Recent Developments in Alcoholism

From the President of the Research Society on Alcoholism This annual book series is a valuable resource for the alcoholism field, because it provides critical and timely reviews of selected areas that have interest to both practitioners and researchers. It tries to achieve a balance between psy­ chosocial and biomedical topics and between research and patient-care activ­ ities. Such a mix is offered in Volume 6. The Research Society on Alcoholism­ whose membership embraces researchers from all disciplines that study the etiology, treatment, and prevention of alcoholism and alcohol-related disa­ bilities-regards the support and sponsorship of this book series as one of its major missions. Ting-Kai Li, M. D. President, Research Society on Alcoholism From the President of the American Medical Society on Alcoholism and Other Drug Dependencies The broadening scope of clinical and scientific interest in alcohol dependence is reflected in this sixth volume of Recent Developments in Alcoholism. It offers valuable reviews on important current issues in the field, namely, the inter­ twining of nature and nurture, a continuing search for predictors and indi­ cators of the disease, and the social impact of alcoholism on the job and in special populations. This material should pique the interest of clinicians from all disciplines. Medical, social, and political planners also need to turn to the expanding body of knowledge in the field of chemical dependence reflected here. The volume is therefore of value to a contemporary readership and to those who will turn to it in future years.

I. Substance Abuse and Posttraumatic Stress Disorder.- Overview.- 1 Posttraumatic Stress Disorder and Substance Abuse: Clinical Issues.- 1. Introduction.- 2. Awareness.- 3. Diagnosis.- 4. Predisposing Factors.- 5. Countertransference.- 6. Treatment Priorities.- 7. The Defenses.- 8. Individual and Group Psychotherapies.- 9. Medications.- 10. Family Therapy.- 11. Conclusions.- References.- 2 The Interrelationship of Substance Abuse and Posttraumatic Stress Disorder: Epidemiological and Clinical Complications.- 1. Behavioral Theories of Alcohol Abuse.- 2. Substance Abuse among Returning Vietnam Veterans.- 3. The Persistence of Substance Abuse Problems in Vietnam Veterans.- 4. A Study of Substance Abuse among PTSD Vietnam Veterans.- 5. The Relationship of Combat Exposure to Substance Abuse.- 6. Findings from the Major Epidemiological Studies.- 7. Methodological Issues in Understanding the PTSD-Substance Abuse Relationship.- 7.1. Sampling.- 7.2. Assessment of PTSD.- 7.3. Assessment of Alcohol and Drug Use.- 8. Clinical Considerations in the Assessment and Treatment of the Dual-Disorder Patient.- 9. Conclusions and Summary.- References.- 3 Biological Mechanisms in Posttraumatic Stress Disorder: Relevance for Substance Abuse.- 1. Introduction.- 2. Biological Findings with PTSD.- 2.1. Psychophysiological Evidence.- 2.2. Biochemical Correlates of PTSD.- 2.3. Hypothalamopituitary Adrenocortical Axis in PTSD.- 2.4. Pharmacological Approaches to PTSD.- 3. Neurobiological Models of PTSD.- 3.1. The Locus Ceruleus and Central Noradrenergic Systems.- 3.2. Alarm Behaviors and Central Noradrenergic Activity.- 3.3. Other Conditioned Arousal States Relevant for PTSD.- 4. Biological Basis for PTSD Symptoms and Substance Abuse.- 4.1. Stress, Inescapable Shock, and Substance Abuse.- 4.2. PTSD and Drug Withdrawal States.- 4.3. Hedonistic Aspects of Drug Abuse.- 5. Conclusions.- References.- 4 Coping and Defending Styles among Vietnam Combat Veterans Seeking Treatment for Posttraumatic Stress Disorder and Substance Use Disorder.- 1. PTSD among Vietnam Combat Veterans.- 2. Addiction and Measuring Ways of Coping.- 3. Peck’s (1981) Model of Competence in Coping.- 4. Method.- 4.1. Subjects.- 4.2. Instruments.- 5. Results.- 6. Discussion.- References.- 5 Posttraumatic Stress Disorder in World War II and Korean Combat Veterans with Alcohol Dependency.- 1. Overview.- 2. Literature Background.- 3. Alcohol Effects on PTSD Symptoms.- 4. Incidence and Implications of Combined Substance Abuse and Psychiatric Disorders.- 5. PTSD in Older Alcoholic Combat Veterans.- 5.1. Subjects.- 5.2. Procedure.- 5.3. Results.- 5.4. Discussion.