Drug and Alcohol Dependence, 5 (1980) 81 - 85 0 Elsevier Sequoia S.A., Lausanne - Printed in the Netherlands

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Book Review

Currents in Alcoholism, Volumes III and IV. Edited by F. A. Seixas. Published by Grune and Stratton, New York, 1978.

Volumes III and IV of Currents in Alcoholism are collections of papers that were presented at the meeting sponsored by the National Council on Alcoholism in the Spring of 1977. Volume III contains biochemical, physio- logical, and clinical studies which have been subdivided into several categories. Volume IV summarizes research in alcoholism related to such topics as man- agement of alcohol disorders, alcohol and family interactions, drinking and the social context, decision-making and self-selection of beverage alcohol, and drinking problems among special populations such as women, ado- lescents, and heroin addicts. Both volumes present recapitulations of previ- ously reported studies, and there is little doubt that some of the manuscripts included are characterized by inadequate experimental design, faulty conclu- sions, methodological weaknesses, and disorganized presentations. Neverthe- less, both volumes contain reports of interesting and original work, and they certainly provide an adequate overview of alcoholism research and theoriza- tion which would be particularly useful for practicing clinicians and active investigators. The most productive means of reviewing these volumes may be to consider each of the sections presented separately, to emphasize important areas of significant contribution, and to suggest implications for future research.

A meritorious aspect of Volume III is the inclusion of three overviews of recent research related to the etiology and treatment of alcoholism. These overviews deal with ethanol’s actions on the brain, by Dora Goldstein, studies on alcohol metabolism, by Olof Forsander, and clinical research in alcoholism, by Edward Sellers. They provide current and relatively critical analyses of important research within these three major areas. In fact, these reviews, although not all inclusive, certainly provide some of the more objective and informative reading that this book has to offer. The weakest aspects of Volume III are possibly a result of certain authors taking advantage of a lack of strict refereeing of their contributions to espouse points of view that are non sequiturs of presented results or that are only weakly supported by their presented or quoted data. The section that suffers most from such transgres- sions is the one dealing with neurological and electrophysiological studies on the effects of ethanol in animals. The notable exception is the chapter by Lumeng et al., which further characterizes a rat strain bred for high alcohol preference. The most interesting aspect of this work is that genetically selected animals will work to obtain alcohol even when water is available as

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an alternate drinking fluid. In the presence of sweetened alcohol solutions and with some food restrictions, such rats will consume sufficient quantities of alcohol to maintain continuously elevated blood alcohol levels which could clearly result in behavioral signs of intoxication.

The section on neurochemistry is rather uneven in content with several good presentations intermixed with those of poor quality. In general, most of the papers in this section present results which were previously published in whole or in major part in various scientific journals, and the only benefit that a reader knowledgeable in this area will find in this section is a good literature review. The papers by Larissa Pohorecky on the effects of ethanol on brain serotonin metabolism and by Edward Sellers et aE. on autonomic concomitants of ethanol withdrawal do contain some novel results in addi- tion to being vehicles for summarizing and reiterating the authors’ prior findings. The paper by Sellers et al. is particularly interesting, indicating that the hyperadrenergic concomitants of alcohol withdrawal are principally mediated by increased central autonomic outflow. This paper provides a good foundation for further research on the causes of autonomic malfunction during ethanol withdrawal and also provides insight into possible therapies for such malfunction.

The third section, concerned with neural concomitants of alcohol use and abuse, entitled Causes and Effects, is primarily concerned with factors affecting alcohol selection by animals. Within this section, the chapter on extinction of ethanol selection by the use of drugs which inhibit the syn- thesis of norepinephrine, provides data which are interpreted by the authors to indicate that the reinforcing effects of ethanol are mediated by noradren- ergic systems. Although such a conclusion may be premature on the basis of the data presented, the possibility does seem intriguing and bears further examination.

