Bout and Continuous Drinking in Alcoholism

100 alcoholics were classified according to their drinking patterns, sex, social class, and preferred alcoholic beverage. The continuous form of drinking (delta alcoholism) predominated in male patients, and the bout variety (gamma alcoholism) in females; as male subjects were more numerous the continuous pattern was the most frequent in the series. The types of alcohol beverage consumed did not affect the relative incidence of drinking patterns, but in males continuous drinking was significantly more common in subjects from social classes I and II (professional and managerial occupations), while patients from these social strata were also more liable to drink spirits. It is suggested that the ambiguous phrase “loss of control” has prevented full recognition of the common occurrence of the continuous form of drinking among United Kingdom alcoholics. The high relative frequency of this pattern, in which marked intoxication is generally avoided, helps to explain some of the difficulties of case finding in alcoholism, as well as the ability of certain alcoholics to drive after heavy drinking without an invariable gross impairment of performance. Thirty per cent of the patients (63 per cent of females) usually drank wine preparations that, whether fortified or not, were commonly inexpensive.     

Beiträge zum Problem des symptomatischen Alkoholismus–I. Endogene Psychosen und “Alkoholismus”*

Abstract We talk in Jellinek's sense about the disease of alcoholism, but we must regard the word “alcoholism” as a collective clinical conception in which we see: (1) “abnormal” habitual drinkers who drink too much and too often, but need not do so, for they are not dependent upon alcohol; (2) “real” alcoholics who also drink too much and too often because they cannot help it, i.e., because of their alcohol dependence they can be only alcoholics or abstainers; (3) symptomatic drinkers, in whom the everyday or periodic misuse of alcohol functions as a symptom or auto-correction system of some fundamental psychiatric disorder. These “double” cases can occur together but can change the course of both diseases, sometimes favourably and sometimes unfavourably. We have investigated this problem of symptomatic alcoholism over a period of many years, and have pointed out the importance of the reciprocal action between the abuse of alcohol and schizophrenia. In the case of our 29 schizophrenic drinkers we have observed and described several typical forms of these pathoplastic constellations. We also found, in the history of 100 non-selected cyclothymics 19 cases of the symptomatic abuse of alcohol, which in the majority of cases led only to a non-typical or even a typical–i.e., manic or melancholically amalgamate–intoxication, but in 8 cases led to a prolonged bout of habitual or relief drinking. Both these possibilities occurred very often in female cyclothymics. In the pathogenesis of not a few cases the endogenic and endoreactive disturbances of the affectivity can, in addition to the well-known sociological and psychological factors, play a causative or pathogenetic role. On the other hand, in the coincidence of schizophrenia and alcoholism, pathoplastic intermediate effects occur only from one case to another.     

An Investigation of an Alcoholism Rehabilitation Halfway House: IV Attractions of the Halfway House for Residents

Ingredients of an alcoholism halfway house rehabilitation programme which were thought a priori to be “therapeutic” were generally considered relatively unimportant by halfway house residents but having a “no drink rule” at the house was perceived as being the most important ingredient. A factor analysis suggested three interpretable dimensions of perceived importance to residents. The first two appeared to reflect relative degrees of interest, firstly, in verbal therapy, and secondly, in the opportunity for social recovery. It is argued that these two dimensions reflect rather different conceptions of a halfway house and that halfway house provision in the alcoholism field should allow for both conceptions and should not at this stage be based exclusively upon one or other of them. The third factor contrasted an interest in “getting by alone” and an interest in exposure to Alcoholics Anonymous and other sources of information on alcoholism. Residents whose alcoholism was relatively chronic tended towards the latter interests.     

The management of medically unexplained symptoms

Medically unexplained symptoms occur in up to 50% of new medical out-patients. Health care seeking may not be related to the presence of physical disease but may reflect social problems, psychological disturbance, or frank psychiatric disorder. Management of unexplained physical symptoms depends on the duration of symptoms. If acute, exclusion of physical disease, as well as providing symptomatic care, is a priority. The patient's fears of illness need to be addressed and an explanation in simple terms of the symptoms provided. Adverse life situations should be identified and, where possible, rectified. Psychiatric disorders require appropriate treatment. When symptoms are chronic, conservative management is required to contain the symptoms and avoid iatrogenic problems.     

Conceptions of alcoholism.

Alcoholism educators have assumed that endorsement of the disease concept of alcoholism would reduce the moral stigma associated with the condition, thereby promoting a more humanitarian approach to the alcoholic. The present study presents data relevant to these assumptions. Measures of beliefs about the medical and moral nature of alcoholism were collected from 1,446 work supervisors in federal agencies. Additionally, social acceptance, tolerance of the alcoholic's absenteeism, and charitable responses to the alcoholic were measured. Results indicated that beliefs about the moral character of the alcoholic and beliefs about the medical nature of alcoholism are significant predictors of social acceptance of the alcoholic, tolerance of work behavior of the alcoholic, and a charitable response to the alcoholic. Findings are discussed in terms of the importance of educational efforts aimed at dispelling beliefs about the moral nature of alcoholism.     

