PUBLISHED BY AMERICAN MEDICAL SOCIETY PHYSICIAN'S ON ALCOHOLISM, Inc. 120 Central Park So. New York, N.Y. 10019
Voluma 3 No. 3 ®Copyright 1968 American Medical Society on Alcoholism, Inc. NEWSLETTER All Rights Reserved GOLDBERG EYES INTERNATIONAL CONGRESS SHOWS ALCOHOLISM FOR MEDICAL SOCIETY POLITICAL INTEREST In addressing the first-meeting of the More than 200 scientists and other professionals from all over the world, in American Medical Society on Alcohol cluding many eastern European nations, exchanged research and treatment find ism in Washington, D.C., Dr.. Leonard ings at the 28th International Congress on Alcohol and Alcoholism which con Goldberg, professor of alcohol pharma vened last month in Washington, D.C. Convention chairman, David J. Pittmann, cology at Sweden's Karolinska Institute, Ph.D., said allocation of govern outlined the broad range and implica mental and provate resources for tions of alcohol research ih that country. AA DOCTORS CONVENE combatting alcoholism and alcohol-re The professor, demonstrated an unusual lated problems throughout the world The 20th annual meeting of Inter has been "meager." But he pointed teaching ability by his breadth of vision national Doctors in Alcoholics Anony and by his capacity for clearcut ex out that interest in alcoholism in the mous was held recently in Atlanta, United States is increasing and is re planations and engaging humor. Dr. Georgia. Members include dentists as Goldberg, describing his work as neuro ceiving more government support as well as MDs. Guest speaker, Dr. Ver evidence by the passage of the recent pharmacology, discovered that a form nelle Fox, medical director of the of horizontal nystagmus, with the fast "Alcoholism Rehabilitation Act," sup Georgian Clinic for Alcoholics, told the ported overwhelmingly by both parties. compononent in one direction, occurs professional members, "Alcoholics re after drinking while the blood alcohol To illustrate how far behind this coun cover when they become addicted to try is compared with others, he pointed curve goes up and that this trend is re people instead of to alcohol, sedatives, versed during withdrawal. The latter out that Stockholm spends $7,000,000 tranquilizers, or any other chemicals." a year on alcoholism service while the 'hase is very prolonged. This nystagmus She emphasized the dangers of cross ' can be interrupted by vomiting or by total United States federal budget for addition among alcoholics because many it is only $11,000,000 annually. the effects of tranquilizers. It differs sedative and psychotropic agents once from gaze nystagmus and from the rov thought non-addictive are now pre The role of state governments m ing motions of the eye, placing the action senting grave addiction and withdrawal tackling alcoholism was exemplified by of alcohol in the reticular formation of problems for some alcoholics at the Iowa Governor Harold E. Hughes' talk the brain. No other animal but man Georgian Clinic. to the Congress. Governor Hughes was exhibits this phenomenon after alcohol wary of statistics. For an example, he ingestion and no other chemical tested The unique group also learned of a said experts say there are 50,000 alco produces it. Other studies with a plat Roosevelt Hospital research team's fol holics in Iowa today when they claimed form-like device can measure yet an low-up study of alcoholic physicians and the same number ten years ago. He said other physiologic response to alcohol nurses. International Doctors in A.A. that total mobilization is needed to fight body swaY,. The measurement, translated was formed by the late Dr. C. P. of the problem and, referring to the In Cape Vincent, New York who organ (Continued on page 3, col. 3) ternational Congress said, "Now we are ized the first meeting of 25 doctors in getting somewhere." 1949. These annual professional meet PSYCHIATRIC FOCI ings in different parts of North America Governor Hughes discussed The Iowa are supplemental to the regular A.A. Comprehensive Alcoholism Project, a AT CONGRESS life members lead in their home towns state agency funded by federal, state Studies presented at the 28th Inter "just like any other A.A. member, and local agencies. Its function is not national Congress on Alcohol & Alco whether he is an unemployed laborer, limited to providing information or holism touched many aspects of the ap a movie star, or a professional . . . In clinical services, but is mainly directed proach of the therapist, personality of A.A., we are all alike in sharing our to improving the abilities of existing the alcoholic, treatment and its results. experience, strength and hope with agencies to c·ope more successfully with That alcoholism has not been totally each other, there are no experts or spe alcoholism and its concomitant prob accepted in regular psychiatric prac cial categories of members." But, A.A. lems. He claims that large state insti tice, was demonstrated in Durham, meetings restricted to one profession tutional programs are undesirable and N. C. where it was found that psychia have never proved successful in the 33- that local resourecs must be developed. tric patients labelled 'excessive drink year history of A.A. unless the alcoholic The trained staff of the 9 strategically ers" were treated like other patients, also attends ordinary, every-day meet located centers of the state project help whereas similar patients labelled 'alco- ings with alcoholics from other walks with the patient's immediate needs tolic's' were more often refused treat of life. For further information about quick mdical help, a place to sleep, ment or prejudicially treated. (D. G. International Doctors in A.A., write: food for a needy family, minimal tools for Mayfield, Vets. Adm. Hosp.). Accord Information Secretary, 