Alcoholism and Clinical Psychiatry

237 Pages·1982·3.82 MB·English

by  Benjamin Kissin MD

Alcoholism
and
Clinical
Psychiatry
Alcoholism
and
Clinical
Psychiatry
Edited by
Joel Solomon
Downstate Medical Center
Brooklyn, New YorK
Plenum Medical Book Company
New York and London
Library of Congress Cataloging in Publication Data
Main entry under title:
Alcoholism and clinical psychiatry.
Bibliography: p.
Includes index.
1. Alcoholism-Addresses, essays, lectures. 2. Psychiatry-Addresses, essays,
lectures. 3. Psychology, Pathological-Addresses, essays, lectures. I. Solomon,
Joel. (DNLM: 1. Alcoholism-Complications. 2. Alcoholism-Therapy. 3. Mental
disorders - Complications. WM 274 A3S48]
RC56S.A44S33 616.86'1 81-22701
ISBN-13: 978-1-4684-4030-0 e-ISBN-13: 978-1-4684-4028-7 AACR2
001: 10.1007/978-1-4684-4028-7
© 1982 Plenum Publishing Corporation
Softcover reprint of the hardcover 1st edition 1982
233 Spring Street, New York, N.Y. 10013
Plenum Medical Book Company is an imprint of Plenum Publishing Corporation
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
Malcolm Beaudett, BS Third-Year Medical Student, State University of
New York, Downstate Medical Center, Brooklyn, New York
Sheila B. Blume, MD Director, New York State Division of Alcoholism
and Alcohol Abuse, Clinical Associate Professor, Department of Psychi
atry, Albany Medical College, Albany, New York
Marc Galanter, MD Director, Division of Alcoholism and Drug Abuse,
Associate Professor, Department of Psychiatry, Albert Einstein College of
Medicine, Bronx, New York
Donald M. Gallant, MD Professor, Department of Psychiatry, Adjunct
Professor of Pharmacology, Tulane University School of Medicine, New
Orleans, Louisiana
Donald W. Goodwin, MD Professor and Chairman, Department of
Psychiatry, University of Kansas Medical Center, Kansas City, Kansas
Meredith Hanson, MSW Clinical Instructor, Division of Alcoholism,
State University of New York, Downstate Medical Center, Brooklyn, New
York
Martin S. Kesselman, MD Professor, Department of Clinical Psychiatry,
State University of New York, Downstate Medical Center, Director of
Psychiatry, Kings County Hospital Center, Brooklyn, New York
Elizabeth T. Khuri, MD Clinical Associate Professor of Public Health,
Cornell University Medical College, New York, New York
Benjamin Kissin, MD Associate Chairman and Professor, Department of
y
vi ContributoR
Psychiatry, State University of New York, Downstate Medical Center,
Brooklyn, New York
Gerald L. Klerman, MD Professor of Psychiatry, Psychiatric Service,
Harvard Medical School, Massachusetts General Hospital, Boston,
Massachusetts
Robert B. Millman, MD Clinical Professor of Public Health, Associate
Professor of Clinical Psychiatry, Cornell University Medical College, New
York, New York
Frederic M. Quitkin, MD Director, Depression Evaluation Service, New
York State Psychiatric Institute; Associate Professor of Clinical Psy
chiatry, Columbia University College of Physicians and Surgeons, New
York, New York
Judith G. Rabkin, PhD Research Scientist, New York State Psychiatric
Institute; Adjunct Assistant Professor of Public Health in Psychiatry,
Columbia University College of Physicians and Surgeons, New York, New
York
Austin Silber, MD Clinical Professor of Psychiatry, Training and Super
vising Analyst, The Psychoanalytic Institute at the New York University
Medical Center, New York, New York
Joel Solomon, MD Clinical Associate Professor, Director, Division of
Alcoholism and Drug Dependence, Department of Psychiatry, State
University of New York, Downstate Medical Center, Brooklyn, New York
Barbara Thornton, RN Unit Chief, Kingsboro Psychiatric Center, Clinical
Instructor, State University of New York, Downstate Medical Center,
Brooklyn, New York
Joseph Westermeyer, MD, PhD Professor, Department of Psychiatry,
University of Minnesota, Minneapolis, Minnesota
Sheldon Zimberg, MD Director of Psychiatry, Joint Diseases, North
General Hospital, New York, New York
Foreword
It is well known that alcoholism continues to be one of this country's major
public health problems. This issue is carefully documented by Dr. Gerald
Klerman, Chief of ADAMHA, in the second chapter ofthis volume. In spite
of the major role that alcohol plays in the health care issues of internal
medicine, neurology, and psychiatry, the subject continues to fall between the
cracks of the various disciplines. For this reason, it has become almost a
discipline of its own; yet there are no academic departments of alcoholism
because academic departments are unidisciplinary and alcoholism is clearly a
multidisciplinary field within medicine.
In spite of the many disciplines involved in the study and treatment of
