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HANDBOOK of Alcoholism Handbooks of Harmacology P and Oxicology T a CRC Press Series

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HANDBOOK of Alcoholism Handbooks of Harmacology P and Oxicology T a CRC Press Series HANDBOOK OF alcoholism Handbooks of harmacology P and oxicology T A CRC Press Series Mannfred A. Hollinger, Series Editor University of California, Davis Published Titles Handbook of Pharmacokinetic and Pharmacodynamic Correlations with Computer Applications Hartmut Derendorf and Guenther Hochhaus Handbook of Methods in Gastrointestinal Pharmacology Timothy S. Gaginella Handbook of Targeted Delivery of Imaging Agents Vladimir P. Torchilin Handbook of Pharmacology of Aging, Second Edition Jay Roberts, David L. Snyder, and Eitan Friedman Handbook of Plant and Fungal Toxicants J. P. Felix D’Mello Handbook of Immunological Methods Canadian Networking Toxicology Center Handbook of Alcoholism Gerald Zernig, Alois Saria, Martin Kurz, and Stephanie S. O’ Malley HANDBOOK OF alcoholism edited by Gerald Zernig, M.D. Alois Saria, Ph.D. Martin Kurz, M.D. Stephanie S. O’Malley, Ph.D. CRC Press Boca Raton London New York Washington, D.C. Library of Congress Cataloging-in-Publication Data Handbook of alcoholism / Gerald Zernig, editor-in-chief ; Alois Saria, Martin Kurz, Stephanie S. O’Malley, co-editors. p. cm. — (Pharmacology and toxicology) Includes bibliographical references and index. ISBN 0-8493-7801-X (alk. paper) 1. Alcoholism—Handbooks, manuals, etc. I. Zernig, Gerald, 1960– II. Saria, Alois. III. Kurz, Martin, 1963– IV. O’ Malley, Stephanie S. V. Pharmacology & toxicology (Boca Raton, Fla) [DNLM: 1. Alcoholism—therapy. WM 274 H2355 2000] RC565 .H245 2000 616.86¢1—dc21 99-053180 CIP This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use. Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage or retrieval system, without prior permission in writing from the publisher. All rights reserved. Authorization to photocopy items for internal or personal use, or the personal or internal use of specific clients, may be granted by CRC Press LLC, provided that $.50 per page photocopied is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 USA. The fee code for users of the Transactional Reporting Service is ISBN 0-8493-7801-X/00/$0.00+$.50. The fee is subject to change without notice. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. The consent of CRC Press LLC does not extend to copying for general distribution, for promotion, for creating new works, or for resale. Specific permission must be obtained in writing from CRC Press LLC for such copying. Direct all inquiries to CRC Press LLC, 2000 N.W. Corporate Blvd., Boca Raton, Florida 33431. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation, without intent to infringe. © 2000 by CRC Press LLC No claim to original U.S. Government works International Standard Book Number 0-8493-7801-X Library of Congress Card Number 99-053180 Printed in the United States of America 1 2 3 4 5 6 7 8 9 0 Printed on acid-free paper How You Can Benefit From This Handbook (… By Way of a Preface) The overwhelming majority of problem drinkers (i.e., alcohol-abusing patients) and alcohol-depen- dent patients are first seen by physicians in general practice, in a primary care setting, or at nonpsychiatric inpatient facilities, such as departments of internal medicine or surgery. If you work in such a setting, this book is for you. It is my firm belief that comprehensive treatment of your alcohol-abusing or alcohol-dependent patient lies within your grasp and should, for that matter, ultimately lie in the hands of one therapist; this book will help you to acquire the necessary expertise to achieve this. You will, in all likelihood, find that you want to delegate some aspects of the medical care of your alcoholic patient to more specialized partners who might have more resources than you with respect to time, logistics, and specialized training. Still, it is you who can give crucial help to your patient who is experiencing alcohol-related problems, right from the first contact and interview. And, let’s face it, you have to do it — you are the one your patient usually first contacts and not necessarily because he or she is aware of her/his alcohol problem. Not yet. With the help of this handbook, you will acquire the necessary skills to help him/her recognize the underlying alcohol problem. Two chapters (Chapter 1, First Contact and Early Intervention; Chapter 9, Psy- chotherapy) are dedicated to explaining which psychological problems you are most likely to