1950 Volney a man to get a job. Community groups ing to another study physicians with Road, Youngstown, Ohio 44511. The have pitched in to provide these. Gover low degrees of authoritarianism treat 1969 meeting is to be held in Monis nor Hughes states proudly, "Today, alco- (Continued on page 4, col. 1) town, N. J. (Continued on page 4, col. 3) Editoria1 EPIDEMIOLOGY OF JELLINEK AWARD ALCOHOLISM: A.A. PRESENTED "THE CONGRESS" Dr. John L. Norris, Chairman of the The first Jellinek Memorial Award, The twenty-eighth international con A.A.'s General Service Board, presented commemorating the late Dr. E. M gress on alcohol and alcoholism, a mo findings of a 1968 summer survey, by J ellinek, a biometrician and scholar h. mentous bringing together of experts that group, of 11,355 American and the field of alcoholism, was presented from all over the world, has come and Canadian alcoholics, during the Sep by the 28th International Congress on gone. The meaning of this exercise as tember convention of the 28th Interna Alcohol and Alcoholism to Dr. Jean an event in man's progress towards the tional Congress on Alcohol and Alcohol Pierre von Wartburg. The young physi elemination of this knotty problem has ism. Of the 60.3% of respondents who cian-biochemist is research investigator yet to be fully realized. Several things were drink-free for from one year to at the Medical Chemical Institute of the were clear. Many dedicated people more than 20 years, 34.9% were dry up University of Bern in Switzerland. Prof. throughout the world are tackling the to five years; 13.3% were dry from six Mark Keller of the Rutgers University problems of alcoholism. These include to ten years; 6.5% from 11 to 15 years Center of Alcohol Studies presented the scientists in the fields of physiology, and 3.6% for 15 to 20 years. Two per award-$1,000 and a bronze bust of Dr. medicine, and psychiatry; sociologists cent were drink-free for more than 20 Jellinek. and economists; lawyers.., and clergy. years. The work for which the Swiss inves Much of the research in treating alco Influencing 54.8% of initial A.A. visits tigator was honored includes studies on holism is of the 'soft' variety, but in were other A.A. members while fami the liver enzyme alcohol dehydrogenase creasingly, genuine steps towards modern lies influenced 34% and physicians, which normally oxidizes 100 mg. of al research in methods and concepts are 16.2%. That more doctors, as part of cohol per Kg of body weight an hour. bringing light to the problems. Perhaps their treatment, are now referring pa Dr. von Wartburg's recent work result the most important phase of the confer tients to A.A. is evidenced by the fact ed in the isolation of an atypical liver ence was the interplay between the dele that of respondents sober 20 years or enzyme which in vitro oxidized alcohol gates from morning till dark around the more, 12% were referred to A.A. by five to flix times faster. In one subject, great coffee table or in the corridors. MDs. And, of recent A.A. referrals, 19% carrier of atypical enzyme, alcohol was oxidized at the rate of 141 mg. an hour. One controversial issue was tackled were made by physicians. Other indu The difference between the action of by Dr. Morris Chafetz of Harvard U. cers included A.A. literature, clergymen, the abnormal enzyme in vitro and in School of Medicine, who warned against employers, all communications media, vivo may be explained by the possible political misuse of any power to con friends, lawyers, psychologists, counsel presence of another enzyme that re fine an alcoholic against his will. Where ling agencies, hospitals and the National tards oxidation. Dr. van Wartburg as we took issue with him because of Council on Alcoholism. stated that children who suffer from gly the real problem of obtaining treatment The data gathered appears significant cogen or carbohydrate storage disease rather than incarceration of the acutely evidence that Alcoholics Anonymous meetings are extremely useful in helping oxidize 460 mg. of alcohol per Kg. c ill alcoholic (and a visit to the treat body weight an hour. Such findings ment facilities at Occaquam where such alcoholics give up their drinking. It also points to the diverse influences which have led him and his associates to sus treatment is now being done reinforces pect the atypical liver enzyme may be the knowledge of its correctness) a re stimulate the alcoholic to attend his first A.A. meeting. meaningful in alcoholism. Thus far these reading of his paper shows the areas of investigators have found three protein agreement. Yes - the alcoholic when constituents of the atypical enzyme. acutely ill should be hospitalized and JOBS AVAILABLE Current work includes determining if not jailed - but this hospitalization Last August, the new Comprehensive all three isoenzymes are abnormal, or should carefully ringed with safe Alcoholism Control Act for the District whether only one or two are. The pike, guards of the individual's eventual free of Columbia was enacted authorizing a whose liver has the same amount of dom. complete scope of treatment facilities alcohol dehydrogenase as human livers, Unfortunately, space limitations have for the affiicted, and outlining procedures is used in these studies. restricted our more complete reportage for handling public intoxication medi Dr. von Wartburg is also trying to of the vast number of excellent papers. cally rather than punitively. In ac find out if the abnormal enzyme occurs To those unmentioned - our regrets. To cordance with this forward-looking more often among alcoholics than in the those mentioned too briefly, the same. legislation, the Rehabilitation Center, normal population. Eventually, he It is hoped that the full proceedings which has been providing