Handbook of Alcoholism

505 Pages·2000·2.69 MB·English

by  Mike Flannagan

H A N D B O O K O F
alcoholism
P
Handbooks of
harmacology
T
and
oxicology
A CRC Press Series
Mannfred A. Hollinger, Series Editor
University of California, Davis
Published Titles
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Vladimir P. Torchilin
Handbook of Pharmacology of Aging, Second Edition
Jay Roberts, David L. Snyder, and Eitan Friedman
Handbook of Plant and Fungal Toxicants
J. P. Felix D’Mello
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Canadian Networking Toxicology Center
Handbook of Alcoholism
Gerald Zernig, Alois Saria, Martin Kurz, and Stephanie S. O’ Malley
H A N D B O O K O F
alcoholism
edited by
Gerald Zernig, M.D.
Alois Saria, Ph.D.
Martin Kurz, M.D.
Stephanie S. O’Malley, Ph.D.
CRC Press
Boca Raton London New York Washington, D.C.
Library of Congress Cataloging-in-Publication Data
Handbook of alcoholism / Gerald Zernig, editor-in-chief ; Alois Saria, Martin Kurz,
Stephanie S. O’Malley, co-editors.
p. cm. — (Pharmacology and toxicology)
Includes bibliographical references and index.
ISBN 0-8493-7801-X (alk. paper)
1. Alcoholism—Handbooks, manuals, etc. I. Zernig, Gerald, 1960– II. Saria, Alois.
III. Kurz, Martin, 1963– IV. O’ Malley, Stephanie S. V. Pharmacology & toxicology (Boca
Raton, Fla)
[DNLM: 1. Alcoholism—therapy. WM 274 H2355 2000]
RC565 .H245 2000
616.86¢1—dc21 99-053180
CIP
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How You Can Benefit From This
Handbook (… By Way of a Preface)
The overwhelming majority of problem drinkers (i.e., alcohol-abusing patients) and alcohol-depen-
dent patients are first seen by physicians in general practice, in a primary care setting, or at
nonpsychiatric inpatient facilities, such as departments of internal medicine or surgery. If you work
in such a setting, this book is for you. It is my firm belief that comprehensive treatment of your
alcohol-abusing or alcohol-dependent patient lies within your grasp and should, for that matter,
ultimately lie in the hands of one therapist; this book will help you to acquire the necessary expertise
to achieve this. You will, in all likelihood, find that you want to delegate some aspects of the medical
care of your alcoholic patient to more specialized partners who might have more resources than
you with respect to time, logistics, and specialized training. Still, it is you who can give crucial
help to your patient who is experiencing alcohol-related problems, right from the first contact and
interview. And, let’s face it, you have to do it — you are the one your patient usually first contacts
and not necessarily because he or she is aware of her/his alcohol problem. Not yet. With the help
of this handbook, you will acquire the necessary skills to help him/her recognize the underlying
alcohol problem. Two chapters (Chapter 1, First Contact and Early Intervention; Chapter 9, Psy-
chotherapy) are dedicated to explaining which psychological problems you are most likely to
encounter at every stage of the disease and how to best cope with the negative emotions that the
alcohol-dependent patient — so severely affected by the disease — will most likely induce in you,
his physician.
However, alcoholism is not restricted to underlying psychological problems. Alcohol damages
a number of organs — and these somatic symptoms are very often those that actually bring the
patient into your office. This handbook will help you to better diagnose and treat these nonpsychi-
atric medical disorders as well. The first section of this handbook, PATIENT CARE, describes the
diagnosis and therapy of alcohol-induced somatic and psychiatric disorders.
In the second section of the handbook, RESEARCH, you will find review-like chapters on
current issues in research on alcoholism. Again, emphasis is on the clinical aspects: epidemiology,
comorbidity, heritability, psychometric instruments assessing treatment success, and meta-analysis
of clinical trials, as well as patient-to-treatment matching. If you want to go deeper into basic
science issues, this handbook offers chapters on the neurochemistry, histopathology, and behavioral
pharmacology of alcoholism. Research on alcoholism, like any research into substance dependence
(addiction), is jeopardized by moralizing and ideology or by ideas that are intellectually stimulating
and attractive, but lack sufficient empirical evidence; thus, a chapter is dedicated to such contro-
versial issues.
So, how many grams of alcohol to a can of beer? How much can somebody drink before
exceeding the legal limit in your state? How much can someone drink before risking organ damage?
What is the correct psychiatric definition of alcohol dependence? Where can that MAST test form
be found for photocopying? You will find answers to these and other questions in the third and
final section of this handbook, USEFUL DATA AND DEFINITIONS.