Towards a Three-process Learning Theory of Alcoholism

An etiological theory of alcoholism stimulus response learning, social learning, and physiological dependence and withdrawal phenomena is outlined. Two extreme types of alcoholic are described and held to anchor a continuum on which any case of alcoholism can be located: the “screwed-up” alcoholic whose alcoholism is largely attributable to inappropriate social learning, and the “precipitated” alcoholic whose alcoholism can largely be explained by stimulus–response learning. A system of criteria by which “precipitated” and “screwed-up” alcoholics can be differentiated is detailed, and an experimental paradigm for testing the theory is described.     

Public Health Implications of the Enroll and Clayson Licensing Reports*

It is well known and emphasized by the Erroll Committee itself that “the picture …, particularly over the last 20 years, is of rising overall consumption, accompanied by an increase in alcoholism death rates and in offences of drunkenness…”, and among the young in the last few years not only a rise in drunkenness offences but also in the rates of alcoholism. (Glass 1972). Further research in this field is obviously necessary, but from the public health point of view one may seriously question whether this is the best time to recommend a marked relaxation of licensing laws, and increase the availability of drink, venues, hours and opportunities for drinking, for all age groups, thus making drink more widely available and socially more acceptable.     

« COVID long » : une opportunité pour approcher la complexité des syndromes fonctionnels post-infectieux

In this work, we address the issue of prolonged symptoms following an infection by SARS-CoV-2, labeled “long COVID”. This clinically unspecific syndrome must be put in perspective with the post-infectious syndromes known for a long time but ultimately poorly understood and little studied, qualified, for lack of convincing arguments for a unambiguous pathophysiology and better terms, as functional somatic syndromes. The clinical implications for clinical care (“holistic” work-up and care of patients), for research (need for truly “bio-psycho-social” investigations), and the social implications of “long COVID” (social construction of the syndrome through the experiences of patients exposed on social networks, inequalities in the face of the disease and its socioeconomic consequences) are considered. “Long COVID” must be view, because of its expected prevalence, as an opportunity to address the complexity of post-infectious (functional) syndromes, their risk factors, and the biological, psychological and social mechanisms underlying them.     

Occupational risk factors in alcoholism

This study has investigated the presence and influence of six of the eight risk factors previously identified, which are common to occupations associated with high rates of alcoholism. The factors studied were availability of alcohol at work, social pressure to drink from colleagues, separation from family due to work commitments, lack of supervision, collusion by colleagues, and stresses and strains. The sample was drawn from problem drinkers attending a community drug treatment centre in London. None of the six factors was found to have a significant influence on the development or maintenance of these subjects' alcohol problems. It is concluded that these risk factors, while previously shown to be associated with those who seek medical treatment for the physical consequences of long-term alcohol misuse, are not of significance in the different populations of those who present for psychological alcohol treatment.     

Alcoholism

Alcoholism, more than any other illness, requires the integration of social and family history, physical symptoms and signs, and laboratory data in order to make a firm diagnosis. Common in alcoholism is the patient's minimization or denial of the disease and its symptoms, thwarting efforts at early diagnosis and intervention. If early diagnosis is to be made, several points should be remembered: 1. Life problems associated with alcohol use are the earliest signs of the disease. 2. There are few reliable early physical symptoms and signs. 3. Laboratory markers of alcoholism are neither sensitive nor specific when used alone as screening tools. 4. Alcoholism questionnaires, e.g., the MAST or the CAGE, should be a part of routine office practice in screening for alcoholism. Effective therapy is available, but early diagnosis is necessary for the best outcome. Gallant has reminded us of the "tragedy of delayed treatment." Early recognition of alcoholism puts the internist, as well as other primary care providers, in the best position to begin the process of healing the patients and their families.     

Skid row alcoholism. A distinct sociomedical entity.

The physical-disease charcteristics of 125 skid row and 736 non-skid row male alcoholics were compared in detail to determine whether skid row alcoholism is characterized by a distinct medical, as well as a social, profile. Trauma, tuberculosis, venereal disease, and malnutrition were more common in the skid row alcoholics. Epilepsy, peripheral neuritis, acute brain syndromes, chronic brain disease, and lifetime recordings of all nervous system illnesses also occurred more frequently in the skid row group, as did gastritis, gastrointestinal hemorrhage, ulcer surgery, and postgastrectomy syndrome. Fatty liver, hypertension, ischemic heart disease, cardiomyopathy, and cardiovascular illnesses of all kinds, however, were less common. The skid row medical profile is, in part, the product of a unique sociologic environment. Thus, skid row alcoholism may be viewed as a distinct sociomedical entity.     