traditional hopes to answer some of the questions will be available this year for those medical, psychotherapeutic, rehabilitative this research poses such as: Do people whose interests require further detail. and social services, is being expanded to with the atypical enzyme sober up more become an 800-bed facility. Broad oppor quickly and can they therefore drink a tunities for physicians in innovation, good deal more? NEW YORK APPOINTS training and research are to be part of Dr. Jellinek is perhaps best known this new-era approach. Recruitment is for his classification of American alco DR. CONWELL now under way for professional posts holics, detailed in his book The Disease Dr. Donald Conwell, Assistant Com which become available early in 1969; Concept of Alcoholism. Prof. Keller, a missioner of Chronic and Preventable however, grades and salaries, dependent long-time associate of Dr. Jellinek and Diseases of New York City's Department on qualifications, are subject to change. editor of the Quarterly journal of of Health, was recently assigned respon Prospective applicants can obtain Form Studies on Alcohol published at Rutgers, sibility for coordinating those city serv SF-171 at any post office or federal headed the 1968 Jellinek Award Com ices handling alcoholism problems. He is agency. mittee. Other members included B charged, also, with the related task of Enttan.ce Maximum Brinkley Smithers; H. David Archibalc.. Physicians" Grades Salary Salary Addiction Research Foundation, Can encouraging better inter-agency rapport. Medical Officer GS-14 $19,771 $24,856 Assisting him in this work is John H. Medical Officer GS-15 21,098 27,029 ada; Dr. David Lester, Rutgers Center Williams, Director of Alcoholism Pro Psychiatrist GS-15 21,098 27,029 of Alcohol Studies; Dr. Harold Kalant, grams. (Continued on page .5, col. 1) (Continued on page 5, col. 2) BOOKS RESEARCH AND Understanding Alcoholism: For the REVIEW Patient, the Family, and the Employer >Y The Christopher D. Smithers Foun New York City physicians, Charles S. dation, Inc., 41 E. .57th St., New York Lieber and Emanuel Rubin, recently 10022. 1968, 257pp., $6.9,5. presented (Gastroenterology. Vol. 54, This book prepared to enlighten the No. 9, pp 642-646) a study of ethanol public about alcoholism, offers sound, as a many-faceted hepatotoxin particu effective help to those afflicted as well larly focusing on its involvement in drug as to those whose lives are touched by detoxification processes. Their prior in its tragedy in numerous and diverse vestigations have demonstrated hepa ways. It is largely derived from a series tic changes due to alcohol indepen of pamphlets on alcoholism issued by dent of nutritional deficiencies. Because the Smithers Fom1qation for laymen ethanol-produced hapatic injury is dose over the years. Some of the included related, reproducible in man and ani topics are: types of !Icobolics; steps mals and characterized by fatty changes toward achieving pernianent sobriety; and necrosis, it should be classed among the fallacy of "controlled drinking;" the those hepatotoxins injuring liver by di imp:~ct of alcoholism on the family; rect action on hepatocytes, not among significant areas of alcol1ol education, those acting indirectly by hypersensi und the law and the alcoholic. The only tivity. One such agent is carbon tetra R. BRINKLEY SMITHERS working foundation in the United States chloride. But, though both produce principally engaged in fighting alcohol hepatic fat accumulation, associnteu R. Brinkley Smithers, chairman of the ism as a disease is the Smithers Foun lesions differ mru·kedly. Functionally, Alcoholism Committee of the Community dation a central agency for collecting, CCI• induces hypnlipemin while a l:~rge Council of Greater New York, was chair c.:lassifying, and distributing inofrmation. ethanol intake does the opposite. man of the Patronage Committee of the It is 11either wet nor dry, but solely The difficulty in classifying ethanol in 28th International Congress on Alcohol interested in helping establish alcohol <)ne or
Editorial EPIDEMIOLOGY OF JELLINEK AWARD ALCOHOLISM: A.A. PRESENTED "THE CONGRESS" Dr. John L. Norris, Chairman of the The first Jellinek Memorial Award, The twenty-eighth international con A.A.'s General Service Board, presented commemorating the late Dr. E. M gress on alcohol and alcoholism, a mo findings of a 1968 summer survey, by J ellinek, a biometrician and scholar ii. mentous bringing together of experts that group, of 11,355 American and the field of alcoholism, was presented from all over the world, has come and Canadian alcoholics, during the Sep by the 28th International Congress on gone. The meaning of this exercise as tember convention of the 28th Interna Alcohol and Alcoholism to Dr. Jean an event in man's progress towards the tional Congress on Alcohol and Alcohol Pierre von Wartburg. The young physi elemination of this knotty problem has ism. Of the 60.3% of respondents who cian-biochemist is research investigator yet to be fully realized. Several things were drink-free for from one year to at the Medical Chemical Institute of the were clear. Many dedicated people more than 20 years, 34.9% were dry up University of Bern in Switzerland. Prof. throughout the world are tackling the to five years; 13.3% were dry from six Mark Keller of the Rutgers University problems of alcoholism. These include to ten years; 6.5% from 11 to 15 years Center of Alcohol Studies presented the scientists in the fields of physiology, and 3.6% for 15 to 20 years. Two per award-$1,000 and a bronze bust of Dr. medicine, and psychiatry; sociologists cent were drink-free for more than 20 Jellinek. and economists; lawyers- and clergy. years. The work for which the Swiss inves Much of the research in treating alco