- References.- II. Alcohol and Its Management in the Workplace.- Overview.- 6 The Epidemiology of Alcohol Abuse among Employed Men and Women.- 1. A Theoretical Framework.- 2. Some Methodological Problems.- 2.1. Definition of Job Stress.- 2.2. Mortality Data.- 2.3. Morbidity Data.- 3. The Detroit Study: Methods and Measures.- 3.1. Alcohol Use and Abuse.- 3.2. Job Pressures and Other Conditions.- 3.3. Job Stress and Background Variables.- 4. The Detroit Study: Results and Discussion.- 4.1. Regression Analysis.- 4.2. Alternative Interpretations.- 4.3. Further Research.- References.- 7 Growth and Transformation in Workplace Alcoholism Programming.- 1. Macrolevel Factors and the Emergence of Workplace Programming.- 2. The New Epidemiology of Alcohol Problems.- 3. Variations in Program Structures.- 4. The Core Technology of Workplace Programs.- 5. The Impact of the EAP Model.- 6. Origins of the Self-Referral Emphasis in EAPs.- 7. Research Findings about Workplace Alcoholism Programming.- 8. Needed Research about Alcoholism and Its Treatment in the Workplace.- References.- 8 Constructive Confrontation and Other Referral Processes.- 1. Constructive Confrontation.- 2. Basis for the Strategy.- 3. Occupational Versions.- 4. Evaluation of Constructive Confrontation.- 5. Self-Referral.- 6. Concluding Remarks.- References.- 9 Identification of Alcoholics in the Workplace.- 1. The Supervisory Identification Process: The Model Described.- 2. The Supervisory Identification Process: The Empirical Research.- 3. The Effect of Organizational Factors and Individual Differences among Subordinates and Supervisors.- 4. Summary and Implications: Expansion of the Program Model.- References.- 10 Monitoring the Process of Recovery: Using Electronic Pagers as a Treatment Intervention.- 1. Experience Sampling Method.- 2. The Process of Recovery.- 2.1. The Beeper Project.- 2.2. The Nature of the Groups.- 2.3. Analysis of the Data.- 3. Clinical Application.- 4. Conclusion.- References.- 11 Posttreatment Follow-up, Aftercare, and Worksite Reentry of the Recovering Alcoholic Employee.- 1. Effectiveness of Aftercare.- 2. Relapse Prevention.- 3. Worksite Reentry of Employed Alcoholics.- 4. A Nontraditional Approach to Aftercare.- 5. Role of EAPs in Aftercare and Relapse Prevention.- References.- 12 New Occupations and the Division of Labor in Workplace Alcoholism Programs.- 1. Certification of Employee Assistance Professionals.- 2. Technical Developments.- 3. Social Movement.- 3.1. Consultants.- 3.2. Administrators.- 4. Standards and Boundaries.- 5. Division of Labor.- References.- III. Consequences of Alcohol Abuse Unique to Women.- Overview.- 13 Effects of Moderate Consumption of Alcoholic Beverages on Endocrine Function in Postmenopausal Women: Bases for Hypotheses.- 1. Introduction.- 1.1. Demographic Considerations.- 1.2. Postmenopausal Estrogenization and Disease Risk.- 1.3. Consumption of Alcoholic Beverages by Postmenopausal Women.- 2. Meager Knowledge concerning Alcohol Effects on Postmenopausal Endocrine Function.- 2.1. Acute Effects of Alcohol.- 2.2. Chronic Effects of Alcohol.- 2.3. Summary of Current Information concerning Endocrine Effects of Alcohol in Postmenopausal Women or in Relevant Animal Models.- 3. Study Design Considerations for the Evaluation of Effects of Moderate Alcoholic Beverage Consumption on the Endocrine Function of Normal Postmenopausal Women.- 3.1. Postmenopausal Endocrine Function.- 3.2. Factors that Influence Circulating Steroid Levels in Normal Postmenopausal Women.- 3.3. Summary of the Factors Known to Affect Postmenopausal Steroid Levels and the Need to Incorporate Such Variables into the Design of Future Studies.- References.- 14 Effects of Alcohol Abuse on Reproductive Function in Women.- 1. Clinical Studies of Reproductive System Dysfunctions in Alcoholic Women.- 1.1. Amenorrhea.- 1.2. Anovulation and Luteal Phase Dysfunction.- 2. Clinical Studies of Alcohol Effects on Female Reproductive Function in Social Drinkers.- 3. Survey Reports of Alcohol Effects on Reproductive Function.- 4. Studies of Chronic Alcohol Effects in Animal Models.- 5. Alcohol Effects on Reproductive Function in Primate Models.- 6. Alcohol Effects on Reproductive Function in Rodent Models.- 7. Studies of Acute Alcohol Effects in Women and Animal Models.