theory of hyperbolic discounting. There is also discussion of factors beyond the individual, namely social causes; policy implications, and consideration of the problem of relapse. In tackling the critical issue of voluntary self-destructive behavior from many perspectives, the book is intended as an important resource for philosophers, psychologists, psychiatrists, economists, and sociologists. Copyright 1999, Cambridge University Press

Ferguson RA, Goldberg DM. Genetic markers of alcohol abuse (review). Clinical Chimica Acta 257(2): 199–250, 1997. (232 refs.)

In this paper, we review the current status of genetic markers for the development of alcohol abuse. Family, twin, half-sibling and adoption studies of alcoholic subjects suggest that the heritability of liability to alcoholism is at least 50%. These findings have fuelled intensive investigation in the fields of neurology, biochemistry, genetics and molecular biology aimed at the identification of markers for the risk of alcoholism. The most promising of these are discussed in detail. Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) polymorphisms, specifically the ADH3*1, ADH2*2, and ALDH2*2 genotypes appear to confer a protective effect against alcoholism, most notably in Oriental subjects. Caucasian alcohol abusers and their first-degree relatives exhibit depressed platelet monoamine oxidase activity, the degree of which is greater in Type II than Type I alcoholics. Electrophysiological characteristics of alcoholics and those at risk for developing alcoholism have also been identified, including the reduced amplitude of the event-related brain potential and, after ethanol ingestion, characteristic EEG alpha-wave activity. Lower platelet adenylate cyclase activity is seen in alcoholics compared to controls, presumably as a result of over-expression of an inhibitory G-protein. Markers related to other signal transduction pathways of the central nervous system including the serotoninergic, muscarinic and dopaminergic systems are also discussed. In this group of markers, the putative association between the inheritance of the AI allele of the D2 dopamine receptor and the susceptibility to alcoholism provides the most dramatic illustration of the challenges presently existing in this field of scientific investigation. Current limitations in the definition, diagnosis and classification of alcoholism, the confounding influences of race and gender on association studies, as well as the statistical approach of linkage studies are discussed as they relate to the endeavor to uncover valid genetic markers for the risk of alcoholism. Copyright 1997, Elsevier Science B.V.

Finn PR, Justus A. Physiological responses in sons of alcoholics. Alcohol Health and Research World 21(3): 227–231, 1997. (15 refs.)

Researchers have differentiated sons of alcoholics (SOA's) from sons of nonalcoholics (non-SOA's) on various measures of physiological activity that appear to be related to the SOA's increased vulnerability to developing alcohol problems. This article summarizes major findings in the literature and discusses the implications of risk-related physiological characteristics for the future development of alcohol problems. SOAPS tend to show signs of physiological activity associated with anxiety states, such as increased heart rate in response to stressful stimuli. Studies also demonstrate that SOA's differ greatly from non-SOA's in their response to alcohol. Drinking alcohol dramatically reduces SOAs' reactivity to both stressful and nonstressful stimuli. Additionally, SOA's appear to be less sensitive to alcohol's intoxicating and impairing effects. However, studies also suggest that some SOARS may experience move of alcohol's rewarding effects for a brief period after drinking. Increased stress- dampening and reduced responsiveness to alcohol's negative effects also appear to predict the development of future alcohol problems and may reflect important vulnerabilities in SOA's. Public Domain

Giesbrecht N, Greenfield TK. Public opinions on alcohol policy issues: A comparison of American and Canadian surveys. Addiction 94(4): 521–531, 1999. (30 refs.)