alcoholism, psychiatry continues to have a special, albeit often neglected,
relationship to alcoholism, and it is the articulation ofthat relationship which
prompted the Department of Psychiatry at the Downstate Medical Center to
organize the conference upon which many chapters in this volume are based.
Particular emphasis in selecting the topics to be covered was placed on the
interface between alcoholism and clinical psychiatry, including affective
disorders, schizophrenia, suicide, adolescence, the special problems of
women, and psychotherapy, to mention only some of them.
The realization that psychiatric disorders cause as well as result from
alcoholism has prompted the Residency Review Committee of the American
Psychiatric Association to call increasing attention to the need for more
training in alcoholism in psychiatric training programs. We hope that this
volume will serve as a resource for trainees, clinicians, and other students of
this area of medicine and health care.
EUGENE FEIGELSON, MD
State University of New York Chairman, Department of Psychiatry
Downstate Medical Center
Brooklyn, New York
vii
Preface
This book is composed largely of papers delivered at a conference held on
October 24 and 25, 1980 at the New York Academy of Medicine. The decision
to develop this conference and subsequent book was based on several events
presently occurring in the fields of alcoholism and psychiatry.
Alcoholism or alcohol dependence is now generally accepted as a
psychiatric disorder and during the acute phase, alcoholism can manifest a
wide range of psychiatric symptomatology. The course of alcoholism is
acknowledged to be progressive and varied and psychiatric factors may be
present at all points along the alcoholic pathway. Psychiatric symptoms may
preexist the alcoholism and playa role in its development, may arise as a
complication of chronic alcoholism, may be part of any phase of acute
alcoholism, or may occur as an independent event in an alcoholic. Until
recently, psychiatrists generally ignored the alcoholic or viewed him as
morally weak, with a bad habit symptomatic of severe underlying psycho
pathology which was substantiated by labeling it with psychoanalytic
terminology.
From the other perspective, the alcoholic community has been wary of
psychiatry and its labels as well as the ability of psychiatrists to treat this
popUlation. Medication was often inappropriately prescribed, groups such as
AA were perceived as threatening, and patients spent years on the couch
drinking their way through interpretations of preoedipal conflicts rather than
directly addressing the problem.
The rapprochement has been slow, but has been taking place neverthe
less. There seems to be general agreement that psychiatric impairment is not
the same in all alcoholics. Many, perhaps even most alcoholics can be treated
without psychiatric involvement because their primary problem is alcohol and
the medical and social complications which arise as a result. Other alcoholics
clearly need the assistance of psychiatric intervention and withholding it may
be ignoring a factor which perpetuates the alcoholism.
Ix
x Preface
The relationships between the various psychiatric disorders and alco
holism need clear delineation. It is hoped that this volume is of assistance in
developing a better understanding of both conditions and, most important,
their effective treatment.
JOEL SOLOMON, MD
Contents
Foreword vii
Eugene Feigelson
1. The Bio-psycho-social Perspective in Alcoholism 1
Benjamin Kissin and Meredith Hanson
2. Prevention of Alcoholism 21
Gerald L. Klerman
3. Alcoholism and Psychiatry: A Cross-cultural Perspective 35
Joseph Westermeyer
4. Altered Use of Social Intoxicants After Religious
Conversion 49
Marc Galanter
5. Alcoholism and Clinical Psychiatry 57
Joel Solomon
6. Alcoholism and Schizophrenia 69
Martin S. Kesselman, Joel Solomon, Malcolm Beaudelt, and
Barbara Thornton
7 A. Alcoholism and Affective Disorders: Methodological
Considerations 81
Joel Solomon
xl
xII Contents
7B. Alcoholism and Affective Disorders: The Basic Questions 87
Donald W. Goodwin
8. Alcoholism and Suicide 97
Joel Solomon
9. Alcoholism and Sociopathy 111
Joel Solomon and Meredith Hanson
10. Hidden Psychiatric Diagnosis in the Alcoholic 129
Frederic M. Quitkin and Judith G. Rabkin
11. Psychiatric Aspects of Alcohol Intoxication, Withdrawal, and
Organic Brain Syndromes 141
Donald M. Gallant
12. Alcohol and Adolescent Psychopathology 163
Robert B. Millman and Elizabeth T. Khuri
13. Psychiatric Problems of Alcoholic Women 179
Sheila B. Blume
14. The Contribution of Psychoanalysis to the Treatment of
Alcoholism 195
Austin Silber
15. Office Psychotherapy of Alcoholism 213
Sheldon Zimberg
Index 231