Loss of control and inability to abstain: the measurement of and the relationship between two constructs in male alcoholics

The constructs “loss of control” and “inability to abstain” have been used extensively in alcohol research. Examination of the literature, however, reveals inconsistencies in the ways researchers have operationalized and measured these constructs and a dearth of empirical investigation of the validity of the constructs. The current study examines a number of methods of operationalizing loss of control and inability to abstain and investigates the relationship of the two constructs with each other. Ninety-seven male alcoholics who participated in an outpatient conjoint alcoholism treatment study provided data on pre-treatment alcohol consumption and self-report measures of lifetime drinking behavior. Nine interview or questionnaire items that best approximated items used in the literature to measure inability to abstain and loss of control were chosen for analysis. Items measuring both constructs were highly intercorrelated and were associated more strongly with quantity rather than frequency of alcohol consumption, suggesting significant overlap between the constructs. None of the items were associated with a particular drinking pattern. The results provide support for a unitary dimension of impaired control, as used in the alcohol dependence syndrome, and suggest that the value of loss of control and inability to abstain as distinct and meaningful constructs should be reconsidered.     

Brain Damage due to Alcohol Consumption: An Air-encephalographic, Psychometric and Electroencephalographic Study

Thirty-three male “alcoholics” and other heavy drinkers were examined by air-encephalography, psychometry and the EEG to determine the incidence of brain-damage. Seventy per cent had radiologically significant atrophy and in 65 per cent of these, psychometry supported a diagnosis of brain-damage, although this was clinically apparent hi only one case. Cortical atrophy seemed more closely related to intellectual damage than ventricular atrophy, and the EEG was relatively unhelpful. The term “omega-alcoholic” is proposed for a type of drinker not previously described. Alcoholic brain damage is not uncommon and may be a factor in heavy drinkers with diagnoses other than “alcoholism”. For both diagnostic and therapeutic reasons, combined radiological and psychometric assessment is suggested as a routine measure in the management of patients who drink heavily.     

Recovery from alcoholism in cirrhotic patients: A study of 45 cases

In order to determine factors that influenced their recovery from alcoholism, 45 men who attended a liver clinic were studied, employing a detailed questionnaire. All had shown classic signs of cirrhosis, and 84 percent were in frank hepatic failure at the time of hospitalization. In general, they were married, blue-collar workers who drank, on average, for 27 years and either abstained or sharply curtailed their alcohol intake for 3.7 years (range one to 11 yrs) following which their hepatic function improved steadily.They reported that severe medical illness was a critical factor in the decision to stop drinking (87 percent) and that continued medical care was very helpful in their recovery from alcoholism (73 percent). Formal alcoholism treatment seldom was employed. Most stated that they “did it on their own.” Improvement in health, in psychologic state, in marital and social relations reinforced sobriety.The results indicate the potential impact of medical illness on the decision to stop drinking and the need to study further the factors that promote recovery from alcoholism in medical settings.     

Alcohol dependence—an illness with a treatment?

Unlike some countries, Britain may have experienced a rise rather than a fall in alcohol-related illness during a decade when consumption has not risen. Objections to the “illness concept” may impede our vision and the range of services we develop. It is possible to agree with objectors to the illness concept that a unidimensional view is unhelpful; that explanations are often only attributions; that the construct “illness” is not needed for help to be offered, its use could undermine self-mastery, and its misuse can breach civil fights. Learning can explain much over-drinking. However, the concept need not imply bimodality of drinkers; the syndrome of alcohol dependence has uses and does not imply a cause; physical and mental explanations are not incompatible; genetic and biochemical research has promise. Developments in treatment are still limited, but the mysteries of the free-will dilemma should not prevent us seeing physiological, psychological and social contributants of partners rather than rivals.     

Hochaltrigkeit als Akzeptanzproblem

The demographic trend towards an ageing society implies increasing numbers of persons well advanced in years. According to a performance-oriented sociocultural frame of reference, the societal acceptance of this group in terms of personal esteem and social integration is no longer self-evident. Based upon generalizing prejudices, disregarding the individual progress of ageing, elderly persons are often perceived as an unproductive burden. By means of detailed theses, problem areas are presented and analysed, linked to a reduction of “useful” social performance and to patterns of reaction against the loss of personal and social acceptance. Potentials for the advancement of a self-determined life practice, aiming at maintaining largely the competence for meaningful personal action, are discussed. A “humanization of well advanced old age” is advocated, combining as long as possible competence for independent living with social integration through active citizenship.     

Rehabilitation und Trainingstherapie als Baustein der COPD-Therapie

Pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) involves the application of complex, multidisciplinary, scientifically based therapeutic methods to improve productivity and quality of life. This leads to better social integration, and reduces disease related disabilities and limitations in activities of daily life. Exercise training is the most important part of the rehabilitation process, with respiratory and physical therapy, evaluation and adjustment of medication playing important roles. Education in smoking cessation programs, nutritional support and osteoprotection can add substantial benefits to the therapeutic process. Essential goals of the treatment program are to provide psychological and social support as well as education, motivation to give the patient the necessary tools to handle exacerbation and develop competence in self management. COPD leads to a progressive reduction in cardiopulmonary function. This article is based on exercise training as the “gold standard” for rehabilitation in these patients. Other essential therapeutic options in the rehabilitation of COPD patients are discussed in other parts of this journal.