- 7.1. Alcohol Effects on Basal Hormone Levels.- 7.2. Alcohol Effects on Artificially Stimulated Pituitary and Gonadal Hormones.- 8. Directions for Future Research.- References.- 15 Maternal Ethanol Use and Selective Fetal Malnutrition.- 1. Introduction.- 2. Pathogenesis of Ethanol-Induced Injury.- 3. Maternal Nutrition.- 4. Ethanol and Fetal Tissue.- 5. Placentotoxicity and Selective Fetal Malnutrition.- References.- 16 Ethanol Metabolism and Hepatotoxicity: Does Sex Make a Difference?.- 1. Pharmacology of Ethanol.- 1.1. Absorption.- 1.2. Ethanol Pharmacodynamics.- 1.3. Ethanol Metabolism.- 1.4. Summary.- 2. Specific Differences between Males and Females.- 2.1. Sex Differences in Various Ethanol Pharmacokinetic Parameters.- 2.2. Sex Differences in Ethanol Metabolism.- 3. Sex Differences in Ethanol Ingestion Rates and Ethanol-Induced Liver Disease.- 4. Summary.- References.- IV. Markers for Risk of Alcoholism and Alcohol Intake.- Overview.- 17 Physiological and Psychological Factors as Predictors of Alcoholism Risk.- 1. Introduction.- 2. The Intensity of Reaction to Ethanol.- 3. Neuropsychological Differences between Higher-Risk and Lower-Risk Populations.- 4. Personality Test Differences.- 5. Enzymes and the Risk for Alcoholism.- 6. Discussion.- References.- 18 Brain Evoked Potentials as Predictors of Risk.- 1. Evoked Potentials and Brain Function.- 2. Evoked Potentials and Heritability of Alcohol Response.- 3. Evoked Potentials in High-Risk Subjects.- 4. Strengths and Possible Pitfalls.- References.- 19 Molecular Markers for Linkage of Genetic Loci Contributing to Alcoholism.- 1. Introduction.- 2. Linkage Analysis Using Panels of Random Protein and DNA Genetic Markers.- 2.1. DNA and Protein Polymorphic Markers.- 2.2. Restriction Fragment-Length Polymorphisms.- 2.3. Protein Polymorphisms.- 2.4. Markers for Loci Expressed in Brain.- 3. Strategies for Use of Markers and the Probability of Establishing Genetic Linkage.- 3.1. Probability of Establishing Genetic Linkage.- 3.2. Contrasting Strategies for Genetic Linkage in the Human.- 4. Linkage Studies with Nonspecific Genomic Markers.- 4.1. Human Studies.- 4.2. Mouse Studies.- 5. Genetic Mapping of Behavioral Traits Related to Alcoholism in the Mouse.- 6. Specific Locus Functionality and Probes.- 6.1. Neurochemical and Receptor Differences.- 6.2. Alcoholism, Impulsivity, and Central Serotoninergic Activity.- 6.3. Platelet Monoamine Oxidase.- 6.4. Benzodiazepine Receptor.- 6.5. Enzymes of Ethanol Metabolism.- 7. Conclusions.- References.- 20 Blood Markers of Alcoholic Liver Disease.- 1. Genetic Markers.- 2. Empirical Markers.- 2.1. Precirrhotic Markers.- 2.2. Markers of Inflammation and Necrosis.- 3. Markers of Alcohol Intake.- References.- 21 Discriminant Function Analysis of Clinical Laboratory Data: Use in Alcohol Research.- 1. Introduction.- 2. Sample Definition.- 2.1. Diagnosis, Homogeneity, and Generalizability.- 2.2. Subject Sample Size/Number of Predictor Variables/Choice of Variables.- 3. Linear versus Quadratic Function Methodology and Conceptual Issues.- 3.1. Measuring Mean Differences and Variability.- 3.2. Scientific Validity.- 3.3. Function Validation.- 3.4. Interpretation of Classification Results.- 4. Discussion.- 4.1. Ethical Issues.- 4.2. What Do We Know and Where Do We Go?.- 5. Summary and Recommendations.- 5.1. Diagnosis.- 5.2. Sample Size.- 5.3. Assessment of Other Variables.- 5.4. Goals and Intentions.- 5.5. Prior Probabilities.- 5.6. Scientific Validity.- 5.7. Validation of Discriminant Function Results.- 5.8. Ethical Concerns Involving Disciminant Function Analysis.- 6. Future Directions.- References.- 22 Acetaldehyde and Its Condensation Products as Markers in Alcoholism.- 1. Urinary Condensation Products or Oxidized Derivatives in Human Subjects: TIQs in Alcoholics.- 2. Urinary THBCs and B Carbolines in Alcoholic Subjects.- 3. TIQ Excretion in Nonalcoholic Human Volunteers.- 4. THBC and BC Excretion in Nonalcoholic Human Volunteers.- 5. Urinary Condensation Products in Untreated and Ethanol-Treated Rats.- 6. Condensation Products in the CSF of Human Subjects and Nonhuman Primates.- 7. Assays of Condensation Products in Blood Components of Humans and Rats.- 8. Summary and Conclusions.- References.