Aims. To study international and within country differences with regard to views by the general public on alcohol policy topics, describe associations with socio-demographic characteristics and drinking practices, and contrast opinions with variations in actual policies. Design, setting, subjects. Large-scale cross-sectional household surveys were conducted in Canada (n = 11 550) and the United States (n = 4004) in 1989-90, involving representative samples of adults aged 18 and older. Measures. Eleven alcohol policy topics were examined: alcohol taxes; hour of off-premise sale; legal drinking age; alcohol sales in corner stores; government advertising against alcohol; warning labels on alcohol products; alcohol advertising on TV; industry sponsorship of cultural or sports events; efforts to prevent service to drunken customers; prevention and education; and treatment. Findings. Even after controlling for drinking levels and respondent characteristics, policy measures that control physical or economic access to alcohol are not as strongly supported as those that provide information or focus on the heavy drinker. There was greater polarization of opinion within both countries for policy items relating to promotion of alcohol or control of physical, demographic or economic access, and virtually no polarization with regard to items such as curtailing service to drunken customers or providing information or treatment. In the jurisdiction with less restrictive measures on a Particular policy, there seems to be greater public support for curtailing access to alcohol and, in some instances, more restrictive policies are associated with lower support for increasing restrictions. Conclusion. Public opinion data are an important resource in determining whether actual policies are compatible with the views of those affected by them. Disjunctions between research on the most effective policy interventions and views by the public point to special agenda for information dissemination and prevention initiatives. Copyright 1999, Society for the Study of Addiction to Alcohol and Other Drugs

Goodwin DW. Is alcoholism hereditary? Archives of General Psychiatry 25:545–549, 1971. (35 refs)

It has been long observed that alcoholism runs in families, nonetheless the task of separating the influences of nature vs. nurture is difficult. This article presents the early, key studies that demonstrated the role of heredity in some cases of alcohol dependence. Copyright 1989, Project Cork Institute.

Gruber J, Koszegi B. Is addiction “rational”? Theory and evidence. Quarterly Journal of Economics 116(4): 1261–1303, 2001. (40 refs.)

This paper makes two contributions to the modeling of addiction. First, we provide new and convincing evidence that smokers are forward-looking in their smoking decisions, using state excise tax increases that have been legislatively enacted but are not yet effective, and monthly data on consumption. Second, we recognize the strong evidence that preferences with respect to smoking are time inconsistent, with individuals both not recognizing the true difficulty of quitting and searching for self-control devices to help them quit. We develop a new model of addictive behavior that takes as its starting point the standard "rational addiction" model, but incorporates time-inconsistent preferences. This model also exhibits forward-looking behavior, but it has strikingly different normative implications; in this case optimal government policy should depend not only on the externalities that smokers impose on others but also on the "internalities" imposed by smokers on themselves. We estimate that the optimal tax per pack of cigarettes should be at least one dollar higher under our formulation than in the rational addiction case. Copyright 2001, Quarterly Journal of Economics

Grucza RA, Cloninger CR, Bucholz KK, Constantino JN, Schuckit MA, Dick DM, et al. Novelty seeking as a moderator of familial risk for alcohol dependence. Alcoholism: Clinical and Experimental Research 30(7): 1176–1183, 2006. (34 refs.)

Background: Disinhibitory personality traits such as high novelty seeking (NS) are moderately heritable, and individuals with substance use disorders (SUDs) frequently exhibit such traits. However, recent studies have cast doubt on the supposition that such traits are true familial risk factors for SUD and particularly for alcohol dependence. Another possibility is that familial risk interacts with personality-associated risk, in which case the association between personality and familial risk might depend on sample composition, accounting for the lack of consensus among studies to date. We examined this possibility by analyzing the association between NS and alcohol dependence in individuals at intermediate and high levels of familial risk for alcohol dependence. Methods: Data from the Collaborative Study on the Genetics of Alcoholism, a multisite family study, were examined. Subjects were 1,111 adult siblings of alcohol-dependent index cases. Parental diagnoses of alcohol dependence and personality scores of NS from the Tridimensional Personality Questionnaire were used to predict alcohol dependence. Results: A significant interaction between NS and familial risk for alcoholism was seen, such that NS was a significantly stronger predictor of alcohol dependence in subjects with one or more parents with alcohol dependence than in subjects without alcohol-dependent parents. Conclusions: Novelty seeking and familial risk interact so that the risk associated with high NS is magnified in families with parental alcohol dependence and NS is a moderator of familial risk. Accordingly, high NS is strongly associated with alcohol dependence in subjects with a parent diagnosed with alcohol dependence, but low NS may protect against the risk associated with familial alcoholism. This interaction may account for conflicting findings from studies that have examined this question previously. (Copyright 2006, Research Society on Alcoholism)

Heyman G. An economic approach to animal models of alcoholism. Alcohol Research & Health 24(2): 132–139, 2000. (29 refs.)

