Abstract

Alcoholism is not a new topic for discussion. One could say that almost everyone has seen the effects of alcohol and alcoholism on a family, either through their own family or the family of someone close to them. In some countries it isn’t a problem because it is not uncommon for someone to drink alcohol on a regular basis. Many countries do not have a drinking age. But in the U.S. it is a big problem, one that requires much attention. Psychologists have been studying this issue for years and the research continues. There are many different types of psychologists and each one focuses on a specific part of the problem, however, they all need the insight from each others work to be successful. Neuroscientists study and test different drugs that may help someone to recover from alcoholism and the effects alcoholism has on the body in general. Developmentalists study different age groups to try and come up with clues as to what ages are affected the most by alcohol and what causes them to fall for the pressure of this so-called disease. They try to understand patterns that people follow when becoming an alcoholic, in order to be able to predict it in people and help them before they fall prey. Social Psychologists study societies part in alcoholism, studying things ranging from the way it is glamorized in the news to the way that society treats someone who is labeled an alcoholic. Clinical psychologists focus primarily on helping those people who have fallen prey to alcohol, by helping them to get out of the web it weaves. Together, the perspectives continue to learn more and more about alcohol, its origin, and its effects, in order to some day beat this beast that has so largely affected the lives of American people.

Although the debate continues as to whether or not alcohol is a disease, one thing is for sure, alcohol is addictive and can be extremely hard to get over ( Washousky, Thomas, 1996). Neuroscientists conduct test with alcoholic patients to test different medicines that could possibly help an addicted alcoholic abstain from alcohol dependency and go on to live a normal healthy life (Whitworth, Fisher, Lesch, Nimmerrichter, Oberbauer, Platz, Potgieter, Walter, & Fleischhacker, 1996). Before I go any further in my discussion of alcoholism, I must first define the term. This is not an easy task because like most unknown things, different people have different views and therefore define the term differently. Webster defines alcoholism as "continued excessive or compulsive use of alcoholic drinks; a complex chronic psychological and nutritional disorder associated with excessive and usually compulsive drinking" (p.69). The American Psychiatric Association defines alcoholism as "a primary chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestations. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial" (Atkinson, 1996, p 798).

One drug currently being tested by neuroscientist is acamprosate. Acamprosate is researched by neuroscientist through placebo-control which has a chemical structure similar to that of aminoacid neuromediators such as taurine and GABA. Acamprosate has been reported to stimulate inhibitory GABA transmission and to antagonize excitatory aminoacids, particularly glutamate (Whitworth, et al. 1996). In a recent study done by Alexander Whitworth et al. (1996) the effects of acamprosate in the treatment of alcohol dependency was tested by comparing acamprosate and placebo in long term treatment of alcohol dependency. Approximately one-half of alcoholic patients relapse within three months of completing treatment. Several neurochemical agents may influence the mechanism of alcoholic cravings and relapse. The mechanisms are currently unknown, however, studies by Whitworth and his colleagues have reported promising results with drugs that influence transmission of serotonin, dipamine and gamma-aminobutyric acid. The subjects in Whitworth’s et al study were patients treated by five Austrian hospitals for chronic or episodic alcoholism of a least 12 months duration, with alcohol being validated by the CAGE questionnaire, the Michigan alcoholism screening test, elevated liver function values, and mean corpuscular volume. Four hundred fifty five patients who had completed five days of alcohol withdrawal treatment were randomly assigned to receive either acamprosate or placebo. They were then assessed on day 0 and on days 30,90,180,270, and 360. They were checked for evidence of relapse and occurrence of side effects. Seven patients did not receive medication and were therefore not included. Of the 448 remaining patients, 179 patients completed 12 months of treatment and 148 patients were followed for an additional year after the trial. The placebo and treatment groups did not differ significantly in measures of severity of alcoholism and depression. After 360 days 18.3% of the acamprosate-treated patients and 7.1% of the placebo-treated patients had been continuously abstinent. After two years the number of patients had decreased due to many patients having relapsed. 11.9% receiving acamprosate remained abstinent as opposed to 4.9% of those receiving the placebo. From these results, the researchers concluded, although alcoholism is notoriously difficult, acamprosate can be a safe and effective adjunct to rehabilitation programs. The authors also suggest that, along with acamprosate, psychosocial treatment, as well as, a pharmacologic approach should be used.