Influencing 54.8% of initial A.A. visits tigator was honored includes studies on holism is of the 'soft' variety, but in were other A.A. members while fami the liver enzyme alcohol dehydrogenase creasingly, genuine steps towards modern lies influenced 34% and physicians, which normally oxidizes 100 mg. of al research in methods and concepts are 16.2%. That more doctors, as part of cohol per Kg of body weight an hour. bringing light to the problems. Perhaps their treatment, are now referring pa Dr. von Wartburg's recent work result the most important phase of the confer tients to A.A. is evidenced by the fact ed in the isolation of an atypical liver ence was the interplay between the dele that of respondents sober 20 years or enzyme which in vitro oxidized alcohol gates from morning till dark around the more, 12% were referred to A.A. by five to six times faster. In one subject, great coffee table or in the corridors. MDs. And, of recent A.A. referrals, 19% carrier of atypical enzyme, alcohol was One controversial issue was tackled were made by physicians. Other indu oxidized at the rate of 141 mg. an hour. The difference between the action of by Dr. Morris Chafetz of Harvard U. cers included A.A. literature, clergymen, the abnormal enzyme and School of Medicine, who warned against employers, all communications media, in vitro in may be explained by the possible political misuse of any power to con friends, lawyers, psychologists, counsel vivo presence of another enzyme that re fine an alcoholic against his will. Where ling agencies, hospitals and the National tards oxidation. Dr. van Wartburg as we took issue with him because of Council on Alcoholism. stated that children who suffer from gly the real problem of obtaining treatment The data gathered appears significant cogen or carbohydrate storage disease rather than incarceration of the acutely evidence that Alcoholics Anonymous oxidize 460 mg. of alcohol per Kg. c ill alcoholic (and a visit to the treat meetings are extremely useful in helping body weight an hour. Such findings ment facilities at Occaquam where such alcoholics give up their drinking. It also have led him and his associates to sus treatment is now being done reinforc·es points to the diverse influences which pect the atypical liver enzyme may be the knowledge of its correctness) a re stimulate the alcoholic to attend his first meaningful in alcoholism. Thus far these reading of his paper shows the areas of A.A. meeting. investigators have found three protein agreement. Yes - the alcoholic when constituents of the atypical enzyme. acutely ill should be hospitalized and JOBS AVAILABLE Current work includes determining if not jailed - but this hospitalization Last August, the new Comprehensive all three isoenzymes are abnormal, or should carefully ringed with safe Alcoholism Control Act for the District whether only one or two are. The pike, guards of the individual's eventual free of Columbia was enacted authorizing a whose liver has the same amount of dom. complete scope of treatment facilities alcohol dehydrogenase as human livers, Unfortunately, space limitations have for the affiicted, and outlining procedures is used in these studies. restricted our more complete reportage for handling public intoxication medi Dr. von Wartburg is also trying to of the vast number of excellent papers. cally rather than punitively. In ac find out if the abnormal enzyme occurs To those unmentioned - our regrets. To cordance with this forward-looking more often among alcoholics than in the those mentioned too briefly, the same. legislation, the Rehabilitation Center, normal population. Eventually, he It is hoped that the full proceedings which has been providing traditional hopes to answer some of the questions will be available this year for those medical, psychotherapeutic, rehabilitative this research poses such as: Do people whose interests require further detail. and social services, is being expanded to with the atypical enzyme sober up more become an 800-bed facility. Broad oppor quickly and can they therefore drink a tunities for physicians in innovation, good deal more? NEW YORK APPOINTS training and research are to be part of Dr. Jellinek is perhaps best known this new-era approach. Recruitment is for his classification of American alco DR. CONWELL now under way for professional posts holics, detailed in his book The Disease Dr. Donald Conwell, Assistant Com which become available early in 1969; Concept of Alcoholism. Prof. Keller, a missioner of Chronic and Preventable however, grades and salaries, dependent long-time associate of Dr. Jellinek and Diseases of New York City's Department on qualifications, are subject to change. editor of the Quarterly Journal of of Health, was recently assigned respon Prospective applicants can obtain Form Studies on Alcohol published at Rutgers, sibility for coordinating those city serv SF -171 at any post uffice or federal headed the 1968 Jellinek Award Com ices handling alcoholism problems. He is agency. mittee. Other members included F charged, also, with the related task of Entrance Maximum Brinkley Smithers; H. David Archibalc.. PhysiC'ianso Grades Salary Salary Addiction Research Foundation, Can encouraging better inter-agency rapport. Medical Officer GS-14 $19,771 $24,856 Assisting him in this work is John H. Medical Officer GS-15 21,098 27,029 ada; Dr. David Lester, Rutgers Center Williams, Director of Alcoholism Pro Psychiatrist GS-15 21,098 27,029 of Alcohol Studies; Dr. Harold Kalant, grams. (Continued on page 5, col. 1 ) (Continued on page 5, col. 2) PHYSIOLOGY PAPERS YOUTHFUL DRINKERS ALCOHOLISM FOR PRESENTED SEEN IN TROUBLE MEDICAL SOCIETY (Continued from page 6, col. 3) Accumulating evidence of consistent (Continued from page 1, col. 1) 'ed in the