Researchers have long sought an animal model for human alcohol consumption. This article describes an economic-based approach to a model of alcohol preference in rats. The procedures are based on an analogy between clinical accounts of human drinking and the economic analysis of consumption. Both clinical and economic investigators typically define consumption patterns in terms of the influence of negative consequences. For example, the related clinical account emphasizes the persistence of heavy drinking despite mounting alcohol-related aversive consequences, and in economic analyses, the term "inelastic demand" is used to refer to the persistence of consumption despite large increases in prices. In the experimental procedure described here, rats worked for alcohol and food. Presses on one lever earned a drink of 10 percent alcohol plus saccharin, and the presses on a second lever earned isocaloric drinks of starch solution. After behavior stabilized, the response requirements (which are analogous to prices) for one or both drinks were increased. The rats maintained baseline alcohol consumption levels despite large increases in the "price" of alcohol. In contrast, the same price increases markedly reduced starch intake. That is, food consumption was sensitive to price hikes, but alcohol consumption was not. The results demonstrate that a common economic framework can be used to describe human and animal behavior and, hence the possibility of an animal of human alcohol consumption. The article also points out that economic concepts provide a framework for understanding a wide range of human drinking patterns, including controlled social drinking and excessive alcohol drinking. Public Domain

Holder HD, Giesbrecht N, Horverak O, Nordlund S, Norstrom Olsson O, et al. Potential consequences from possible changes to Nordic retail alcohol monopolies resulting from European Union membership. Addiction 90(12): 1603–1618, 1996. (44 refs.)

This paper projects the consequences of modifying or eliminating the current national alcohol retail monopolies in Sweden, Norway and Finland as a possible result of those countries' membership in the European Union (EU). First, the authors project absolute alcohol consumption in each country based on different possible changes in alcohol price and availability. Then they predict the future levels of alcohol-related problems likely so result from increased per capita alcohol consumption (Sweden and Norway only). All of the scenarios examined in this paper are expected to lead to increases in per capita alcohol consumption. The smallest increase in consumption would result from a partial elimination of the current monopoly and a modest reduction in alcohol prices. In that case, projected per capita consumption in Sweden for inhabitants 15 years and older would rise from 6.3 to 9.3 litres; in Norway, from 4.7 to 6.7 litres; and in Finland, from 8.4 to 11.1 litres. The greatest projected increase in consumption would result from a complete elimination of the state monopolies such that all beer, wine and spirits were sold in food shops, grocery stoves and gasoline stations, along with a substantial drop in alcohol prices as a result of private competition within each country and increased cross-border alcohol purchases. That scenario would result in projected per capita consumption of 12.7 litres in Sweden, 11.1 litres in Norway and 13.7 litres in Finland. The authors project that a 1-litre increase in consumption would result in a 9.5% increase in total alcohol-related mortality in Sweden and a 9.7% increase in Norway. Further, alcohol-related assaults would increase by 9% in Sweden and 9.6% in Norway. A 5-litre increase in consumption would result in a 62% increase in alcohol-related mortality in Sweden and a 60% increase in Norway, and a 57% increase in alcohol-involved assaults in both countries. Copyright 1996, Society for the Study of Addiction to Alcohol and Other Drugs

Johnson V. I’ll Quit Tomorrow (rev. ed.). New York: Harper & Row, 1980.