Two of the better chapters within this volume are contained in the sec- tion on metabolism of ethanol. These chapters debate currently popularized hypotheses that increased ethanol metabolism after chronic consumption results from induction of a “hypermetabolic state” in the liver, and they also provide evidence that nutrition and temporary hypoxia interact to produce the liver damage seen with chronic ethanol consumption.

The section which purportedly introduces new techniques for studies of alcohol action contains a chapter on the effects of ethanol on primary cell cultures which inexplicably indicates that addition of ethanol to the culture medium increases the rate of cell growth. These results, however, are not explored at any length. A rather cumbersome method for determination of acetaldehyde in biological samples in also presented. Nevertheless, this method may, under certain conditions, provide the necessary sensitivity to exceed that obtained with the usual gas-chromatographic procedures.

The section on interactions between pharmacologic agents and ethanol contains information on how the monoamine oxidase inhibitor, pargyline, may be transformed in uiuo to a potent inhibitor of aldehyde dehydrogenase. The transformation of pargyline to a product which inhibits aldehyde dehy-

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drogenase seems to be mediated by an NADPHdependent, SKF 525A- resistant microsomal system. With such information, future studies can be aimed at isolating and identifying the products of this metabolism and may well produce a rather specific and potent inhibitor of acetaldehyde meta- bolism in humans and animals. A further chapter of interest in this section demonstrates that increases in liver total ATPase activity observed after acute or chronic dosing with ethanol could be prevented by concomitant administration of phenobarbital. Although not examined in this chapter, an assessment of the effects of phenobarbital administration on changes in bruin Na+,K+-ATPase activity after chronic ethanol administration would be inter- esting and might resolve some of the questions surrounding the relationships between changes in ATPase activity in brain and the phenomena of ethanol tolerance and physical dependence.

The studies included in Volume III on the effects of ethanol on the heart characterize the lowering of the threshold for electric stimulation of the heart. The authors contend that chronic ethanol ingestion may promote ventricular fibrillation and thus damage contractile elements of heart muscle fibers. However, these conclusions are reticently presented, and the reader is left to surmise that substantially more work is required before such results could be generalized.

The section concerning clinical research on alcoholism contains a collec- tion of studies which range from those involving the effects of food on blood alcohol levels to methods which can be used for diagnosing alcohol abuse in patients on admittance for hospital care. A chapter on gender-related differ- ences in alcohol-induced impairment of performance reaches the conclusion that there appear to be no significant differences between men and women in responses to alcohol ingestion. It would be appropriate if the authors included in their discussion some of the more recent literature regarding the role of sex steroids in ethanol intoxication (cf. Jones and Jones, in Greenblat and Schuckit (eds.), Alcoholism Problems in Women and Children, Grune and Stratton, 1976). The chapters concerned with diagnostic aids for deter- mination of alcohol abuse are worthy of serious consideration. The proposed clinical blood tests are easily performed and many times routinely adminis- tered. Thus, their use within a hospital admissions program may better aid physicians in identifying individuals with a history of alcohol abuse and thereby provide a basis for rendering more rational hospital treatment and encouraging appropriate aftercare referrals.

Volume IV is divided into two major sections which seem more arbi- trarily determined than real. The section presenting material related to psy- chiatric and psychological investigations contains work which is difficult to separate from that described as social and epidemiological. This is largely because most psychosocial research must of necessity consider person and environmental variables as well as their potential interactions in attempting to account for given behavioral patterns. Hence, review of this volume will concentrate on topical areas and themes across studies rather than be sec- tionally restricted. Of particular interest are those investigations which give

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evidence of careful planning, ongoing research activities, and considerations for treatment management and evaluation. For example, Halikas, Darvish, and Weller report findings of significant overlap in alcohol and drug abuse problems among heroin addicts, and Davies, Stern, and Van Deusen outline a novel approach for investigating interpersonal patterns among families with alcoholic members. Both works represent continuing research efforts which have significant implications for treatment delivery. Burrus also reports an innovative approach to measurements of empathetic sensitivity and respon- siveness and their relationships to peer ratings of competence and likability as well as treatment outcome at six months. This latter study is important in that it encompasses investigation of therapist characteristics as critical vari- ables in influencing degree of client change.