brain for determination personal and social factors associated with into voltage and fed into a frequency o~ metabolic pathways of serotonin. Di the youthful problem drinker and the analyzer, differentiates accurately be sulfuram was found to block aldehyde young "accelerated" alcoholic make it tween the effects of different tranquil dehydrogenase. Also serotonin, of which possible to identify youth headed for izers. For example, chlordiazepoxide ad 5HTP is a precursor was increased after alcoholism. ministered with alcohol decreases body alcohol. The sometimes parallel, sometimes sway. Surprisingly, accordingly to an supplemental findings were presented by other series of experiments, a person can EEG Capt. Albert E. Reister of Wilford Hall accurately reflect his own blood alcohol EEG effects were studied at Rutgers USAF Hospital at Lackland Air Force levels by self-estimation of the intensity Base, Texas; by Robert A. Zucker of U., (Greenberg, L. A. et al) who found of his moods. Michigan State University; and by Dr. that high congener beverages caused C. M. Rosenberg of Rozelle, Australia. Significantly, the concept of the alco more prolonged drowsiness. Skala, J. The profile of the youth who is at high hol-Antabuse phenomenon has recently of Charles U., Prague, Cz;echoslovakia risk of developing into an alcoholic been enlarged, from the older hypothe found that sleep deprivation of 127 includes the following features: sis of a delay in acetaldehyde degrada hours was more likely to produce slight ( l) Early environmental failure, re tion, to include the newly-discovered Korsakoff syndrome than delirant states sulting in lack of a sense of self-worth fact that Antabuse sensitizes CNS recep in alcoholics. G. Wahlstrom of the U. in the family, characterized by (a) eco tors to acetaldehyde effects. Thus, a of Uppsala, Sweden, used the EEG to nomic deprivation, (b) paternal alco small dose of alcohol will block receptor measure CNS sensitivity to hexobarbi holism resulting in parental discord, sites to the reaction making it possible tal. After prolonged pretreatment with (c) one parent absent before subject's to drink large amounts without as much hexobarbital, the sensitivity decreased. 15th birthday, and (d) a punitive, un hazards after ingestion of Antabuse. This was also true after prolonged pre fair, disinterested father. Pyrazole, a compound which decreases treatment with alcohol. However, in the (2) Hostility tow:ard the father. the alcohol metabolism rate, is being latter case a different temporal pat ( 3) A dose relationship with the used in this area of research. Addition tern of increase in threshold after with ally, studies of alcohol tolerance by Dr. drawal indicated a possible fundamen mother. (4) Unhappy, angry cynical and de Goldberg demonstrate that alcoholics tal pharmacological difference in the ab rogatory in views of intimate relation need larger amounts of alcohol to in stinence phase. crease alcohol blood levels and to de- H. E. Himwich of the Thudicum Re- ships. (5) Limited academic and job aspir velp impairment of function. For the search Laboratory, Galesburg, Ill., found ations. same impairment of function as in a ( ethanol could block blood pres moderate drinker, the alcoholic may \,_.,;: response to noxious stimuli more ( 6) The feeling that things never turn out right. have to drink 30 times as much. One easily than it could stop EEG arousal. interesting question is posed by these R. E. Docter of San Fernando Valley ( 7) A self-sufficient facade. ( 8) Excessive dependency, with results - Why don't alcoholics exhibit State College, Northridge, Cal., found more damage than they do? that moderate doses of alcohol given drawal or hostility. alcoholics produced not drowsiness but ( 9) Severe personality disorder. Dr. Goldberg showed how insights ( 10) High levels of anxiety and neu apparent excitation according to EEG into the problem of aic·oholism could be rosis, and occasionally schizophrenia. and other data. He concluded that al provided by social phenomena. For in ( ll) Abuse of beer. cohol has stimulant and sedative pro stance, before going to sea, the 20 per perties depending on the dose. Opto ( 12) Use' of alcohol to relieve loneli- cent of Norway's young people who kinetic responses, mesured by Y. Mizoi ness, depression and frustration. enter the merchant marine for one year of Kobe U,., Kobe, Japan, were sensi ( 13) Impulsive, thrill-seeking. are given a neurosis index which subse tive enough to provide a medicolegal (14) Use of drugs. quently can be directly correlated to the test of alcohol response. ( 15) One or more suicide attempts. incidence of alcoholism. And, remark From Dr. Rosenberg's work comes ably, a 1963 strike in Sweden's alcohol Neurological Papers the hypothesis that the earlier the on monopoly, which abruptly stopped the Other neurological investigations set of problem drinking the faster the country's liquor supply for three weeks, showed no difference in pain tolerance acceleration of the addictive process. resulted in a decrease in suicides, a de between alcoholics and non-alcoholics mortality in Nmway, where 113% of the crease in cases of drunkenness and a (L. D. Boutin, St. Peter, Minn.) Alco expected number of 1722 male patients temporary decrease in admissions of al hol did not change responses to aversive followed up had died. Tuberculosis, coholics to institutions. Dr. Goldberg's visual stimuli (Z. H. Garfield, Temple carcinoma, cardiomyopathy, apoplexy further work shows that the moderate U ., Phil.) but did have a qualified effect and epilepsy were mainly responsible, drinker's drinking is geared to his en in making subjects underestimate time the excess mortality ascribed to cirr vironment while that of the ·true alco (P. Stokes, Cornell