This work introduced the technique of "the intervention", a method to initiate treatment. The use of "interventions" promoted earlier treatment and prompted care for those previously seen as either "unready" or "inaccessible". The adoption of this clinical approach dispelled the myth that a patient's apparent motivation to cease use is a significant factor in determining treatment outcome, thus revolutionizing alcohol treatment, and by example, drug abuse treatment as well. This work also introduced the concept of "enabling", i.e. the interactions of the family and the alcoholic which unwittingly support the continuation of drinking or drug use. Efforts to counter these behaviors, tied to the framework of the "intervention", offer family a constructive role, beyond "detachment with love", the primary orientation of Al Anon, the self-help group for family members. Copyright 1990, Project Cork Institute.

Li T-K, McBride WJ. Pharmacogenetic models of alcoholism (review). Clinical Neuroscience 3(3): 182–188, 1995. (81 refs.)

This article reviews recent efforts in developing laboratory animal models for the study of alcoholism and abnormal alcohol-seeking behavior. Through selective breeding, stable lines of rats that reliably exhibit high and low voluntary alcohol consumption have been raised. The high preference animals self-administer ethanol by free-choice drinking, and operantly for intragastric infusion, in amounts that produce intoxication. With chronic free-choice drinking, the preferring rats develop tolerance and physical dependence. Low to moderate concentrations (50-150 mg%) of ethanol are reinforcing to the preferring rat, as evidenced by intracranial self-administration studies. Compared with nonpreferring animals, they are less affected and develop tolerance more quickly to the sedative-hypnotic effects of ethanol. Neurochemical, -anatomical and -pharmacological studies indicate that innate differences between the alcohol-preferring and -nonpreferring lines in the brain limbic structures. Depending on the animal model under study, a change in the main dopaminergic pathway and/or the serotonergic, opioid, and GABAergic systems that regulate this pathway may underlie the vulnerability to the abnormal alcohol-seeking behavior in these pharmacogenetic animal models of alcoholism. Copyright 1995, Wiley-Liss, Inc.

Marques PR, Voas RB, Tippetts AS, Beirness DJ. Behavioral monitoring of DUI offenders with the alcohol ignition interlock recorder. Addiction 94(12): 1861–1870, 1999. (14 refs.)

Aims. To evaluate patterns of blood alcohol concentration (BAC) and driving logged on the ignition interlock recorder and to assess whether this event record is a useful outcome measure for a behavioral intervention. Design. Descriptive analyses of recorder data and multivariate analysis of the predictors of high BACs associated with a motivational intervention for driving-under-the- influence (DUI) offenders using an interlock. Setting. Two interlock service centers in Alberta, Canada. Participants. 1309 first-time and multiple DUI offenders who agreed to participate during interlock installation. Intervention. A human-services (supportive guidance) intervention based on motivational interviewing and pragmatic counseling was delivered to interlock users in Calgary, but not to interlock users in Edmonton, Canada. Measurements. This report summarizes the patterns and predictors of BAC warnings (0.02-0.039%) (20-39 mg/dl) and failures (greater than or equal to 0.04) (greater than or equal to 40 mg/dl) from more than 3 million in-vehicle breath tests. Data come from three sources: driver records, questionnaires and the interlock. Findings. From the beginning to the end of the interlock use period, there was a significant linear decline in the proportion of positive BAC driving to total driving. After controlling for prior offenses, demographics and reported drinking levels, offenders in the intervention site (Calgary) were less likely to have recorded fail BACs than were offenders in the control site (Edmonton). The temporal patterns of BAC fails with the interlock mimic the high-risk periods for DUI arrests and alcohol-involved fatal crashes. Conclusions. The interlock successfully blocks drinking and driving during high-risk periods. Preliminary recorder data suggest the services intervention may be affecting DUI behavior. Copyright 1999, Society for the Study of Addiction to Alcohol and Other Drugs

Maryniak I. Death in Russia. Index on Censorship 31(2): 24–29, 2002. (1 ref.)