encounter at every stage of the disease and how to best cope with the negative emotions that the alcohol-dependent patient — so severely affected by the disease — will most likely induce in you, his physician. However, alcoholism is not restricted to underlying psychological problems. Alcohol damages a number of organs — and these somatic symptoms are very often those that actually bring the patient into your office. This handbook will help you to better diagnose and treat these nonpsychi- atric medical disorders as well. The first section of this handbook, PATIENT CARE, describes the diagnosis and therapy of alcohol-induced somatic and psychiatric disorders. In the second section of the handbook, RESEARCH, you will find review-like chapters on current issues in research on alcoholism. Again, emphasis is on the clinical aspects: epidemiology, comorbidity, heritability, psychometric instruments assessing treatment success, and meta-analysis of clinical trials, as well as patient-to-treatment matching. If you want to go deeper into basic science issues, this handbook offers chapters on the neurochemistry, histopathology, and behavioral pharmacology of alcoholism. Research on alcoholism, like any research into substance dependence (addiction), is jeopardized by moralizing and ideology or by ideas that are intellectually stimulating and attractive, but lack sufficient empirical evidence; thus, a chapter is dedicated to such contro- versial issues. So, how many grams of alcohol to a can of beer? How much can somebody drink before exceeding the legal limit in your state? How much can someone drink before risking organ damage? What is the correct psychiatric definition of alcohol dependence? Where can that MAST test form be found for photocopying? You will find answers to these and other questions in the third and final section of this handbook, USEFUL DATA AND DEFINITIONS. A final word on different psychotherapeutic approaches: please remember that the aim of this handbook is to help you obtain a helpful attitude toward the alcohol-dependent patient and explain his or her behavior in a way that opens new therapeutic perspectives for you. Trans-Atlantic differences in clinical traditions (i.e., the “behavioral-cognitive U.S.” vs. the “psychoanalytic Central Europe”) should not be of too much concern. Do not be disconcerted by skirmishes between the different psychotherapeutic “schools”; always ask yourself how you can make use of what each school has to offer. Remain open and eclectic when trying to help each patient, one at a time, each with his/her personal history and special needs. One of the great strengths of this handbook lies in the fact that both U.S. and European clinicians and researchers have contributed to it; make use of the different cultural approaches represented in this book and be flexible in adapting your own therapeutic approach to the special therapeutic setting in which you find yourself. Both “oversocialized institutionalization” and the “merciless kick ’em-out-quick” health care systems have their advantages and disadvantages. Use them in your patients’ best interest. The goal of this handbook is to provide you with everything (well, almost everything) you need in a book that you can hold in one hand. We truly hope that you like it so much that you consult it again and again. If we have forgotten something that you consider important, please let us know. My e-mail address is [email protected] and my telephone number is +43-699- 1714-1714. You can find my complete postal address in the contributor list. We really would like to hear from you — good or bad. Gerald Zernig, M.D. Editor-in-Chief Dedication A number of people have helped me to obtain the necessary competence to conceive and edit this handbook. Every one of them has furthered my education in her/his own special way. Dear friends, please allow me to thank you in this public way (and in temporal order). This book is dedicated to you. My parents Horst and Gertrude, Oma, Karin (although she does not want me to) and her mother Erni; my kids Patrick and Bernhard (for having led the nomadic life with me and for being such great sons); my brother and his family, Karli and Margit Leyrer; Uncle Heri and Aunt Inge; Uncle Rudi, Uncle Herfried, and Aunt Hansi; Helmut Tritthart (for introducing me to science); Rob and Lynne MaLeod (for lifelong friendship and for introducing me to the American, sorry, Canadian way of life); Wolfgang Schreibmayer (for showing me how much fun tinkering in the lab can be, and for being Skipper Wolf); Fred
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