Alcohol and Tobacco: Medical and Sociological Aspects of Use, Abuse and Addiction

364 Pages·2011·5.721 MB·English

by  Otto Michael Lesch MD, Henriette Walter MD, Christian Wetschka PhD, Michie N. Hesselbrock PhD, Victor Hesselbrock PhD (auth.)

Otto-Michael Lesch
Henriette Walter
Christian Wetschka
Michie Hesselbrock
Victor Hesselbrock
Alcohol and Tobacco
Medical and Sociological Aspects
of Use, Abuse and Addiction
Otto Michael Lesch, MD
Henriette Walter, MD
Medical University of Vienna, Austria
Christian Wetschka, PhD
Vienna, Austria
Michie N. Hesselbrock, PhD
Victor Hesselbrock, PhD
University of Connecticut, Farmington, CT, USA
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Acknowledgements
After more than 30 years working with them for many interesting hours bring-
psychiatric patients especially with ad- ing in new and important research ide-
dicted patients I thank many friends, as. Especially I would like to thank H.
experts and researchers. At the begin- Poltnig, who died much to early, for pro-
ning of my work in 1972 Berner P., Mad- ducing the fi rst LAT-documentation.
er R. and Strotzka H. supported my ed- Henriette Walter helped to produc e the
ucation and they made it possible to fi rst German manuscript, Christian Wet-
organize in a catchment area a social schka brought in his social the rapeutic
psychiatric network. In this network a expertise and Michie and Victor Hessel-
long term treatment (chain: outpatient- brock included their knowledge about
inpatient-outpatient) could be devel- the subgroups of alcohol depen dence
oped. There it was possible to investi- used in the United States.
gate the long term course of psychiatric, Last but not least I have to thank
especially of alcohol addicted patients. my family, especially my wife Elisabeth,
After 4 years of work the fi rst results because they had to miss me many
could be published. In this ongoing re- weekends in the last 30 years. They for-
search an international discussion pro- med a climate to be able to relax and also
cess started. Boening J., Pelc I., Tabakoff made clear that beside working with
B., Platz W. and DeWitte P. have always addicted patients many other much
drawn my attention to the fact, that in more exiting sites in life exist.
addictive processes psychosocial fac-
tors have the same importance than Otto Lesch
biological vulnerabilities. These experts
but also a lot of others from many coun-
tries helped me to publish the most im-
portant results and invited me to many
international conferences to discuss
our data. My research team produced Assistant: Josefi ne Kalenda
many new results and I have to thank Translation: Miriam Mahler
V
Foreword
It is a pleasure to write this foreword for with the sequelae of alcohol and tobac-
the text by Professor Otto-Michael L esch co use, including comorbidity with psy-
and colleagues dealing with the impor- chiatric syndromes. The emphasis on
tant topics of alcohol and tobacco. The comorbidities is an essential compo-
thoughts offered from this broad based nent for a clinically oriented text dea-
book are likely to be applicable to read- ling with alcohol and tobacco as psy-
ers with interests in a wide range of chiatric symptoms, especially anxiety
substances of abuse. An earlier version and depression, can both increase the
of this text, published in German, has risk for substance dependence and re-
stood the test of time, and the updated fl ect important consequences of their
chapters in this edition were developed clinical course.
in consultation with eminent clinicians A special strength of this book,
and researchers from sociology (Chris- not surprisingly, is a sophisticated de-
tian Wetschka), social work (Michie scription of a broad range of possible
Hesselbrock), and psychology (Victor typologies of alcohol and tobacco de-
Hesselbrock) – contributions that com- pendence. While much emphasis is
plement the approaches offered by pla ced on the approach developed by
Professor Lesch. Professor Lesch and his colleagues, the
The content refl ects the wealth of text is careful to discuss additional ap-
experience of the authors, including proaches, including those related to ge-
the more than 30 years in the fi eld netic predispositions.
expended by Professor Lesch. The in- Underscoring the clinical useful-
form at ion offered here includes obser- ness of the information offered is the
vations on the history of relevant dia g- breadth of the discussion of treatments.
nos es; descriptions of the importance These include combinations of socio-
to societies of alcohol and tobacco use logical and psychological approaches,
and problems; theories of factors that as well as a presentation of potentially
contribute to discussions of the diag- useful pharmacological therapies. The
nostic approaches of the American Psy- book also recognizes the interest that
chiatric Association’s DSM, as well as clinicians are likely to have in prevent-
those generated by the World Health ing alcohol- and nicotine-related disor-
Organization; along with expansions of ders.
these criteria to detecting substance re- In closing, this updated English
lated problems in clinical practice. An version of a well established text has
important part of the material deals much to offer a wide range of clinicians.
VII
Foreword
The book should be considered as po-
tentially important reading for students
entering our fi eld as well as for well es-
tablished practitioners.
Marc A. Schuckit, MD,
Distinguished Professor of Psychiatry
Department of Psychiatry
University of California, San Diego
Editor, Journal of Studies on Alcohol
and Drugs
NIAAA’s Jack Mendelson Honorary
Award, NIAAA Keller Honorary Award,
Middleton Award for the best research
within the VA system, American Psy-
chiatric Association’s Hofheimer Prize
(now the APA Award for Research), So-
ciety for Biological Psychiatry’s Gold
Medal Award for lifetime achievement,
Research Society on Alcoholism’s Dis-
tinguished Scientist and Seixas
Awards, James B. Isaacson Memorial
Award, Jellinek Award.
VIII
Foreword
Alcoholism and smoking are the most lated causes (cancer, cardiovascular
frequent causes of addiction in our disease and respiratory diseases). Alco-
century. The extent to which alcohol is hol and tobacco dependence has re-
associated with health problems is re- markably wide-ranging effects on al-
markable, with Europe sadly adopting most all organs of the human body. For
a leading role. 55 million adult Europe- this reason, it is very important that not
ans use alcohol irresponsibly and 23 only psychiatrists and addiction ex-
