Medical and Social Aspects of Alcohol Abuse

414 Pages·1983·9.85 MB·English

by  Glenn R. Caddy (auth.)

Medical and
Social Aspects of
Alcohol Abuse
Medical and
Social Aspects of
Alcohol Abuse
Edited by
BORIS T ABAKOFF
Alcohol Drug Abuse Research and Training Program
University oj Illinois at the Medical Center and
Westside Veterans Administration Medical Center
Chicago, Illinois
PATRICIA B. SUTKER
Veterans Administration Medical Center and
Tulane University School of Medicine
New Orleans, Lousiana
and
CARRIE L. RANDALL
Veterans Administration Medical Center
Charleston, South Carolina
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Main entry under title:
Medical and social aspects of alcohol abuse.
Includes bibliographical references and index.
1. Alcoholism. 2. Alcohol-Physiological aspects. 1. Tabakoff, Boris, date-
II. Sutker, Patricia B. III. Randall, Carrie L., date- . [DNLM: 1. Alcohol,
Ethyl. 2. Alcoholism. WM 274 M4875]
RC565.M346 1983 616.86/1 83-4786
ISBN-13: 978-1-4684-4438-4 e-ISBN-13: 978-1-4684-4436-0
001: 10.1007/978-1-4684-4436-0
©1983 Plenum Press, New York
Softcover reprint of the hardcover 1s t edition 1983
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Contributors
ERNEST L. ABEL • Research Institute on Alcoholism, 1021 Main Street, Buffalo,
New York
GLENN R. CADDY • Department of Psychology, Nova University, Fort Lauder
dale, Florida
R. LORRAINE COLLINS • Department of Psychology, State University of New
York at Stony Brook, Stony Brook, New York
RICHARD A. DEITRICH • Alcohol Research Center, Department of Pharmacol
ogy, University of Colorado Medical Center, Denver, Colorado
GERHARD FREUND • Veterans Administration Medical Center and Depart
ments of Medicine and Neuroscience, College of Medicine, University of
Florida, Gainesville, Florida
WALTER A. HUNT • Behavioral Sciences Department, Armed Forces Radio
biology Research Institute, Bethesda, Maryland
TING-KAI LI • Departments of Medicine and Biochemistry, Indiana University
School of Medicine, and Veterans Administration Medical Center, Indi
anapolis, Indiana
G. ALAN MARLATT • Department of Psychology, University of Washington,
Seattle, Washington
GARY MCCLURE • Department of Psychology, Georgia Southern College, Sta
tesboro, Georgia
v
CONTRIBUTORS
VI
BARBARA S. MCCRADY • Brown University and Butler Hospital, Providence,
Rhode Island
PETER M. MILLER • Sea Pines Behavioral Institute, Sea Pines Plantation, Hil
ton Head Island, South Carolina
TED D. NIRENBERG • Psychological Services, Veterans Administration Medical
Center, Providence, Rhode Island
DENNIS R. PETERSEN • Alcohol Research Center, School of Pharmacy, Univer
sity of Colorado, Boulder, Colorado
CARRIE L. RANDALL • Research Services, Veterans Administration Medical
Center, 109 Bee Street, Charleston, South Carolina
EDWARD P. RILEY • Department of Psychology, State University of New York
at Albany, Albany, New York
JEFFREY ROTHSTEIN • Department of Physiology and Biophysics, University of
Illinois at the Medical Center, Chicago, Illinois
MARC A. SCHUCKIT • Alcohol Treatment Program, Veterans Administration
Medical Center, 3350 La Jolla Village Drive, San Diego, California, and
Department of Psychiatry, University of California, San Diego, California
KENNETH J. SHER • Department of Psychology, University of Missouri, Colum
bia, Missouri
BORIS T ABAKOFF • Westside Veterans Administration Medical Center, Chicago,
Illinois, and Alcohol and Drug Abuse Research and Training Program,
Department of Physiology and Biophysics, University of Illinois at the
Medical Center, Chicago, Illinois
DAVID H. VAN THIEL • Department of Medicine, Division of Gastroenterology,
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Preface
Alcohol use affects, either directly or indirectly, nearly all facets of Western civi
lization. Eastern cultures are also not exempt from the influence of alcohol, and
the present decade has been a time of increased alcohol use in all parts of the
world. The problems of alcohol abuse and alcoholism are of concern to a variety
of professionals in the biomedical and psychosocial health sciences, and-although
the alcohol research literature contains much information on the relationships
between alcohol ingestion and physiological, neurochemical, pharmacologic,
genetic, environmental, and psychological effects in humans and in subhuman spe
cies-there is at the present time no advanced textbook that integrates the avail
able information for use by both students and professionals.
The writing of Medical and Social Aspects of Alcohol Abuse constitutes an
attempt to create a scholarly reference and resource for students, researchers, prac
