The Biology of Alcoholism: Vol. 7 The Pathogenesis of Alcoholism: Biological Factors

635 Pages·1983·0.66 MB·English

by  Gerald E. McClearn (auth.)

THE PATHOGENESIS
OF ALCOHOLISM
BIOLOGICAL FACTORS
THE BIOLOGY OF ALCOHOLISM
Volume 1: Biochemistry
Volume 2: Physiology and Behavior
Volume 3: Clinical Pathology
Volume 4: Social Aspects of Alcoholism
Volume 5: Treatment and Rehabilitation of the
Chronic Alcoholic
Volume 6: The Pathogenesis of Alcoholism
Psychosocial Factors
Volume 7: The Pathogenesis of Alcoholism
Biological Factors
THE PATHOGENESIS
OF ALCOHOLISM
BIOLOGICAL FACTORS
Edited by
Benjamin Kissin and Henri Begleiter
Downstate Medical Center
Brooklyn, New York
PLENUM PRESS. NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Main entry under title:
The Pathogenesis of alcoholism.
(The Biology of alcoholism; v. 7)
Includes bibliographical references and index.
1. Alcoholism - Physiological aspects. 2. Alcoholism - Genetic as
pects. I. Kissin, Benjamin, 1917 - II. Begleiter, Henri. III. Series.
[DNLM: 1. Alcoholism. WM 274 K61b]
RC565.B52 1971 vol. 7 616.86'ls [616.86'1] 82-22284
ISBN-13: 978-1-4613-3520-7 e-ISBN-13: 978-1-4613-3518-4
DOl: 10.1007/978-1-4613-3518-4
© 1983 Plenum Press, New York
Softcover reprint ofthe hardcover 1st 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
Henri Begleiter, State University of New York, Department of Psychiatry,
Downstate Medical Center, Brooklyn, New York.
Nelson Butters, Boston University School of Medicine, Boston, Massachusetts
J.
Remi Cadoret, University of Iowa, College of Medicine, Iowa City, Iowa
Howard Cappell, Addiction Research Foundation, Toronto, Ontario, Canada
Theodore J. Cicero, Department of Psychiatry, Washington University School
of Medicine, St. Louis, Missouri
Richard A. Deitrich, Alcohol Research Center and Department of Phamacology,
University of Colorado School of Medicine, Denver, Colorado
Carlton K. Erickson, College of Pharmacy, University of Texas, Austin, Texas
C. J. Peter Eriksson, Research Laboratories of the State Alcohol Monopoly
(Alko), Helsinki, Finland
Kennon M. Garrett, Alcohol and Drug Abuse Research Center, Department
of Physiology and Biophysics, University of Illinois Medical Center, Chi
cago, Illinois
William M. Grove, Department of Psychology, University of Minnesota, Min
neapolis, Minnesota
Paula L. Hoffman, Department of Physiology and Biophysics, University of
Illinois Medical Center, Chicago, Illinois, and Westside Veterans Ad
ministration Medical Center, Chicago, Illinois
A. Eugene LeBlanc, Addiction Research Foundation, Toronto, Ontario,
Canada
v
vi Contributors
Joan C. Martin, Department of Psychiatry and Behavioral Sciences, University
of Washington, Seattle, Washington
Gerald E. McClearn, Institute for the Study of Human Development, The
Pennsylvania State University, University Park, Pennsylvania
Nancy K. Mello, Alcohol and Drug Abuse Research Center, Harvard Medical
School-McLean Hospital, Belmont, Massachusetts
Bernice Porjesz, State University of New York, Department of Psychiatry,
Downstate Medical Center, Brooklyn, New York
David H. Ross, Division of Molecular Pharmacology, Departments of Phar
macology and Psychiatry, The University of Texas Health Science Center
at San Antonio, San Antonio, Texas
Aryeh Routtenberg, Department of Psychology, Northwestern University, Ev
anston, Illinois
Christopher Ryan, Western Psychiatric Institute and Clinic, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Ann Pytkowicz Streissguth, Department of Psychiatry and Behavioral Sci
ences, University of Washington, Seattle, Washington
Boris Tabakoff, Department of Physiology and Biophysics, University of Illinois
Medical Center, Chicago, Illinois, and Westside Veterans Administration
Medical Center, Chicago, Illinois
Gail Winger, Departments of Pharmacology and Psychology, University of
Michigan, Ann Arbor, Michigan
Roy A. Wise, Center for Research on Drug Dependence, Department of Psy
chology, Concordia University, Montreal, Quebec, Canada
James H. Woods, Departments of Pharmacology and Psychology, University
of Michigan, Ann Arbor, Michigan
Alice M. Young, Departments of Pharmacology and Psychology, University of
Michigan, Ann Arbor, Michigan
Preface
The previous volume, The Pathogenesis of Alcoholism: Psychosocial Factors,
attempted to describe the interaction of biological, psychological, and
social factors that lead to the initiation and perpetuation of alcoholism.
The preface to that volume presented our particular view of the bio-.
psycho-social interaction as a progressive process in which earlier
developments produce new pathogenetic mechanisms, which in turn
lead to still other cyclical feedback activities. Although influences from
each of the three phenomenologic levels are at work during each stage