million can be categorized as alcohol perts tackle this subject, but that physi-
dependent. The costs of treating the cians, regardless of their specialisation,
medical sequelae of alcohol abuse and are also aware of the problem and are
related occupational defi cits, which are able to diagnose and choose adequate
paid by the health systems, are tremen- and timely interventions.
dous, e. g. Germany has reported costs With his book, “Alcohol and To-
of 20 billion Euros per annum. Besides bacco: Medical and Sociological As-
the dependence itself, a myriad of alco- pects of Use, Abuse and Addiction”,
hol related sequelae ranging from acci- Professor Otto-Michael Lesch, a psychi-
dents to suicide, as well as social and atrist of the highest international repu-
occupational problems (family prob- tation, with over 40 years of experience
lems, unemployment), need to be ex- in treating dependents, has not only
amined. A particular cause for concern explored all of the major issues, but has
is the permanently declining age of ini- also managed to consider most aspects
tiation for alcohol use, which in the of dependence (prevention, diagnos-
meantime has dropped to the age of tics, sequelae, therapy). Despite the
13–14. In view of the early onset of comprehensive scope of his book, the
chronic alcohol consumption, an in- authors have successfully managed to
crease in the number of alcohol de- discuss certain aspects in more depth
pendents and severe alcohol related without losing sight of the whole pic-
sequelae, e. g. liver cirrhosis, have to be ture. In this book, both theory-based
expected in the future. researchers as well as professionals in
Most alcohol dependents also practice will fi nd the information they
smoke and, in fact, there are hardly any are looking for. Especially interesting
who do not. The effects of smoking are are a number of case studies from
similarly health damaging and a German practice which have been included in
study has shown that around 110,000 the book. Here, the authors have put
people die each year from tobacco-re- special emphasis on the typology of al-
IX
Foreword
Statement
cohol dependence which Lesch himself version is now available for many inter-
developed. Lesch’s typology of alcohol ested readers in the European Commu-
dependence has received wide accept- nity and I hope it helps to increase the
ance internationally and has recently quality of life of dependent patients.
been re-evaluated and structured by a
research group, directed by Lesch. The
reason why this typology is so impor-
tant is because it can be used as a tool Helmut K. Seitz, MD, PhD, AGAF
to predict both the assessm ent for prog- Distinguished Professor
noses, and therapeutic responses to of Internal Medicine,
different therapies. Gastroenterology and Alcohol Research,
With his work, Otto-Michael L esch University of Heidelberg, Germany
continues the classical tradition of Ger- Honorary Professor, Huazhong
man-speaking psychiatrists in the do- University, Wuhan, P. R. China
main of alcohol research and treat- Director, Salem Medical Center,
ment. In this respect, he sets new Heidelberg, Germany
standards in almost all areas by intro- Head, Department of Medicine and
ducing modern viewpoints and new Center of Alcohol Research
scientifi c results. As President of the Liver Disease and Nutrition, Salem
European Society for Biomedical Re- Medical Center, Heidelberg,
search on Alcoholism (ESBRA), I would Germany President of European
like to congratulate Otto-Michael Lesch Society for Biomedical Reseach
and his colleagues on this work and on Alcoholism
also thank him sincerely. The English (ESBRA)
Statement
In as far as this book uses personal terms
and defi nitions, they apply equally to
women and men; for the sake of clarity,
and without any intention to discrimi-
nate, only one gender-specifi c denomi-
nation has been used.
X
Table of contents
1 Information about the origination of this book. . . . . . . . . . . . . . . . . . . . . . 1
1.1 Aims of this book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1
1.2 Personal reasons for the fi rst author writing this book . . . . . . . . . . . . . . . . . . . . . 3
2 Addiction – a short overview of a widespread disease. . . . . . . . . . . . . 5
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2
2.2 Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.3 The Diagnosis addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.4 Aetiology of addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.5 Secondary disorders and addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.6 Secondary diseases and brain functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.7 Subgroups of addicts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.8 Motivation of addicts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.9 The path from motivation to therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.10 Addiction and relapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.11 Specifi c groups of addicts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.11.1 Co-morbidity of tobacco and a lcohol-addiction. . . . . . . . . . . . . . . . . . . . . . 11
2.11.2 Overweight, eating disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.11.3 Gender. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.12 Addiction and the homeless . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.13 Polytoxicomania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.14 Non-substance dependence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3 Aetiology of addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.1 The psycho-socio-biological model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 3
3.2 Psychological theories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.2.1 Behavioural approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.2.2 Models of depth psychology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.2.3 Depth psychological approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.2.4 Ego-psychological approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.2.5 The psychological model of object relations . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.2.6 Theoretical approach of Narcissism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.2.7 Explanation models according to family psychotherapy. . . . . . . . . . . . . . . 20
3.3 Social explanation approaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.4 Biological theories about the aetiology of tobacco and alcohol addiction . . . . 22
3.4.1 Important fi ndings about tobacco and alcohol use from basic research 22
XI