ticing clinicians, and paraprofessionals who wish to understand the complex inter
play of factors related to acute and chronic alcohol intoxication, the effects of alco
hol on body functions, and treatment approaches to alcohol abusers and alcoholics.
The book includes an introductory section that summarizes the history of
alcohol production and use and provides definitions of alcohol abuse, problem
drinking, and alcoholism. The following chapters discuss the neurochemical and
neuropharmacologic effects of acute and chronic alcohol intoxication and issues
related to the genetic basis of alcoholism, alcohol metabolism, pathological conse
quences of alcohol abuse, the phenomena of alcohol tolerance and dependence, and
the effects of prenatal alcohol exposure on the fetus. Problems arising from alco
hol's interactions with other drugs and issues related to the prevention and treat
ment of alcoholism are extensively covered.
vii
Vl11 PREFACE
In summary, we hope that this book will represent an important component
of the education and training of a variety of professionals in the basic and clinical
sciences. The content should enable such individuals to better understand the fac
tors leading to alcohol abuse and the consequences of such abuse, and it should
stimulate thought regarding directions for continued research and clinical efforts.
Boris Tabakoff
Patricia B. Sutker
Carrie L. Randall
Contents
Chapter 1
Alcohol Use and Abuse: Historical Perspective and Present Trends 1
GLENN R. CADDY
1. Alcohol Use in Historical Perspective 2
1.1. Recent Trends in Alcohol Consumption .............. . 5
2. Alcohol Consumption and Alcohol Problems 9
3. Development of the Concept(s) of Alcoholism.. . ........ . 11
3.1. The Traditional Approach .. 15
3.2. The Social-Learning/Behavioral Models 16
3.3. The Multivariate Approach. . . . . . . . . ............ . 17
3.4. Advantages of the Multivariate Approach ........ . 20
3.5. Implications for the Future . . . . . . . . ....... . 22
4. References . . . . . . . . . . . . ........... . 23
Chapter 2
The Genetics of Alcoholism . 31
MARC A. SCHUCKIT
1. Types of Studies Supporting a Genetic Influence in Alcoholism 31
1.1. Family Studies . . . . . . . . . ........... . 32
1.2. Animal Studies. 32
1.3. Genetic Marker Studies .......................... . 33
1.4. Twin Studies . . . . . . . . . . . . . . . . . . ..... . 33
1.5. Adoption Studies ..... . ....... . 34
2. Possible Biological Mechanisms for a Genetic Influence
in Alcoholism .. 35
2.1. Absorption/Metabolism .. 36
2.2. Acute Reaction ................... . 37
2.3. Functional Tolerance. 38
IX
x CONTENTS
2.4. Susceptibility to Chronic Consequences .. 38
2.5. Personality ..................... . 38
2.6. Relationship to Other Psychiatric Disorders. 39
3. A Prospective Search for the Biological Determinants of Alcoholism. 40
4. Summary . . . . . . . . . . . . . . . . . .................. . 42
5. References .. . ................... . 42
5.1. Books and Reviews .. 45
Chapter 3
The Absorption, Distribution, and Metabolism of Ethanol and Its
Effects on Nutrition and Hepatic Function 47
TING-KAI LI
1. Introduction 47
2. Absorption and Distribution ........ . 48
3. Pharmacokinetics and Alcohol Elimination Rates ........ . 49
3.1. Intra- and Interindividual Variations in Alcohol Elimination
Rates. 52
4. Processes and Organs Responsible for Ethanol Elimination. . . . 54
5. Significant Pathways of Ethanol Metabolism. . . . . . . . . 55
6. Enzymes That Oxidize Ethanol to Acetaldehyde . . 55
6.1. Alcohol Dehydrogenase . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
6.2. Properties of Alcohol Dehydrogenase and Genetic Variation in
Isoenzymes of Human Alcohol Dehydrogenase. . . 57
6.3. Catalase and MEOS . . . . . . . . . . . 60
7. Enzymes That Oxidize Acetaldehyde to Acetate. . . . . . . . . . . . . . . . 62
7.1. Aldehyde Dehydrogenase. . . . . . . . . . . . . . . . . . . . . . . . . 63
8. Control of Ethanol and Acetaldehyde Metabolism in Liver. 64
9. Effect of Chronic Ethanol Ingestion on Alcohol Elimination Rate. . 67
to. Chronic Ethanol Ingestion and Nutrition . . . . . . . . . 69
11. Ethanol Oxidation and Hepatic Metabolism 70
11.1. Effects on Carbohydrate and Fat Metabolism 70
11.2. Effects on Protein and Amino Acid Metabolism. 72
12. References .. . ......... . 74
12.1 Monographs and Reviews ................ . 76
Chapter 4
Effects of Ethanol upon Organ Systems Other than the Central
Nervous System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
DAVID H. VAN THIEL
1. Introduction .. 79
2. Ethanol and the Gastrointestinal Tract ......... . 80