of the clinical course, it would appear that social factors are most
significant in the early phase, psychological factors at the intermediate
level, and biological ones toward the end. These differences are only
relative, however, for influences of all three types surely are operative
during all stages of the syndrome.
This appears to be particularly true for the biological parameters
of activity. Don Goodwin (1976), who has supplied much of the data
that support the role of hereditary factors in alcoholism, is wont to say
that all living behavior is biological-by definition. The operational
evidence for this is perhaps more evident in alcoholism than in other
syndromes. For example, the general social indifference of many Asians
to alcohol may reflect the presence of an atypical isoenzyme of alcohol
dehydrogenase rather than some independently derived cultural norm.
Similarly, the greater tendency of certain individuals to develop psy-
vii
s
8 edical complication rrhosis, Pancreatitis, Cardiomyo-pathy, etc.
M Ci
e ve
mag ratig
7 ain da cipient Persevedrinkin
Br In
lcoholism 6 Protracted ab-stinence syndrome Persistent low-grade withdrawal symptoma-tology
A
tic Course of 5 Development of physical dependence Withdrawal symptoms Tremor
e
n f
e o
hog ent e
The Pat 4 Developmtoleranc Metabolic
TABLE 1. 3 evelopment of psychological dependence ositive reinforcement conditioning paradigm
D P
s
2 The psycho-pharmaco-logic effectof alcohol Euphoriant Stimulant Sedative
al al
Predisposing factors Biological Genetic Prenatal Constitution Psychobiologic Psychological
ke off me
vere WernicKorsaksyndro
e
S
ysiological Ph and psychological cravings Reactivation of physical dependence by drinking
s g
n nce kin cal
Anxiety DepressioSleep disturba uring drin Loss of control fter bstinence ysiologiPh craving
D AA
oral ogical
vi ol
ha ysi
e h
B P
al
c
gig
on
ycholcravi
s
P
Tranquilizing Antidepressant Intoxicating
Addictive Personality Psychosis Neurotic reactions cial Family Cultural Social
o
S
x Preface
chological dependence on alcohol may be due to differences in the
pharmacological action of alcohol in different individuals, or indeed to
differences in the structure and function of the individual's brain
reward system. Certainly there must be a biological anlage to all social
and psychological activities-by definition-and our understanding of
the entire process will inevitably be enriched by our knowledge of
biological function.
One of us (Kissin, 1979) has outlined the biological stages of
alcoholism leading from incipient predisposing vulnerability to final
severe organic disease. The eight stages in development of alcoholism,
as described at the top of Table 1, are self-explanatory and form a
clinical sequence that occurs in the history of most, or perhaps all,
alcoholics. The items listed in each column represent the more signifi
cant effects and reactivities resulting from the dominant mechanisms
that characterize each phase (i.e., the respective headings). Although
the social and psychological equivalents of these biological developments
are not specifically spelled out, they are easily extrapolated from the
biological and behavioral data.
At this point, two alternative models of the course of the devel
opment of alcoholism seem to have been presented here-the linear
sequential model illustrated in Table 1 and the computer
feedback-feedforward model described in Chapter 13 of the previous
volume (Gohlke et at., 1983). These two models are not at all contra
dictory; they are indeed rather complementary. The linear model of
Table 1 can readily be translated, with only slight modification, into the
feedback loops of the computer model generated by Collike et al. (1983).
For example, Ludwig (1983) has postulated that persistent subclinical
withdrawal symptoms (Table 1, column 6) produce a secondary psy
chosocial dependence on alcohol, feeding back to column three. Simi
larly, recent evidence (Ryan and Butters, Chapter 12) suggests that
early damage to the frontal lobes (column 7) results in perseverative
drinking, another type of feedback to column three, which then follows
sequentially into the next three columns.
These, then, are the dominant themes of these two volumes: that
alcoholism is a multidetermined condition involving biological, psycho
logical and social influences; that these influences may themselves be
modified by activities at the other levels (social and psychological
tendencies may result from biological anlage, biological reactivities may
be changed by social and psychological experience); that alcoholism is
a progressive syndrome in which different sequential effects are intro
duced at different stages; and finally that, because of the progressive
nature of alcoholism, intervention should be directed at interrupting