Medical and social aspects of alcohol abuse


Medical and social aspects of alcohol abuse

edited by Boris Tabakoff, Patricia B. Sutker, and Carrie L. Randall

Plenum Press, c1983

大学図書館所蔵 件 / 3



Includes bibliographies and index



Alcohol use affects, either directly or indirectly, nearly all facets of Western civi- lization. Eastern cultures are also not exempt from the influence of alcohol, and the present decade has been a time of increased alcohol use in all parts of the world. The problems of alcohol abuse and alcoholism are of concern to a variety of professionals in the biomedical and psychosocial health sciences, and-although the alcohol research literature contains much information on the relationships between alcohol ingestion and physiological, neurochemical, pharmacologic, genetic, environmental, and psychological effects in humans and in subhuman spe- cies-there is at the present time no advanced textbook that integrates the avail- able information for use by both students and professionals. The writing of Medical and Social Aspects of Alcohol Abuse constitutes an attempt to create a scholarly reference and resource for students, researchers, prac- ticing clinicians, and paraprofessionals who wish to understand the complex inter- play of factors related to acute and chronic alcohol intoxication, the effects of alco- hol on body functions, and treatment approaches to alcohol abusers and alcoholics.


1 Alcohol Use and Abuse: Historical Perspective and Present Trends.- 1. Alcohol Use in Historical Perspective.- 1.1. Recent Trends in Alcohol Consumption.- 2. Alcohol Consumption and Alcohol Problems.- 3. Development of the Concept(s) of Alcoholism.- 3.1. The Traditional Approach.- 3.2. The Social-Learning/Behavioral Models.- 3.3. The Multivariate Approach.- 3.4. Advantages of the Multivariate Approach.- 3.5. Implications for the Future.- 4. References.- 2 The Genetics of Alcoholism.- 1. Types of Studies Supporting a Genetic Influence in Alcoholism.- 1.1. Family Studies.- 1.2. Animal Studies.- 1.3. Genetic Marker Studies.- 1.4. Twin Studies.- 1.5. Adoption Studies.- 2. Possible Biological Mechanisms for a Genetic Influence in Alcoholism.- 2.1. Absorption/Metabolism.- 2.2. Acute Reaction.- 2.3. Functional Tolerance.- 2.4. Susceptibility to Chronic Consequences.- 2.5. Personality.- 2.6. Relationship to Other Psychiatric Disorders.- 3. A Prospective Search for the Biological Determinants of Alcoholism.- 4. Summary.- 5. References.- 5.1. Books and Reviews.- 3 The Absorption, Distribution, and Metabolism of Ethanol and Its Effects on Nutrition and Hepatic Function.- 1. Introduction.- 2. Absorption and Distribution.- 3. Pharmacokinetics and Alcohol Elimination Rates.- 3.1. Intra- and Interindividual Variations in Alcohol Elimination Rates.- 4. Processes and Organs Responsible for Ethanol Elimination.- 5. Significant Pathways of Ethanol Metabolism.- 6. Enzymes That Oxidize Ethanol to Acetaldehyde.- 6.1. Alcohol Dehydrogenase.- 6.2. Properties of Alcohol Dehydrogenase and Genetic Variation in Isoenzymes of Human Alcohol Dehydrogenase.- 6.3. Catalase and MEOS.- 7. Enzymes That Oxidize Acetaldehyde to Acetate.- 7.1. Aldehyde Dehydrogenase.- 8. Control of Ethanol and Acetaldehyde Metabolism in Liver.