Another test done by neuroscientists, was a trial of desipramine for primary alcohol dependence stratified on the presence or absence of major depression done by Mason, Kocsis, Ritvo, and Cutler (1996). Many scientist believe that treatment of depression in alcoholics may decrease their risk of a drinking relapse after a period of abstinence. This test was done on 26 alcoholic patients with and without depression. Tricyclic antidepressant desipramine was used for six months, and a placebo was used in another 25 depressed and nondepressed patients. The major tests used were the Hamilton Depression Rating Scale, time line follow back interviews, and breath alcohol concentrations and collateral. Compared to baseline, the final Hamiltonian Depression Scale scores for desipramine-treated depressed patients, was significantly decreased relative to the placebo group, indicating that the medication reduced depression in this group, however, the nondepressed groups depression scores were not significantly greater in the desipramine group. There was also no significant difference between depressed and nondepressed patients in the effect of desipramine on abstinence. From this, researchers concluded that treating depression secondary to alcoholism, may reduce risk for drinking relapse in some patients, however, the use of desipramine to reduce relapse in nondepressed alcoholics is not supported by this test. Traditionally, pharmacotherapy for alcohol-related problems has focused on treating withdrawal symptoms, because many clinicians believed that patients should not use any psychoactive medications due to the risk of relapsing into chemical dependency (Mason et al). With recent advances in the neurobiology of alcohol dependency, and of psychological factors implicated in relapse, researchers now believe that medications can potentially be useful in long-term treatment of alcoholism. This would explains the recent study of different medications that can support patients’ efforts to remain abstinent, without having undesirable mood-altering properties, that could place patients at risk for development of a new dependence.

Opiate receptor antagonists, is another group of medications that are being tested because they act directly on some biologically based symptoms of alcohol dependence, such as psychic cravings and binge drinking. Two currently used opiate receptor antagonists are naltrexone and nalmetene (Mason et al, 1996). Stephanie S. O’Malley, a psychologist at Yale University School of Medicine, and her coworkers, did a test on naltrexone. As cited in Bower (1996) they believed that naltrexone blocked physiologically reinforced effects of alcohol and made alcohol less stimulating and attractive. They felt that brief treatment with this drug, along with training in ways to avoid and resist alcohol cravings, could help overcome or at least help control alcoholism. The study consisted of 97 people seeking treatment for alcohol dependence at an outpatient clinic. These patients randomly received either daily naltrexone or placebo pills. They also received weekly therapy that taught them coping skills, such as ways to decrease stress and avoid alcohol use. In addition to this, they were also encouragement to stay sober by those around them. The test was conducted over a 9-month period. It was found that the two naltrexone groups displayed far greater abstinence rates than the placebo groups. Six months after the test was done a follow up test was then conducted. The results showed that two-thirds of patients given placebos had resumed alcohol consumption, to the point that they were again diagnosed with alcohol abuse or dependence, as opposed to, only one-third of those given naltrexone (Bower). O’Malley and her group are now studying whether a year of treatment will offer further benefits.

In addition to the study of medicines, neuroscientist also study the effects of alcoholism on alcoholic’s bodies. One study done by Ferguson and colleagues (1996) was conducted to determine the risk factors for developing delirium tremens in an impatient setting. This study included 200 patients who did not have delirium tremens at admission, but who had discharge diagnoses of conditions related to alcohol abuse. By using lab results and vital signs from each patient, the variables associated with development of delirium tremens were assessed. Delirium tremens developed in 24% of the patients and 8% died. The factors that were determined to indicate higher risk for developing delirium tremens, were black race, being jobless or homeless, concurrent acute illness at the time of admission, a longer period of time since the last drink of alcohol, higher levels of blood urea nitrogen, higher respiratory rate, lower level of albumin, and lower systolic blood pressure. From this test, the researchers concluded that, readily discernible clinical characteristics may be the best predictors of development of delirium tremens.