This article considers an array of social problems in Russia. Alcohol poisoning, infectious disease, and high suicide rate resulting in lower life expectancy and a shrinking population. Regarding alcohol, acute alcohol poisoning is the cause of 35,000 deaths annually. Alcohol use too is related to other declining social indicators: a decreasing life expectancy; deaths exceeding births; two-thirds of pregnancies are aborted; and the suicide rate is one of the highest in the world. The Russian population is shrinking by 750,000 annually. In part this is also an indictment of the medical system. Seven percent of the general population and as high as 40% of the prison population has TB. Conditions of gross over-crowding, coupled with poor coordination between prison and health officials, exacerbates this problem. The prison system has been described as an epidemiological pump, releasing hundreds of thousands of infected individuals into the general population annually. Similarly AIDS as well as other sexually transmitted disease has been ignored and inadequately addressed. The authors sees the media as having failed to bring problems to light. Copyright 2002, Writers & Scholars International, Ltd.

McCord W, McCord J. Some current theories of alcoholism: A longitudinal evaluation. Quarterly Journal of Studies on Alcohol 20:727–749, 1959. (27 refs)

This articles reports on a study conducted to address the nature of the well recognized phenomenon of the familial nature of alcoholism. This can be the result of either genetic and/or environmental and/or social-psychological factors. This prospective study uses subjects, born between 1926 and 1933 from the urban Boston area, drawn from cases in a project undertaken as a preventive intervention for juvenile delinquency. Thus the case material dates from the early 1930s. The methods are described and data presented in seven tables. Two developmental paradigms emerge from the analysis. In one, men with alcoholic fathers were more likely to become alcoholic if their mothers had shown high esteem for the sons' fathers. These alcoholics were likely to drink on a daily basis. Even if not alcoholic themselves, they tended to report encountering problems when drinking. In the other developmental paradigm, lack of maternal control increased the likelihood of alcoholism in adulthood. It is recognized that these developmental models interact with other variables.

McSweeney FK, Murphy ES, Kowal BP. Regulation of drug taking by sensitization and habituation (review). Experimental and Clinical Psychopharmacology 13(3): 163–184, 2005. (241 refs.)

The authors argue that drug taking is an operant behavior that is reinforced by the drug itself. The effectiveness of a drug as a reinforcer is modulated by sensitization and habituation to the drug as it is consumed. According to this model, drug taking stops when habituation reduces the ability of the drug to reinforce its own consumption. Drug taking resumes when spontaneous recovery restores the effectiveness of the drug as a reinforcer. This parsimonious model provides a framework for understanding many findings in the drug literature, including acute and chronic tolerance, the effect of deprivation on consumption, the contextual specificity of tolerance, polydrug abuse, cross-sensitization between stress and drugs, behavioral sensitization, priming, and reinstatement. Although this model cannot explain all aspects of drug taking (e.g., the effect of cognitive manipulations), it has many implications for understanding and controlling human drug consumption and addiction. (Copyright 2005, American Psychological Association)

Mennella JA, Garcia PL. Children’s hedonic response to the smell of alcohol: Effects of parental drinking habits. Alcoholism: Clinical and Experimental Research 24(8): 1167–1171, 2000. (28 refs.)

Background: Previous research in our laboratory revealed that during the first year of life, infants who had more exposure to alcohol, as inferred from questionnaires about parental alcoholism and alcohol intake, mouthed an ethanol-scented toy more compared with less exposed infants. The present study focused on older children (3.8-6.0 years) to determine whether their hedonic response to the odor of alcohol was related to the drinking habits of their parents. Methods: Age-appropriate, game-like tasks that were fun for children and minimized the impact of language development were used to examine their preferences and identification of a variety of odors, one of which was beer. Results: The children's preference for the odor of beer varied as a function of the escape drinking of their mothers alone or both parents. That is, children who lived in a household in which one or both parents drank alcohol to escape were significantly more likely to dislike the odor bottle that contained alcohol when compared with children whose parents did not drink to escape. This difference between the groups was odor specific. Additional analyses also revealed that the fathers of children who rejected the beer odor reported drinking significantly more than the fathers of those who liked the odor. Conclusions: These findings suggest that some early learning about alcohol is based on sensory experiences and anchor it to children's experiences at home and the emotional context in which their parents experience alcohol. Copyright 2000, Research Society on Alcoholism