- 9. Effect of Chronic Ethanol Ingestion on Alcohol Elimination Rate.- 10. Chronic Ethanol Ingestion and Nutrition.- 11. Ethanol Oxidation and Hepatic Metabolism.- 11.1. Effects on Carbohydrate and Fat Metabolism.- 11.2. Effects on Protein and Amino Acid Metabolism.- 12. References.- 12.1 Monographs and Reviews.- 4 Effects of Ethanol upon Organ Systems Other than the Central Nervous System.- 1. Introduction.- 2. Ethanol and the Gastrointestinal Tract.- 2.1. Ethanol and the Oral Cavity.- 2.2. Ethanol and the Esophagus.- 2.3. Ethanol and the Stomach.- 2.4. Ethanol and the Small Bowel.- 2.5. Ethanol and the Large Bowel.- 2.6. Ethanol and the Pancreas.- 2.7. Ethanol and the Liver.- 3. Muscle Systems.- 3.1. Heart Muscle.- 3.2. Skeletal Muscle.- 4. The Hematologic System.- 4.1. Bone Marrow.- 4.2. Iron Kinetics.- 4.3. Vitamin Deficiency.- 4.4. Macrocytosis.- 4.5. White Blood Cells.- 4.6. Coagulation and Platelet Disorder.- 5. Kidney Disease and Alcoholism.- 6. Pulmonary Disease and Alcoholism.- 7. The Endocrine System and Alcoholism.- 7.1. Gonadal and Adrenal Effects.- 7.2. The Alcoholic Female.- 8. Effects of Ethanol on the Hypothalamic-Pituitary-Adrenal Axis.- 9. Effects of Alcohol on the Hypothalamic-Pituitary-Thyroidal Axis.- 10. The Effects of Alcohol on Growth Hormone and Prolactin.- 11. Effects of Alcohol on Vasopressin and Oxytocin.- 12. Biological Markers of Alcoholism.- 13. References.- 5 Ethanol and the Central Nervous System.- 1. Ethanol and Behavior.- 1.1. General Aspects.- 1.2. Motor Function.- 1.3. Mental Processes.- 1.4. Psychological Reactions.- 1.5. Hangover.- 2. Ethanol and Membrane Structure and Function.- 2.1. Ethanol-Membrane Interactions.- 2.2. Effect of Ethanol on Electrical Properties and Ion Translocation.- 3. Ethanol and Electrical Cellular Activity.- 3.1. Electrophysiological Studies.- 3.2. Sleep Studies.- 4. Ethanol and Synaptic Transmission.- 4.1. Neurotransmitters.- 4.2. Cyclic Nucleotides.- 5. Ethanol and Metabolism.- 5.1. Intermediary Metabolism.- 5.2. Aberrant Neurotransmitters.- 6. Consequences of Long-term Ethanol Consumption.- 6.1. Clinical Effects.- 6.2. Animal Models for Brain Damage.- 7. Summary.- 8. References.- 6 Neurologic Diseases Associated with Chronic Alcohol Abuse.- 1. Introduction.- 1.1. Scope.- 1.2. Types of Interactions between Alcohol and Disease.- 1.3. Pathogenetic Mechanisms.- 1.4. Prevalence of Alcohol-Associated Diseases.- 2. Physical Dependence.- 3. Chronic Diseases of the Central Nervous System.- 3.1. Psychiatric-Behavioral Diagnoses (DSM-III).- 3.2. Neurologic-Neuropathologic Diagnoses (SNOMED).- 3.3. Nutritional Deficiencies.- 3.4. Degenerative Syndromes.- 3.5. Hepatic Encephalopathy.- 3.6. Subdural Hematoma.- 3.7. Other CNS Disorders.- 4. Peripheral Polyneuropathy.- 5. Nutritional Deficiencies.- 5.1. Gastrointestinal Tract.- 5.2. Calories.- 5.3. Vitamins.- 6. Conclusions.- 7. References.- 7 Biology of Tolerance and Dependence.- 1. Introduction to Tolerance and Dependence.- 2. Factors Contributing to Tolerance and Dependence.- 3. Classifications and Definitions of Tolerance.- 3.1. Environment-Dependent and -Independent Tolerance.- 3.2. Acute Tolerance.- 3.3. Chronic Tolerance.