U., New York). hosis being comparatively small (P. holic is geared to himself. Alcohol could not be ascribed a direct Sundry, U. of Oslo, Norway). Of an role in the morbility and mortality due After a brief history of the organiza alcoholic population which was 'natu tion was delivered by retiring president, to lung disease in alcoholic smokers ral' (untreated) after ten years, 36% Dr. A. Zentner, Dr. Ruth Fox was in (J. G. Rankin, U. Melbourne, Austra were still actively alcoholic, 23% in stalled as the new president of the . ' but alcoholism was 11ssociated with active, 18% were dead, 23% had moved greater syphilis rate and more car (R. J. Gibons, Addiction research foun American Medical Society on Alcohol bon monoxide in the blood (F. Par dation, Toronto.) ism. She outlined the Society's plans for theine, N ordhorn, West Germany) . Reprints of the papers may be ob regional divisions which will hold sever Pathology tained from the authors or inquiry could al meetings during the year in addition Alcoholism carried a greater risk of be made at the NAAP. to the annual national meeting. FOCI AT CONGRESS tion between community agencies ters on the children of alcoholic fami (Continued from page 1, col. l) helped identify alcoholism in situations lies. Warshaw's Rutkiewicz presented where it formerly went unnoticed. This principles of organizing welfare for more alcoholic patients. According to led to greater skill in engaging and children of alcoholics because studies the authors, (R. M. Gray, U. of Utah, treating families with alcoholism prob from many countries show that paren Salt Lake City) authoritarianism is in lems. (P. Cohen, Family Service of the tal alcoholism spawns nearly half of aL. congruent with the expectations of Cincinnati area) . In this regard, J. A. criminals, 2/3 of prostitutes, 2/5 of alco alcoholics and authoritarian doctors Ewing of Chapel Hill stressed that ap holics, and 3/5 of the mentally retarded. tend to avoid this type of role relation proaches which involve significant other Total rehabilitation of the alcoholic as ship. C. B. Truax of the U. of Arkan persons in the alcoholic's life are more sas, Fayetteville, Ark., was able to train well as treatment for his family must promising than treating the patient underlie efforts at salvaging his chil non-professionals within a short period alone. P. H. Esser of The Netherlands dren. It may be necessary to provide of time to function at the level of ex worked with alcoholics using "conjoint foster c·are or institutionalization to free perienced. The work of F. Schual family therapy" with the assistance of the child from his problem environment. H. Salter, and M. G. Paley, of New an A. A. member who knows from ex Less extreme measures such as organ York's Pilgrim State Hospital showed perience that an alcoholic is an emo ization of afterschool and play activities, that distinct advantages accrued when tional prisoner of the disordered pat with provision of meals, clothing, money patients helped each other. At this alco tern of his family life and knows it is and health services for the child-plus a holism service, group therapy is con best to intervene at home where the multi-faceted program designed to re ducted exclusively by alcoholic patients. life of an alcoholic breaks down. The store the alcoholic family to social via This helps the newer patients with their visiting psychiatrist evaluates the home's bility-offer much more hope for these anxieties while bettering the morale of emotional climate by participating and the older and improved patients who vulnerable children. moving directly into the family life of become involved with helping. The Treatment Aids Discussed the alcoholic and fulfilling the parent groups consist of 5 to 8 members with Many treatment aids discussed in figure role providing them emotional out a therapist, although there is a clude disulfuram, which was found less support. He notes who wants what large group follow-up discussion which, from whom and the family members effective for psychopathic patients by the staff's limited numbers can super learn to shift conflicts to the level of E. Negulici of Bucharest, but endorsed vise. interpersonal processes. They learn to for a widespread informed use with Return to Society appreciate the scapegoat status of the alcoholics by R. W. McNichol, Arkan sas State Hospital, Benton. After an alcoholic undergoes treat alcoholic member who suffers most and Conditioning therapy with apomor- ment, and begins to acquire the habit is therefore compelled to continue his of abstinence, his old alcoholic com drinking behavior. The therapist helps phine, (0. Kondas, Comenius ,U. Brat panions and his own loneliness tend to family members replace sickness-induc islava, Czechoslovakia) succinylcholine lure him back to drinking. Few alco ing defenses with healthier ones. Re (J. Clancy, U. of Iowa, Iowa City ) holics can bear that psychosocial temp sults of this program with ten families LSD 25 (A. A. Kurland, Spring Grow tation without relapse, reports J. Vesel so far have been promising. Hospital, Baltimore, Md., and F. G. of Yugoslavia. 0. Irgens-Jensen found Johnson Addiction Research Foundation, Females Young and Old London Ont.) Alcoholics Anonyomous loneliness itself in very isolated men A study from Warsaw revealed that living in north Norway was not com the incidence of female alcoholism tends (B. Leach, Roosevelt Hospital, N.Y.) bined with increased alcohol consump to increase as urbanization, industrial T. Dancey, McGill U. of Montreal) and tion. (Nat. Inst. Ale. Research, Oslo). ization and female employment increase. 