One cannot peruse Volume IV without being struck by the energy devoted to studying the affective components of alcoholism disorders and relationships between depression and problem drinking. A number of reports focus on the role of depression in development of and sequelae to maladapt- ive drinking. Bell, Schwab, Lehman, Traven, and Warheit offer a particularly valuable contribution in describing the distribution of depressive symptoma- tology and its relationship to sociodemographic variables and drinking pat- terns in a sample of over 3000 people. Unfortunately, however, some of the studies attempting to investigate such interactions lack sophistication in isolating reliable or operational definitions of depression, fail to take into account potentially confounding negative cognitive or affective states such as anxiety and worry, and confuse causality with association. Another special area of concentration is description of problematic drinking among popula- tions of adolescents and women. Although the report by Kaplan and Pokorny is lengthy and confusing in presentation, the authors tie together several interesting hypotheses regarding self-perceptions, drinking patterns, and social consequences of antisocial activities among adolescents. Contextual drinking patterns among men and women are handled well by Harford, and Beckman presents valuable data describing the psychosocial characteristics of women who drink to excess.

Other presentations of particular interest include Cantor’s description of the Veteran’s Administration program to employ ex-addict and alcoholic counselors in treatment settings. Although this author reports that such counselors have fared well in terms of maintaining employment positions, there is no justification for his assumption that their contribution to the treatment process has been of direct benefit to patient therapeutic success. This seems to be a matter for future investigation and one which has impor- tant implications for treatment design. Mention should also be made of two particularly original and intriguing reports related to treatment outcome. In this day of increasing accountability, Paredes and Gregory studied relation- ships between dollar expenditures and therapeutic needs or benefits. Their conclusion that monies are not necessarily allocated to the most severe alcohol problems is certainly interesting. Alterman, Gottheil, and Thornton investigated variations in patterns of drinking among alcoholics in a program

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which allowed personal decision-making regarding alcohol intake and the relationship of drinking in this situation to six-month treatment outcome. Interestingly, abstinence was not the only drinking pattern associated with later treatment success. However, this and other studies reported in Volume IV reflect follow-up data of six months maximum, highlighting the need for expansion in terms of longitudinal research.

Considerable effort is currently being expended to explore complex relationships among alcohol ingestion, cognitive performance, personality characteristics, and subject gender variables. These issues are not adequately addressed in Volume IV and, in fact, this section is one of the weakest in the collection of papers. At this point, results reported are confusing and provide no basis for closure. In contrast, there is more appropriate treatment of other topics that have received increasing attention in recent years; for example, parenting practices and alcohol intake, paternal alcoholism and offspring behavior, and assessment of relationships between adolescent drinking and antisocial expression. Related to these issues is a report by Mayer, Black, and MacDonall on potential interactions between child abuse and parental alco- holism. Indeed, one of the advantages of Volume IV is its attention to rela- tionships between maladaptive drinking or its treatment and family inter- action patterns and contextual variables.

Finally, mention should be made of the two comprehensive sectional reviews in Volume IV. Papers by Schuckit and Irgens-Jensen adequately sum- marize the important issues covered within each section and suggest impor- tant implications for future research. Obviously, targets for focus include treatment follow-up and accountability, psychosocial explanations for mal- adaptive drinking behavior, relationships among depressive affect, self-selec- tion of beverage alcohol, and antisocial expressions, abstinence versus con- trolled drinking as treatment goals, and drinking problems among special populations of women, adolescents, and opiate addicts. Despite the weak- nesses inherent in this summary of conference papers, many of the articles reflect the increasing sophistication of alcoholism research today and take into account the complex interplay of factors contributing to the devel- opment, sustenance, and management of the disorder and its variations. It is especially in this light that Volume IV has summarized the major areas of psychosocial alcoholism research, suggested areas for future investigation, and provided a valuable source of information for active clinicians and researchers needing a manageable overview.

Boris Tabakoff Patricia B. Sutker