Alcohol

283 Pages·1991·23.63 MB·English

by  Norman S. Miller M.D.

Alcohol
DRUGS OF ABUSE
A Comprehensive Series for Clinicians
Volume 1 MARIJUANA
Mark S. Gold, M.D.
Volume 2 ALCOHOL
Norman S. Miller, M.D., and Mark S. Gold, M.D.
Alcohol
Norman S. Miller, M.D.
Cornell University Medical College
White Plains, New York
and
Mark S. Gold, M.D.
Fair Oaks Hospital
Summit, New Jersey
and Delray Beach, Florida
Springer Science+ Business Media, LLC
Library of Congress Cataloging-in-Publicatoon Data
Miller, Norman S.
Alcohol / Norman S. Ml 11er and Mark S. Gold.
p. cm. — (Drugs of abuse ; v. 2)
Includes bibliographical references and Index.
ISBN 978-1^899-3552-6
1. AlcohoUsi». 2. Alcohol—Physiological effect. I. Gold, Mark
S. II. Title. III. Series: Drugs of abuse (New York, N.Y.) ; v. 2.
[DNLM. 1. Alcohol, Ethyl—adverse effects. 2. Alcoholism.
3. Substance Abuse. H1 DR892 v. 2 / / WM 274 M6485a]
RC565.M4439 1991
616.86' 1—dc20
DNLM/DLC
for Library of Congress 91-2391
CIP
ISBN 978-1-4899-3552-6 ISBN 978-1-4899-3550-2 (eBook)
DOI 10.1007/978-1-4899-3550-2
© 1991 Springer Science+Business Media New York
Originally published by Plenum Press, New York in 1991
Softcover reprint of the hardcover 1st edition 1991
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
In my judgement such of us who have never fallen victims
[to alcoholism] have been spared more by the absence of
appetite than from any mental or moral superiority over
those who have. Indeed, I believe if we take habitual
drunkards as a class, their heads and their hearts will bear
as advantageous comparison with those of any other class.
-ABRAHAM LINCOLN
Preface
This book is written for a truly general medical audience.
Clinicians, researchers, residents, and students will find Al
cohol a direct treatment of the major drug problem in Amer
ica. Along with the first volume in this series on marijuana,
Alcohol is timely and relevant. The subject is presented with
clarity in an effort to provide professionals and interested
readers with a basic background in the field of alcohol
studies. The emphasis is on what is known and can be coun
ted on as fundamental knowledge on the various aspects of
history, epidemiology, diagnosis, treatment, and prevention
of alcoholism. Because drugs other than alcohol are such an
important feature of the contemporary alcoholic, they are
covered as a part of the natural history of alcoholism.
Change and progress are essential to knowledge; past
and current research in the alcohol field, as well as detailed
discussions of what further needs to be investigated, are in
cluded in the volume. The student as well as the practitioner
vii
viii PREFACE
will find the contents useful for didactic purposes as well as
a clinical reference. We believe that the researcher will also
profit from the comprehensive coverage of the subject. The
chapters are organized in sections to highlight important
topics and are arranged in a sequence to ensure a logical de
velopment of the subject, alcohol. Throughout the book we
combine our clinical and research experiences to provide
a synthesis that we hope will have widespread clinical
usefulness.
N.S.M.
M.S.G.
Contents
CHAPTER 1. Introduction and History 1
CHAPTER 2. Prevalence and Pattern
of Use 11
Epidemiology of Alcoholism 12
CHAPTER 3. Genetics of Alcoholism 23
Alcoholism in Families 23
Twin Studies 25
Adoption Studies 25
High-Risk Studies 27
Tolerance 28
The Role of Environment 29
The '~ddictive Personality" 31
Summary 31
ix
X CONTENTS
CHAPTER 4. Neurological Effects
of Alcohol 35
Cerebral Effects 35
Limbic Effects 41
Brain Stem Effects 42
Central Nervous System 43
CHAPTER 5. Medical Complications
of Alcoholism 47
Cardiovascular System 48
Gastrointestinal System 50
Nutritional Complications 53
Endocrinological Effects 56
Nervous System 58
Cancer 60
Infectious Diseases 61
CHAPTER 6. Tolerance and Dependence 67
Tolerance 69
Innate and Acquired Tolerance 69
Pharmacokinetic Tolerance 72
Pharmacody namic" Tolerance 74
Cross-Tolerance 75
Dependence and Withdrawal 75
CHAPTER 7. Clinical Diagnosis of
Alcoholism 83
Historical Perspective 83
The Concept of Addiction 87