The book breaks all the rules about treating alcoholism. It’s not just about the stereotypical alcoholic but for the invisible majority, the middle class drinkers, the people who are in control of their lives but with one significant exception that they have already concluded that their use of alcohol is excessive. These are the silent majority the ‘Sophisticated Alcoholics’. Nobody really knows how many there are but there is a suspicion that the number is very large indeed. People who come to see me privately for help with their own personal battles with alcohol are invariably members of this group. The book would be about a cure were alcoholism to be an illness instead of a behaviour but, instead it is about resolution, a permanent change of relationship between the person and the bottle so that alcohol ceases to retain any importance in a life. I belonged to this group for too many years and now I don’t. People can completely change their relationship with alcohol if they address the real issues lying behind and driving their actions because I and others have done so. Alcoholism, as it turns out has nothing to do with alcohol.
The present volume contains a large variety of treatment approaches to the long-term rehabilitation of the alcoholic, ranging from the biological to the physiological to the psychological to the social. The multiplicity of proposed therapies, each of which has its strong proponents, suggests that alcoholism is either a complex medical-social disease syndrome requiring a multipronged treatment approach or a very simple illness for which we have not yet dis covered the remedy. The latter may, indeed, be true, but we cannot use what we do not know and must use what we do know. We do, however, have the obligation to be responsible in our treatment, to provide the best that is known at this time, and to be discriminating in our prescription of appropriate treat ment for individual patients. If there is one conclusion we would like to offer in our preface, it is that alcoholics constitute a markedly heterogeneous popula tion with widely disparate needs, for whom, at least at our present level of knowledge, a broad spectrum of treatment modalities is necessary. If this is true, then probably most of this book has validity. With this volume on the treatment and rehabilitation of the chronic alco holic, we bring to completion our five-volume series, The Biology of Alcoholism. As the title of the present volume indicates, we have departed from our original intention to deal solely with biological aspects of the syndrome and have attempted rather to produce a more comprehensive work.
An intriguing look at the history of alcoholism and its dramatic effects, from the first fermented grape to current advances in genetic research. • Includes sidebars with statistics, fascinating facts, and portrayals of alcoholism in pop culture • Provides a specialty bibliography of significant materials from the fields of history, epidemiology, psychology, and addiction therapy
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.
The question how alcohol alters mood states and why this may end up becoming an addiction is puzzling alcohol researchers since decades. In this volume, an assembly of highly distinguished experts and leaders in alcohol addiction research provides lucid presentations of the current knowledge and research challenges as well as interesting viewpoints on future research directions aimed to stimulate communication and convergence between clinical and preclinical researchers, and to renew interest in the vibrant field of alcohol addiction research among a wide scientifically minded audience. Five Current Topics are discussed in this volume: Neurobiological mechanisms of alcoholism, Genetics, Clinical phenotypes and their preclinical models, Brain imaging, and Translational approaches for treatment development, both pharmacological and non-pharmacological. These areas have in our opinion brought alcohol research substantially forward and influenced our thinking about how to reach our common paramount goal, namely to offer effective treatment solutions for an extensive group of patients with largely unmet medical needs.