The effects of maternal alcohol consumption during pregnancy is also a topic of much research. Kevin Nugent, Barry Lester, Sheila Greene, Dorith Wieczorek-Deering, and Paul O’Mahony (1996) did a study on the effects of maternal alcohol consumption and cigarette smoking during pregnancy on acoustic cry analysis. 127 mothers were interviewed during their last trimester of pregnancy to ascertain their history of alcohol and tobacco use. The mothers consumed an average of .21 ounces absolute alcohol per day, with 62% classified as moderate drinkers, 10.6% as heavy drinkers, and 26% as nondrinkers (Nugent et al). Neurobehavioral status was measured, using acoustic characteristics of the infant’s cry, which they collected on the third day of life. According to Nugent and her colleagues, multiple regression analysis showed that more ounces of absolute alcohol per day was related to more dysphonation and higher first formant. They computed a total of 11 cry variables. Effects of alcohol or smoking were found on five of the 11. Two of which were the effects of alcohol. Using the Duncan Multiple Range Test the results showed that the mean first formant of the cry was significantly higher in infants whose mothers were heavy drinkers than in infants of mothers who were moderate drinkers or mothers who did not drink during pregnancy (Nugent et al).

Genetic research is also a large part of neuroscientists study. They not only want to find out how to avoid or overcome alcoholism, they are also interested in finding out how it starts so they can help avoid it, before it starts. Lee M. Silver, a molecular biologist at Princeton University, and his colleages, as cited in Bower (1996), did a study on mice to try and identify chromosomes that seem to contribute to a preference for alcohol. They found that alcohol drinking in males seems to be promoted by a chromosome 2 region inherited from either parent, and female drinking is linked to chromosome 11 inherited from the father. Although researchers have not yet located the exact genes in mice that influence alcohol drinking, and have not yet found equivalent human genes to those that operate in alcohol favoring mice, the research at least gives neurogeneticists a bit of insight as to what genes to begin testing when doing studies on human genes.

When developmentalists begin their studies on alcoholism, they can begin at a prenatal stage, in studies such as the one done by Nugent and his colleagues, who focused their study on the effects of a pregnant mothers alcohol consumption on her unborn child. Much research has been done on alcohol related diseases such as Fetal Alcohol Syndrome and other such diseases associated with alcohol. The two most common areas of research, however, seem to be in studying alcohol’s effects in adolescents and in the elderly.

Alcohol abuse by teenagers is down slightly, but alcohol is still most teens’ drug of choice, according to Heyman (1996). Teenage drinking is a very serious problem. In the mid 1980s, 5 to 6 percent of high school seniors said they used alcohol every day. In 1995 that was down to 3.5%, with 1 to 2 percent drunk every day (Heyman, 1996). Although alcohol is still a major cause of death among teens, there has actually been a slight decrease in the last several years. This is being credited to public education and public awareness, as well as, lowered blood alcohol level for a driving under the influence arrest. The reasons that teens turn to alcohol are vast. Heyman seems to feel that rebellion, peer pressure, and the portrayal of alcohol use as absolutely normal by the media, advertising agencies, and the sports industry are the major reasons. Usually when teens start to use alcohol, they are in an experimental phase. They are curious about what alcohol does and want to experience what it is like to be under the influence of alcohol. Unfortunately, this experimentation can lead to a psychological addiction very quickly. According to Heyman, some of the signs of alcohol abuse in teenagers are mood swings, appearing to be out of touch with their environment, being very intense and angry at times, changes in school and job performance, changes in friends, interests, and overall changes in their behavior, personality and physical appearance as well. Heyman believes that a large majority of teens who use alcohol are "unhappy with who they are," he feels it is "important for educators to help teens to feel good about themselves, develop interests and talents, and help them believe in themselves, so they don’t have to change who they are " (p.15).