A final word on different psychotherapeutic approaches: please remember that the aim of this
handbook is to help you obtain a helpful attitude toward the alcohol-dependent patient and explain
his or her behavior in a way that opens new therapeutic perspectives for you. Trans-Atlantic
differences in clinical traditions (i.e., the “behavioral-cognitive U.S.” vs. the “psychoanalytic Central
Europe”) should not be of too much concern. Do not be disconcerted by skirmishes between the
different psychotherapeutic “schools”; always ask yourself how you can make use of what each
school has to offer. Remain open and eclectic when trying to help each patient, one at a time, each
with his/her personal history and special needs. One of the great strengths of this handbook lies in
the fact that both U.S. and European clinicians and researchers have contributed to it; make use of
the different cultural approaches represented in this book and be flexible in adapting your own
therapeutic approach to the special therapeutic setting in which you find yourself. Both
“oversocialized institutionalization” and the “merciless kick ’em-out-quick” health care systems
have their advantages and disadvantages. Use them in your patients’ best interest.
The goal of this handbook is to provide you with everything (well, almost everything) you
need in a book that you can hold in one hand. We truly hope that you like it so much that you
consult it again and again. If we have forgotten something that you consider important, please let
us know. My e-mail address is [email protected] and my telephone number is +43-699-
1714-1714. You can find my complete postal address in the contributor list. We really would like
to hear from you — good or bad.
Gerald Zernig, M.D.
Editor-in-Chief
Dedication
A number of people have helped me to obtain the necessary competence to conceive and edit this
handbook. Every one of them has furthered my education in her/his own special way. Dear friends,
please allow me to thank you in this public way (and in temporal order). This book is dedicated
to you.
My parents Horst and Gertrude, Oma, Karin (although she does not want me to) and her mother
Erni; my kids Patrick and Bernhard (for having led the nomadic life with me and for being such
great sons); my brother and his family, Karli and Margit Leyrer; Uncle Heri and Aunt Inge; Uncle
Rudi, Uncle Herfried, and Aunt Hansi; Helmut Tritthart (for introducing me to science); Rob and
Lynne MaLeod (for lifelong friendship and for introducing me to the American, sorry, Canadian
way of life); Wolfgang Schreibmayer (for showing me how much fun tinkering in the lab can be,
and for being Skipper Wolf); Fred Lembeck (for initiating my scientific adolescence and for
watching over me in his quiet way) and the people in his lab; Rufina Schuligoi (for teaching me
early on that psychology isn’t bogus at all); Kypt Stoschitzky Moni and Monika (for being such
great learning partners and loyal friends); Les and Sandy Bailey and Hali Hartmann; Hartmut
Glossmann (for the good things he has done to me) and his crew; Alison Abbott (for being such a
strict style teacher, for introducing me to a whole new world of science, scones, and everything
British, and for putting up with my American accent); Ryan Huxtable (for whetting my appetite
for addiction research); Hermann Dietrich (for teaching me so much about animal behavior and
care); Uschi and Peter Schallert; Norbert Reider; Ruth Galvan; Gerda Topar; Martin and Thea
Holtzhauer; the Mittelbauvertreter at the University of Innsbruck (for standing by me in hard times);
Hans Tuppy; Sigurd Hoellinger (for seeing to it that things were done the right way in very emotional
times); Hartmann Hinterhuber, W. Wolfgang Fleischhacker, and the members of the Akutstation
(for allowing me to get my first whiff of psychiatric work and for many, many fruitful discussions);
Sue Iversen; Jim Woods (for taking me into his lab and welcoming my family and me to the U.S.,
for teaching me most of what I know about behavioral pharmacology, for being such a generous
supervisor, and for being a boss who came to help us to carry boxes); Gail Winger (for teaching
me how to do i.v. self-admin and for being such a great style teacher); Eduardo and Kirsten Butelman
(who, among other things, gave me my first subscription to The New Yorker); Beck Q.O.P. McLaugh-
lin, the Woods Lab and Jim’s friends — Charles France, Alice Young, Ellen Walker, Harriet deWit,
Bill Woolverton, Bob Schuster; Pat Needle (for being such a great mother for us needy NIDA
INVEST fellers), Ben Lucchesi and his Motley Crew, Ed Domino, Rick Neubig; Chris Fibiger (for
taking me into his lab, for teaching me in vivo microdialysis, for very generously letting me do
things that he was not really particularly interested in anymore, and for being such an excellent
science, logics, and style teacher); Catriona Wilson, Matt Taber (among other things, for brewing
that Hornikeivitz), Emmerich and Genevieve Ceschi (for helping us to feel right at home in
Vancouver); Michael Lehofer, Norbert Kriechbaum, and Doris Hoenigl (for teaching me so much
about psychotherapy, with special thanks to Norbert for his navigational skills); Hans-Georg
Zapotoczky (for exposing me to psychiatric work); Konrad Schauenstein (for his support and very
fruitful discussions); Regina Hutter (for being my first therapist and supervisor); Mannfred
Hollinger (for picking me and whetting my appetite for this handbook); Hartmann Hinterhuber (for
steering my little academic ship gently into a safe and productive harbor); the members of the
Psychiatry Department at the University of Innsbruck (for taking me aboard); some officials of the
University of Innsbruck (for watching over me and providing us with the operant conditioning set-
up), and the members of the Saria lab for keeping up with me; Helmuth Provaznik (for showing
me a whole new world); Brigitte (for her support and for being such a wonderful partner in our
LATship); Lisa (for helping me to understand adolescence better); and Wuff (for tolerating the
competitor for his mother’s love in such a cavalier fashion). Last, but certainly not least, I would
like to thank Luis and Astrid Saria, who have stood by me in very hard times, have tolerated my
more expansive moods, and are such perfect hosts. Luis, thank you for talking science with me for
over 20 years now and for managing the difficult task of being both my boss and my friend!