Mulder RT. Alcoholism and personality. Australian and New Zealand Journal of Psychiatry 36(1): 44–51, 2002. (72 refs)

Objective: The search for an alcoholic personality has been pursued with varying enthusiasm throughout the 20th century. This paper reviews the methodological issues, research designs and current theories relating alcoholism and personality. Method: A selected literature search using computerised databases was ordered via the four major research design strategies: cross sectional studies, high-risk studies, longitudinal studies and genetic epidemiology studies. Results: Cross sectional studies have suggested that two broad bands of personality, impulsivity/novelty seeking and neuroticism/negative emotionality, are associated with alcoholism. Although high-risk studies have repeatedly shown that sons of male alcoholics are at increased risk of alcoholism, whether this risk is related to personality variables is unclear. Many authors believe that the presence of antisocial personality disorder is a confounder and that this may explain some of the contradictory findings. Longitudinal studies have consistently reported that antisocial behaviour and hyperactivity are related to later alcoholism. Negative emotionality seems to be less important and may largely be a consequence of the alcoholism itself. Genetic epidemiological studies suggest that personality measures play a modest but significant role in the genetic influence of alcoholism. The strongest relationships are with conduct disorder and antisocial behaviour. The postulated alcoholic subtypes (Type I, Type II or Type A/B) based on age of onset and personality style have been challenged by recent research. The most vulnerable to alcoholism may be those with both high impulsivity/high novelty seeking and high neuroticism/negative emotionality. Conclusion: Antisocial behaviour and hyperactivity are the most consistent behaviours associated with alcoholism. These behaviours are not specific for alcoholism and are associated with many other psychiatric conditions. Personality variables by themselves explain only a small proportion of the risk for alcohol dependence. There is no alcoholic personality nor are there personality measures which are specific to vulnerability to later alcohol dependence. Attempting to link alcoholism with theoretical, poorly validated models of personality is premature. Copyright 2002, Royal Australian and New Zealand College of Psychiatrists

Nemtsov AV. Alcohol-related human losses in Russia in the 1980s and 1990s. Addiction 97(11): 1413–1425, 2002. (42 refs.)

Aims. To examine the rates of alcohol-related harm in relation to levels of alcohol consumption before, during and after a major anti-alcohol campaign in Moscow. Design. Changes in State alcohol sale and alcohol consumption and certain forms of alcohol-related harm were observed as a function of time. Findings. Following the 1985 anti-alcohol campaign, State alcohol sales decreased by 38.0% in 1.5 years in Moscow, and total consumption decreased by 28.6%. At the same time, admissions for alcohol-related mental and behavioural disorders, deaths from liver cirrhosis, alcohol poisoning and other blood alcohol positive violent deaths decreased by 63.3%, 33.0% 50.8% and 50.9%, respectively. There was a linear correlation between medical variables and alcohol consumption during its decrease in 1985-86. An increase in blood alcohol positive violent deaths began in 1987, before the increases in other variables. Growth of total alcohol consumption began in 1987, and continued during all subsequent years, although it was especially high in 1992-93 at the time of the introduction of market reforms in Russia. Alcohol-related mental and behavioural disorders and liver cirrhosis mortality increased after a time-lag following the rise in alcohol consumption. Conclusions. The findings provide stark evidence of the potential impact of policy measures applied to general alcohol consumption on alcohol-related harm. Copyright 1998, Society for the Study of Addiction to Alcohol and Other Drugs

NIAAA. The genetics of alcoholism. Alcohol Health and Research World. 19(3): 161–256 (entire issue), 1995.

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