In a 1995 study, done by Gregory T. Smith, Mark S. Goldman, Paul E. Greenbaum, and Gruce A. Christiansen, the expectancy for social facilitation from drinking was tested. The study was done over a 2 year period. Four hundred sixty one adolescents participated, ranging from age 12-14 years old, with 46% being male. During this time, many of them first began drinking. The Alcohol Expectancy Questionnaire-Adolescent Form (AEQ-A) Scale was used for measurement. The results showed a striking increase in self-reported drinking, including problem drinking, each year. Researchers noted that teens’ expectancy for social facilitation from alcohol and their drinking experience, influenced each other in a reciprocal, positive feedback fashion. The greater the expectancy endorsement, the higher subsequent drinking levels, and the higher the drinking levels, the greater the subsequent expectancy endorsement. From this, Smith and colleagues comment that "results bolster the hypothesis that, expectancy actively influences drinking and point to the importance of expectancy-based intervention efforts" (p.32).

Another study done with adolescents was one done by Melinda Hohman and Craig Wiston LeCroy (1996). This particular study was done to predict adolescent A.A. affiliation. Alcoholics who receive treatment in in-patient settings are routinely referred to Alcoholics Anonymous upon discharge, yet not all affiliate with A.A. In 1990 there were over one million members in the United States, with approximately 3% of its members being under the age of 21. The characteristics of A.A. affiliates have been studied in the past to help improve discharge planning, but this study was done specifically on adolescents. The study consisted of 70 adolescents who had completed in-patient treatment and were contacted as part of a follow-up survey. Half the group had affiliated with A.A. A discriminate analysis was used to predict affiliation. Six variables were included in this study: A.A. affiliation, gender, prior treatment experiences, parents’ involvement in treatment, peers’ use of drugs or alcohol, and feelings of hopelessness. A correlation matrix was calculated for all the independent variables that showed very low correlation’s with one another, indicating that different constructs were indeed being measured. Results showed that, friends who use drugs was the greatest discriminator of the chosen variables, between the groups. The next best discriminator was prior treatment. Therefore, Hohman and LeCroy predict that "affiliates are more likely to have friends who use little or no drugs, and they have experienced prior treatment" (p.344). Through research such as this, developmentalists are able to further pinpoint what leads to alcoholism and what causes some people to seek treatment. With knowledge such as this, more people will be aware of what to avoid and will hopefully be more willing to seek the help they need.

Although gender was a variable in the above study, the results did not determine a difference based on gender. Other research, however, tends to show that men are more affected by alcohol than women. George E. Vaillant (1996) did a study in which he attempted to determine the course of male alcohol abuse from the age of 40 to 60 years. The subjects were 268 former Harvard University undergraduates and 456 nondelinquent inner-city adolescents who had been repeatedly studied in multidisciplinary fashion since 1940. At some point in their lives, 21% of the college and 33% of the core city men met DSM-III criteria for alcohol abuse. The results showed that, by the age of 60, 18% of the college alcohol abusers had died, 11% were abstinent, 11% were controlled drinkers, and 59% were know to be still abusing alcohol. This was opposed to 28% of the core city alcohol abusers who had died, 30% who were abstinent, 11% who were controlled drinkers, and only 28% who were known to be still abusing alcohol. Vaillant concluded that "although the samples differed, in that the core city men began to abuse alcohol when younger, they were more likely than the college men to become alcohol dependent. In addition to this, the core city men were twice as likely to achieve stable abstinence" (p. 1616).

Along with adolescents, elderly citizens are reporting to be battling with alcoholism. An Ohio State University study shows that recent retirees report having more alcohol-related problems than they did before leaving the workforce (Richardson, 1996). Retirement is now being associated with increased problems with alcohol. This suggests that, retirement may be more stressful, especially during the first six months, causing many retirees to convert to alcohol. In following 222 men and women from just before retirement to one year after retirement, researchers found that several other negative symptoms worsened in the first six months post-work. New retirees reported more health difficulties, physical evidence of anxiety such as dizziness and headaches, and signs of depression such as difficulty getting up in the morning. Fortunately, after a year many of these symptoms lessened, with the exception of alcohol use. Richardson reported that, alcohol-related problems increased at both the six-month and one-year follow-ups. These findings suggest that, people planning retirement need help in adjusting to life beyond work. Retirees need to know that it’s normal to feel anxiety about retirement, and they need to find ways to deal with the anxiety.