0. H. Mowrer, U. of Illinois), Psycho- Positive rehabilitation measures used And G. J. Salzberger's study of alco drama, (H. Wiener, N.Y. ) Nictotinamide in Czechoslovakia says J. Skala, are holism in the aged female at Pilgrim and adenine (R. Lecoq, St. Germain aimed at developing the patient's con State Hospital, where about 60% of the en-Laye, France, and half-way houses structive nature. In-hospital treatment geriatric patients took to drink once (E. Tuominnen, Helsinski, Finland.) is consistent, demanding and purpose they began to feel the growing sense of ful to enable the patient to bear ever isolation attending old age, showed that Results greater stress in life. A. A. Lazarus of multiple factors, somatic as well as B. Kissin, Downstate U. College of Temple University Medical School re psychological, were part of the etiology. Medicine, Bklyn, who found different ports, equal attention must be given The family of the aged female alcoholic treatment methods more effective with to stopping overt drinking behavior by reacts with shock, and embarrassment, different psychologic'al and socioeco broad spectrum behaviorial treatment fears gossip and wishes to conceal nomic classes of alcoholics. which also deals with guilt, and anxiety. mother's failing. Her drinking, ex Treating the Family plained as strictly for medicinal pur CONGRESS INTERESTED poses, obscmes the patient's needs for (Continued from page 1, col. 3) The importance of understanding and self-assurance, understanding, compan holies in Iowa willing to submit to help treating the alcoholic's family was un ionhip, and a feeling of usefulness in have a home - a coordinating agency derscored by numerous reports to the her fading universe. These women are that cares and will stick with them." Political parties in Iowa both have Congress. A London study of the coping agitated and hallucinating during acute behavior of alcoholics' wives (Oxford planks calling for rehabilitation ser episodes, commonly claiming that ani J. F. Institute of Psychiatry) resulted in vices, which prompted the governor to mals are running across the ceiling identification of five factors, "attack," say, "The agitation for adequate treat making faces at them. Prompt control "withdrawal within marriage," "protec ment and rehabilitation has now be of the agitation. is essential in the elder tion," "acting out," and "safeguarding come a chorus that can be heard." ly, decrepit and in the rehabilitative family interests," possibly important to Presentations on psychiatric, bio period, drug therapy is combined with the development and treatment of alco chemical, physiological, adolescent anCI. psychotherapy and environmental man holism. Further, the importance of co driver safety aspects of alcoholism were operation between agencies and fami ipulation. also given at the convention and some lies of alcoholics was stressed by a Children of them are highlighted here in other Cincinnati study in which coopera- One important area of interest cen- columns. BOOKS RESEARCH AND Understanding Alcoholism: For the REVIEW Patient, the Family, and the Employer ·)y The Christopher D. Smithers Foun New York City physicians, Charles S. dation, Inc., 41 E. .57th St., New York Lieber and Emanuel Rubin, recently 10022. 1968, 257pp., $6.95. presented (Gastroenterology. Vol. 54, This book prepared to enlighten the No. 9, pp 642-646) a study of ethanol public about alcoholism, offers sound, ns a many-faceted hepatotoxin particu effective help to those afflicted as well larly focusing on its involvement in drug as to those whose lives are touched by detoxification processes. Their prior in its tragedy in numerous and diverse vestigations hnve demonstrated hepa ways. It is largely derived from a series tic changes due to alcohol indepen of pamphlets on alcoholism issued by dent of nutritional deficiencies. Because the Smithers Found,ation for laymen ethanol-produced hapatic injury is dose over the years. Some of the included related, reproducible in man and ani topics are: types of alcoholics; steps mals and characterized by fatty changes toward achieving per~anent sobriety; and necrosis, it should be classed among the fallacy of "controlled drinking;" the those hepatotoxins injuring liver by di impact of alcoholism on the family; rect action on hepatocytes, not among significant areas of alcohol education, those acting indirectly by hypersensi and the law and the alcoholic. The only tivity. One such agent is carbon tetra working foundation in the United States chloride. But, though both produce R. BRINKLEY SMITHERS principally engaged in fighting alcohol hepatic fat accumulation, associated R. Brinkley Smithers, chairman of the ism as a disease is the Smithers Foun lesions differ markedly. Functionally, Alcoholism Committee of the Community dation a central agency for collecting, CCI' induces hypolipemia while a large Council of Greater New York, was chair classifying, and distributing inofnnation. ethanol intake does the opposite. man of the Pah·onage Committee of the It is neither wet nor dry, but solely The difficulty in classifying ethanol in 28th International Congress on Alcohol interested in helping est Psuclwlo f.!.i~ t s ·o 0 appeared in Psychosomatic Medicine ual meeting. Bayshore Inn, Vancouver, Psychologist GS-13 Sl4,l:ll:ll! $ 19,:lOH (vol. 28, p. 405, 1966). The Commit Canada. Psychologist GS-14 16,946 22,031 tee stressed that although it is unlikely Interested physicians"' should write to that biological factors will ever prove IN MEMORIAM Dr. Paul Travis, Director, Rehabilitation ail-important to the exclusion of man's Center for Alcoholics, Occoquain, Vir socio-cultural relations as a cause of al Dr. Richard Buckley, Hoboken, coholism, if such factors can be demon New York, died in August of 1968. I ·inia, 22125 or call Area Code 703, \ .90-1.544, Lorton, Va. Psychologists"" strated, "they will provide a stronger Member in good