Alcohol and Tobacco: Medical and Sociological Aspects of Use, Abuse and Addiction PDF
Preview Alcohol and Tobacco: Medical and Sociological Aspects of Use, Abuse and Addiction
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 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photoco- pying machines or similar means, and storage in data banks. Product Liability: The publisher can give no guarantee for all the information contained in this book. This does also refer to information about drug dosage and application thereof. In every individual case the respective user must check its accuracy by consulting other pharmaceu- tical literature. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. © 2011 Springer-Verlag/Wien Printed in Germany SpringerWienNewYork is part of Springer Science+Business Media springer.at Copy editing: Claire Speringer, 1030 Vienna, Austria Typesetting: PTP-Berlin Protago-TEX-Production GmbH, 10779 Berlin, Germany Printing: Strauss GmbH, 69509 Mörlenbach, Germany Printed on acid-free and chlorine-free bleached paper SPIN: 12610372 With 122 Figures Library of Congress Control Number: 2010935024 ISBN 978-3-7091-0145-2 SpringerWienNewYork 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
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