With findings such as Richardson’s (1996), physicians are trying to become more actively involved in the diagnosis and treatment of alcoholism in the elderly. Researchers believe that "social isolation and the psychological problems of many elderly people, in addition to the denial commonly associated with alcoholism, may both exacerbate a drinking problem and make it difficult to differentiate from other disorder" (Atkinson, 1996, p. 799). Despite the prevalence of alcoholism in older Americans, very few treatment programs are designed specifically for them. There is a need for better age-specific definitions and guidelines regarding alcoholism in the elderly. Atkinson states that "early warning signs and reduction of stress may have important roles in preventing the disease" (p.799). If the alcoholism rate remains constant, there will be 50% more elderly alcoholic patients at the turn of the next century than at the end of the 1970s. If alcoholism is not diagnosed by private physicians, emergency rooms, or hospitals, there will be few opportunities for the diagnosis. This is due, in part to, few elderly people entering into alcoholism treatment programs in the community without being referred by a physician or health professional.

Sheldon Zimberg (1996) believes that the answer to this problem is early detection, as well as, age-specific interventions. For the elderly this would consist of treatment focusing on the stresses of aging and co-existing depression, rather than alcohol use itself. Zimberg has found this approach to be "equally effective in long-standing alcoholics and those who develop a drinking problem in late life" (p.47). The only way to do this, is to continue with research such as this that allows psychologist to try and detect alcoholism in the elderly, as well as, anybody and develop programs such as these interventions Zimberg discusses, that allow them to get past this trial and move on. This, however, can be hard with all the glamorizing of alcohol on the media; as well as, the label that someone carries when they have a problem with alcohol.

Society plays a large role in alcoholism and it’s abuse. The media glamorizes alcohol, by advertising beautiful women choosing the man who drinks the right beer, or portraying the idea that without alcohol there is no fun. The commercials are countless, yet society is also the same one which labels people with alcohol abuse problems as "alcoholics" and, therefore, less of a person. Society views them as someone who is sick, they have a disease that will be with them for the rest of their lives, and unless they seek help through a program such as Alcoholics Anonymous, they will never get anywhere in life. Social psychologists focus on these beliefs. They study how alcohol is glamorized and it’s effects on people, as well as, how this attitude that goes along with being labeled an "alcoholic" with a disease, effects abusers. In the past, if someone had a drinking problem they were labeled a drunk and looked down upon, as more and more middle to upper class people began to battle with alcohol, society, which was run by these people, began to label these abusers as "alcoholics" and defined alcohol abuse as an uncontrollable disease. Along with this belief, came the introduction of Alcoholics Anonymous. A group organized to help "alcoholics" remain abstinent and cope with the feelings that go along with being abstinent. Unfortunately, this idea has gone a bit out of hand. Now, people who may or may not have a problem, are being forced to admit to having a disease and being required to attend these meetings in order to receive treatment from any professional, as well as, get their license back if they have lost it for Driving Under the Influence. Wilfrid Sheed (1995) wrote a book about the over use of alcohol as a disease called In Love With Daylight. Psychology Today published an excerpt from Sheeds book which discusses his frustration of joining a substance abuse clinic and being forced to accept his addiction as a disease. Sheed originally wanted to overcome an addiction to pills, but was forced to deal with his alcoholism instead. When Sheed refused to admit that he had a drinking problem, he was labeled as being in denial and until he "told them what they wanted to hear" (p.27) they told him they could not help him. Sheed discusses his belief that the disease proposition "probably begun as a necessary cover to give drunks a little breathing room, while they wrestled with a temptation more powerful than anything nondrinkers could imagine." However, as Sheed states it, "to be overmatched against a particular temptation is not necessarily to be diseased" (p.29).

With controversies such as this one, social and clinical psychologists began to study different treatment opportunities. Behavioral Health Management magazine published an article which discusses the changing face of addictions treatment and how with society’s help, the field is reinventing itself to meet today’s needs. Due to evolving client needs and programmatic priorities, changes are beginning. Clinical practices are being challenged by clients who are multi-needy, often presenting with concurrent personality disorders, mental health issues, developmental impairments, polysubstance dependency, and often greater needs for primary health care services (Washousky & Thomas, 1996). This is prompting specialized addiction programming services. This new care system, needs a continuity of care that links or networks agencies into an operational partnership treatment system based on the patients needs. Washousky and Thomas suggest early introduction of vocational rehabilitation activities, comprehensive child and family services, and a strong emphasis on drug-intensive day rehabilitation services as an alternative to inpatient care. They also suggest that there be a standardized criteria for client placement, in addition to, opportunities for clinicians to enhance skills and competencies, while experimenting with new treatment approaches within a clinical environment that emphasizing cultural sensitivity and diversity.