standing-Ameri should write to Dr. James A. Vander basis for the disease concept of alco can Medical Society on Alcoholism. pool, Chief of Clinical Services of the holism, and will increase the hope of same institution, or call Area Code 703, finding means of preventing or aborting For this issue of PAN, Mrs. Helen 690-1.547. the addictive process." Borel acted as assistant editor. PHYSIOLOGY AND PATHOLOGY STRESSED IN MEDICAL PHASE Papers from Japan, Germany, Chile, that 24% of alcoholics do not develop in the urine ( R. Derache, U. of • Canada, Czechoslovakia and France liver damage. Diet histories and esti louse, France) efflux of potassium 1 tl demonstrate the geographic diversity of mates of alcohol consumption when cells incubated with alcohol (H. M. and the many biochemical and physiological compared between the group who did J. E. Redetski, Louisiana State U., New research reports presented at the In and did not develop such damage Orleans) inhibited active transport of ternational Conference on Alcohol and showed no significant differenc·cs. On amino acids, leading to effective pro Alcoholism. Many phases of the activity the other hand, further data of Dr. tein deficiency (Y. Israel, U. of Chile, of alcohol were investigated, and by Charles Lieber of U.S. showed fatty Santiago). Electrolyte derangements many methods. metamorphosis occurring independent Hereditary Basis of dietary regimen, and after only 2 unexplainable by known diuretic or Proponents of an hereditary basis days of ethanol consumption; electron hormonal changes induced by ethanol for alcoholism, could be encouraged microscope studies showed the mito ingestion were found by J. H. Mendel by the isolations of different isozymes chondrial alteration, smooth endoplas son et al (NIMH, Chevy Chase, Wash., D.C.) of alcohol dehydrogenase by J. P. mic reticulum increase and focal cyto Increased mitochondrial size might Wartburg and T. M. Schenker of plasmic degradation expected from his previous longer term studies. D. Gaill be related to the increased metabolism Switzerland. Another genetically related of alpha-glycerophosphate in ethanol investigation was that of Prof. ]. Mar ard of the University of Toulouse, treated rats, suggested K. H. Kiessling clones and colleagues of Chile, who ex France was unable to find increased of U. of Uppsala, Sweden. tended their studies of color vision steatosis in rats whose diet prior to alco hol consumption was rich in lipids and M . H. Kniseley, (Med. Coli. South among the alcoholic, using the Farns poor in proteins. He felt that during Carolina, Charleston, S.C.) found that worth Munsell 100 hue test, and con malnutrition, alcohol is metabolized alcohol produced sludging, increasingly cluding that a genetic polymorphism re more slowly. 0. A. Forsander from the lated to color vision defects of the X at increased concentrations, and sug Research Laboratories of the State Al chromosome is present among alcohol gested that because of this, blocked cap cohol monoply of Helsinki, Finland illaries might produce the brain dam ICS. measured redox levels in cytosol and age, and that of the liver and heart in Hypgonadism, particularly Klinefelt mitochondria and the Respiratory Quo alcoholism. er's syndrome, is associated with a dis tient. The changes after alcohol could Acetaldehyde proportionate rate of alcoholism, ac be explained by the inhibition of oxi An important warning on laboratory cording to E. Negulici et al, of Bucha dation of fatty acids in the citric acicl rest, Rumania. They ascribe this to cycle. procedure was made by Dr. E. B. T11uit, Jr. of the Battelle Memorial Insti deficient psychosexual maturation. W. R. Wooles (merical Coil. Va., The possibility that nurture may in- Columbus, Ohio. He found that b Richmond, Va.) administered chlorcy precipitation by several reagents fluence alcohol preference was indicated will clizine and promethazine to rats and cause acetaldehyde release in blood con- by the experiments of M. U eda and S. found them effective in reducing fatty taining inebriating levels of alcohol. Komura of Japan's Kyoto University. liver development. Mice of a low alcohol-preference strain This constitutes significant artifact. were nursed by a 'foster mother' of a Metabolic Effects That acetaldehyde accumulation is related to the effect of antabuse, was high alcohol preference strain. When Other general metabolic effects of demonstrated by Feldstein, A. (Wor compared to controls, they had a sig alcohol found increased fibrinogen levels nificantly higher alcohol intake. cester Foundation for Experimental related to the elevated erythrocyte sedi Biology, Shrewsbury, Mass.) whose Fatty Liver mentation levels often seen (Rice, E. W. radioactive carbon tagged 5 hydroxy Fatty-liver came under scrutiny. Singer Memorial Institute, Pittsburgh, tropytophol administered to rats was G. Ugarte et al, from Chile, concluded Pa.), increased elimination of sulfur ( CDntinued "" page 3. c-Dl. l ) Published quarterly by American Medical Society on Alcoholism, Inc. Publication has PHYSICIAN'S ALCOHOL NEWSLETTER Non-Profit Org. been made possible by a grant from the 120 Central Park South U.S. POSTAGE Christopher D . Smithers Foundation. PAID New York, New York 10019 New York, N.Y. Permit No. 6929 EDITORIAL BOARD Editor-in-Chief - Frank A. Seixas, M.D. Inlernist, Sec'y N. Y. Med. Soc. on Alcohol ism; Associate Editors-Lr~ther C/ond, M .D. - Internist, Asst. Medical Director, Equitable Life Assur. Co., Ruth Fox, M.D.- Psychia trist., ~!cdical Director, :\fat'! Council on Alcoholism. Stanley Gitlou:, M.D. - Asso. Clinical Prof. Medicine, New York Medical College. Sidneu Greel!berg, M.D.-Internist, Consultatation Center for Alcoholism. Percu Ruberg, M.D. - Psychiatrist. Donald \.. • Mackay, M.D.- Montreal, Quchec.