Gerald Zernig, M.D.
The Editors
Gerald Zernig, M.D., is Associate Professor in the Division of Neurochemistry, Department of
Psychiatry, School of Medicine, University of Innsbruck, Austria. Born in 1960 in Hartberg, Austria,
he obtained his medical degree in 1984 from the University of Graz, Austria. He worked as an
Assistant Professor in the Department of Biochemical Pharmacology, University of Innsbruck,
where he attended rounds at the Intensive Care Ward of the Department of Psychiatry (W. Wolfgang
Fleischhacker and Hartmann Hinterhuber). He became Associate Professor in 1992. From 1992 to
1995, Dr. Zernig worked as a NIDA INVEST fellow and as an FWF Schroedinger Fellow with
James H. Woods, Department of Pharmacology, University of Michigan, Ann Arbor, investigating
the behavioral pharmacology of drug dependence. From 1995 to 1996, he worked with H. Christian
Fibiger, Department of Psychiatry, University of British Columbia, Vancouver, Canada, on neuro-
chemical and behavioral experiments on cocaine, heroin, and nicotine dependence. From 1996 to
1997, Dr. Zernig treated patients suffering from alcohol and/or other substance dependence and
other psychiatric disorders at the Department of Psychiatry, University of Graz (Hans-Georg
Zapotoczky). Upon his return to the University of Innsbruck, Dr. Zernig became a member of Alois
Saria’s Division of Neurochemistry. He contributes behavioral pharmacological experiments to the
division’s neurochemical investigations on neuropeptides and drugs of abuse; he is currently
investigating the effect of alcohol on “Ecstasy” (MDMA) reinforcement.
Alois Saria, Ph.D., is Professor of Neurochemistry and Head of the Division of Neurochemistry,
Department of Psychiatry, School of Medicine, University of Innsbruck. Born in Austria, he obtained
his Ph.D. degree in 1979 from the University of Graz, Austria. He worked as Assistant Professor
from 1979 to 1985 in the Department of Pharmacology and became Associate Professor in 1985.
In 1987, he moved to Innsbruck to become head of the Division of Neurochemistry at the Depart-
ment of Psychiatry. His research included molecular mechanisms of signal transduction with special
emphasis on neuropeptides, psychoactive drugs, and narcotics. In 1993, the Institute of Scientific
Information evaluated xenobiotics research (research about biological actions of exogenous com-
pounds) and ranked Dr. Saria as number 17 of the top 50 “high-impact authors” worldwide (Current
Contents, 3/1993, pp. 3–13) Trained as a biochemist, his clinical duties involve drug monitoring
of antipsychotics and antidepressants. In 1998, Dr. Saria became full Professor of Neurochemistry.
From 1982 to 1996, he carried out research at several institutions including the Karolinska Institute
in Sweden, and facilities in the United States. In 1996, he was a Fulbright scholar and Burroughs
Wellcome Visiting Professor at the Department of Anatomy and Neurobiology, University of
Kentucky at Lexington. Dr. Saria is a member of the editorial board of the European Journal of
Pharmacology and the Journal of Neural Transmission.
Martin Kurz, M.D., is Head Physician, Alcohol and Substance Dependence Therapy Unit, Depart-
ment of Psychiatry, School of Medicine, University of Innsbruck. Born in 1963 in Innsbruck,
Austria, he studied medicine at Graz and Innsbruck. After obtaining his medical degree in 1989,
he joined the Department of Psychiatry, Innsbruck University Hospital, where he specialized in
psychiatry and neurology. He was board-certified as a psychiatrist and neurologist in 1997. Dr. Kurz
became a certified psychotherapist in 1997. Since 1997, he has been Head Physician at the Alcohol
and Substance Dependence Therapy Unit, Innsbruck University Hospital.
Stephanie S. O’Malley, Ph.D., is Professor of Psychiatry and Director of the Division of Substance
Abuse Research, Department of Psychiatry, School of Medicine, Yale University. Dr. O’Malley
received her Ph.D. from Vanderbilt University and joined Yale University in 1984. Dr. O’Malley
has contributed a number of seminal studies and research articles on the pharmacotherapy and
psychotherapy of alcohol dependence, among them the “classic” on the combined use of psycho-
therapy and naltrexone (S. S. O’Malley, A. J. Jaffe, G. Chang, R. S. Schottenfeld, R. E. Meyer,
and B. Rounsaville, Naltrexone and coping skills therapy for alcohol dependence. A controlled
study. Arch.Gen.Psychiatry 49, 881–887, 1992).