Social psychologists, as well as, developmental psychologists study such things as the effects of alcoholism on children and how some children of alcoholics become alcoholics themselves. Being a child of two alcoholics, I was told throughout my life that I was "more apt to become an alcoholic than a child who had "normal" parents." Whether or not that was true, it did have an effect on many of the decisions that I made, with regard to alcohol. Albert Ullman and Alan Orenstein (1994) hypothesized that the power of an alcoholic parent within a household is related to whether offspring become alcoholic. They believe that, children and adolescents are more likely to emulate and identify with a powerful alcoholic parent and through these processes, learn that alcohol can make them feel powerful. Two surveys were conducted, one of parents and one of their offspring 17 years later. The results showed that, adult offspring usually display the same pattern of drinking as their parents. Bennette Steinglass, as cited in Ullman & Orenstein, and associates at the George Washington School of Medicine, distinguished two types of alcoholic families, one in which the alcoholic is tolerated and supported in drinking behavior and one in which this behavior is considered unacceptable and is not allowed to interfere with ongoing family activities. The first type of family described produces intergenerational alcoholics. Steinglass et al, believe that by tolerating and supporting the drinking behavior, the family is giving the alcoholic control and giving the child the impression that drinking is okay. The second type, teaches the children that drinking is a negative thing that should not be tolerated. The role that the nonalcoholic parent plays is very essential to the outcome of the children as well. If, for example, the mother continues to make excuses for the alcoholic father and allows him to drink in front of the children, she is not teaching them it is wrong. This, of course, is excessive drinking, not social drinking that is under control. Through such research, nonalcoholic parents can learn more about how to protect their children from following their alcoholic parents footsteps.

Clinical psychologists, use the work of the other psychologists to help them to better understand alcoholism and the people who are affected by it. Clinical psychologists focus on counseling alcoholics, and others who are affected by alcoholism, either by a parent’s problems or someone else they love. It is the clinical psychologists job to try and detect alcoholism in current patients and to help alcoholic patients find the reason they began drinking. This allows them to help the person overcome their problem, or at least control it. Most alcoholics do not have preexisting psychiatric conditions, however, about 20% are suffering from psychiatric disorders that they may be trying to medicate with alcohol (Neimark Conway, & Doskoch, 1994). Clinical psychologists play a large role in trying to understand alcoholism and develop promising medications along with psychosocial interventions. Many clinical psychologists also participate in group therapy sessions, much like A.A. Some effective treatments, according to Neimark et al. (1994), are aversion therapy, stress management, and family therapy. Some clinical psychologists have been involved in a new concept of self-help that makes the distinction between chronic drinkers and problem drinkers. It is called Moderation Management. It is designed to help problem drinkers considered to be on the low end of the alcoholic’s continuum, by cubing their drinking habits rather than eliminating them entirely (Kishline, 1996). The basic concepts of Moderation Management are derived from brief behavioral self-management approaches to alcohol abuse, which in turn are based on controlled studies with problem drinkers (Kishline). Clinical psychologists must try to keep up with all the new programs available, as well as, the research. They must also continue to try and help their patients to overcome this need to consume alcohol that inadvertently hurts the patient and those who love them.

Alcoholism is a large topic. Thousands of studies, possibly millions of studies, have been done on this topic, yet it is still a large problem. We now know a lot more about alcoholism, such as it’s effects and origin, through the genetic research of neuroscientists, and the role of society from the work of social psychologists, along with the stages and effects of alcoholism from developmental psychologists, as well as, the clinical psychologists work with alcoholic patients, however, the research must continue. Unfortunately, we do still have millions of Americans that are effected by alcoholism and, whether it is a disease or not, to this day, there is no cure!

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