- 3.4. Neuronal Systems Responsible for Development of Tolerance.- 4. Biochemical Determinants of Ethanol Tolerance.- 5. Characteristics of Physical Dependence on Ethanol.- 6. Etiological Factors Contributing to the Development of Physical Dependence.- 7. Neurochemical Systems Determining Physical Dependence.- 8. Pharmacologic Management of the Acute Alcohol Withdrawal Syndrome.- 8.1. Treatment Strategy.- 8.2. Benzodiazepines.- 8.3. Paraldehyde.- 8.4. Barbiturates.- 8.5. Antipsychotics.- 8.6. Chlormethiazole.- 8.7. Anticonvulsants.- 8.8. Miscellaneous.- 9. References.- 8 Alcohol Consumption and Prenatal Development.- 1. Fetal Alcohol Syndrome/Fetal Alcohol Effects.- 1.1. Major Characteristics Associated with FAS and FAE.- 1.2. Risk Factors.- 2. Alcohol as a Teratogen in Animals, 1973-1979.- 2.1. Effects on Growth and Development and Postnatal Mortality.- 2.2. Morphologic Anomalies.- 2.3. Behavioral Teratogenic Effects.- 2.4. Neuroanatomical Changes.- 2.5. Neurochemical Alterations.- 2.6. Effects on Biochemistry.- 2.7. Protein and Nucleic Acid Synthesis.- 3. Critical Discussion and General Conclusions.- 3.1. Future Trends.- 4. References.- 9 Interaction of Ethanol with Other Drugs.- 1. Introduction.- 1.1. Definitions.- 1.2. Dose-Response Curves.- 1.3. Metabolic Principles.- 2. Centrally Acting Compounds.- 2.1. Depressants.- 2.2. Stimulants.- 2.3. Neurotransmitters.- 2.4. Metabolic Interactions.- 3. References.- 10 Psychological Correlates and Explantions of Alcohol Use and Abuse.- 1. Psychodynamic Models.- 1.1. Psychoanalytic Theory.- 1.2. The Alcoholic Personality.- 1.3. Power Motivation.- 2. The Disease Model.- 2.1. Craving/Loss of Control.- 3. Behavioral and Social-Learning Approach.- 3.1. Social Learning: The Role of Modeling.- 3.2. Tension-Reduction Hypothesis.- 3.3. Cognitive Factors: The Role of Expectancy.- 3.4. Relapse Prevention.- 4. Future Directions.- 5. References.- 11 Alcoholism Treatment Approaches: Patient Variables, Treatment Variables.- 1. Critical View of Treatment Outcome Evaluation.- 1.1. Evaluation of Heterogeneous Treatment: The "Horserace" Approach.- 1.2. Patient-Treatment Matching.- 1.3. An Alternative Model for Treatment Evaluation.- 2. Treatment Variables.- 2.1. Biological Variables.- 2.2. Individual Psychological Variables.- 2.3. The Interpersonal System.- 3. Patient Variables.- 3.1. Problem Drinking in Old Age.- 3.2. Problem Drinking in Women.- 3.3. Problem Drinking in Persons with Other Psychiatric Disorders.- 4. Implications.- 4.1. Definition and Measurement of Problem Drinking for Specific Populations.- 4.2. Definition and Measurement of Mediating Variables for Specific Populations.- 4.3. Stages of Intervention.- 4.4. Other Implications for Treatment Research.- 4.5. A Brief Description of a Hypothetical Treatment Study with Women Alcoholics.- 4.6. Concluding Remarks.- 5. References.- 12 Prevention of Alcohol Abuse.- 1. Approaches to Prevention.- 2. Alcohol Education.- 2.1. Comprehensive Educational Programs.- 2.2. Behavioral Programs.- 3. Mass Media.- 4. Alcohol Control Legislation.- 4.1. Efforts to Limit Availability of Alcohol.- 4.2. Criminalization and Punishment of Alcohol-Related Behaviors.- 5. Conclusions.- 6. References.

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