PUBLISHED BY AMERICAN MEDICAL SOCIETY PHYSICIAN'S ON ALCOHOLISM, Inc. Two Park Avenue New York, N.Y. 10016

Vol. 5, No.4 Fall, 1970 © Copyright 1970 American Medical Society on Alcoholism, Inc. NEWSLETTER All Rights Reserved ADVANCES IN ALCOHOLISM "Mini-Delusions" Trouble Alcoholics, Browne-Mayers RESEARCH REPORTED AT Tells Eastern Psychiatric Research Meetings . ~atients. suffel'in~ from nlcoh?lism and dtug abuse may experience "mini-delu- LIVER DISEASE MEETINGS SIOns -that 1s, recurnng false behefs that alter behavior and thinking-reported Dr. A. .N . Bro';ne-~ayers ~nd a team .of psychiatrists from The New York Hospital, Research reports on alcoholism and C01nell Umvemtr, ~.edical College 111 .White Plains to the 15th Annual Meeting of alcohol-related factors in liver disease the E~stem Psyc.luatl.lC Research Association. TlJ,e theme of the meeting, which was were presented at the 21st Annual Meet­ held 11.1 . ~w York Ctty on oven:ber 7-8, was Drug Abuse: Current Concepts and ing of the American Association for the ~e~ea10l.1. Dr. Brown~-Mayers smd that even though the patient appears to achieve Study of Liver Diseases held November 1~1S1ght .utto th.e d e l .u~tons, .the err~n~ous belief will frequently reappear at a later 4-5, 1970, in Chicago. Following are tu~e Wlt~l ~II Jts ?n~n~al v1gor .. MmJ-delusions are dependent upon psychodynamic some of the highlights of the meetings. f01ces w1thm the mdlv!dual pat1ent and are also closely allied to denial mechanisms. In a series of about 50 addiction Rates of Ethanol Metabolism Decrease patients, mini-delusions were seen clearly Following Withdrawal from Alcohol NAAAP ANNUAL MEETING at least five times. As an example, Dr. The rates of ethanol disappearance Browne-Mayers cited an alcoholism pa­ from the blood and the activities of the DISCUSSES ALCOHOL tient who complained that she had been ethanol oxidizing enzymes were studied taken off the debutante committee of the in 25 chronic alcoholics during ethanol Junior League in her community. Investi­ ingestion and withdrawal to determine AND ADDICTIONS gation showed that she had never even hether or not changes in the rates were been on such a committee. When she was Addictions in their various forms were .. ccompanied by parallel changes in the given this information, she seemed to discussed by experts in many fields at activity of the enzymes. In the study, accept it as true, but a few weeks later, the 21st Annual Meeting of the North conducted by E. Mezey of the Baltimore and then months later, she returned to American Association of Alcoholism Pro­ City Hospitals and Johns Hopkins Uni­ her original recollection of the upsetting grams held in San Antonio, Texas, Sep­ versity School of Medicine, the patients, time "when they took me off the com­ tember 27-0ctober 2, 1970. who had a history of recent alcohol in­ mittee." take and no overt clinical evidence of In the Clinical Symposium, Daniel X. Freedman, M.D., Professor and Chair­ Mini-delusions characteristically are live•• disease, were placed on a normal generally plausible and not bizarre. The diet supplemented by ethanol for 3-5 man of the Department of Psychiatry of the University of Chicago, discussed the emotion or the accompanying affect is days. A liver biopsy was obtained wlth generally within normal range. They do assay of the two enzyme activities on growing problem of addiction in "The Great Stoned Age." Relating the abuse not occupy the whole spectrum of the liver homogenates. Repent studies were patient's mental life. The conviction dis­ perfo••med on 12 patients after 1, 2, and of alcohol and drugs to the larger prob­ lem of wh~t societ~ defines as accept­ ~ppears completely at times, reappears 3 weeks of continuous hospitalization m other cases, is denied in still others and abstinence from alcohol. Liver bi­ able behav10r, he sru.d that every society that use~ drugs invents customs to regu­ and. is frequent~y rationalized. The pro~ opsies revealed val'ious degrees of fatty fesswnal therapist may not realize he is infiltration in 24 patients and alcoholic late thetr use and purpose. The medical professiop, which in a modem tech­ listening to a mini-delusion because it hepatitis in 1. Follow-up biopsies showed is usually plausible and reasonable. Psy­ decreases in fatty infilh·ntion in all the n.ological society is the only system con. - s1dered. capable of handling drugs must chotherapy, group, individual, and milieu patients. The mean 1·ate of ethanol dis­ therapy have been the chief methods to appearances from the blood decreased thread Jts way carefully through the myr­ iad and changing patterns of alcohol deal with this phenomenon. Psycho­ from 19.7 ± 3.2 (SD) to 14.9 ± 0 ..5 mg/ pharmacological agents, when tried, ap­ 100 m1/hr (p < .001) within one week and drug abuse to determine wby a particular person uses thugs, what it peru· to exert little influence in over­ of discontinuation of ethanol. ADH in­ coming this problem. creased during the 1st and 2nd week means to him, and bow to help him from 9.3 ± 3.2 to 19.0 ± 5.6 micromoles/ learn new behaviors once he is off the Fatalities Due to Alcoholism · mg protein/hr (p < .001), and decreased dru~ Are Under-Reported in New York In addition to the general sessions, back to normal values in the 3rd week. Mic.l1ael M. Baden, M.D., Deputy special panel discussions were also held ~ccording to Mezey, these findings sug- Chief Medical Examiner of the City of for various sections: Administration I}St that the J"ates of ethanol disap­ ew York, reported that deaths due to Community Action, Education, Research earance from the blood are J"egulated nlcohousm are widely under-reported. In and Training, Social Work, and Treat­ by factors other than the absolute activi­ ew Yol'k City last year, of the more ment Services. The host agency for the ties of tbe ethanol oxidizing enzymes. than 6,000 deaths related to alcoholism conference was the Texas Commission ' (Continued on page 5) on Alcoholism. (Continued on page 6) 1 EDITORIAL MEETINGS

Exploding A Myth ject does not correspond with the facts JANUARY 25-28, 1971 - 38th Annual About Alcoholism . . . (The) false belief (that alcoholism Meeting, National Association of Private The study of alcoholism is confused remans an insignificant phenomenon) Psychiatric Hospitals. Sonesta Beac· by many misconceptions-often impres­ has been shared by a number of foreign Hotel, Key Biscayne, Florida. Informa­ sionistic statements from the untested ex­ researchers, such as Sadon, Lolli, and tion from NAPPH, 353 Broad Avenue, perience of one man, copied without in­ Silverman, all of whom have been dis­ Leonia, N.J. 07605. vestigation until they become axioms, so proved by Perrin." ,I encased in authority that to question Tracing the increase of admissions of THURSDAY, JANUARY 28, 1971, 8:30 them is heresy. Though it is difficult alcoholic psychoses to mental hospitals p.m. - AMSA meeting, featuring film enough to gain a hearing for su~h her­ (from 900 in 1947 to 2,700 in 1962) and "Eagleville-You're Not Alone." Discus­ esies when they attack an undocumented their percentage of all mental hospital sants will be Howard D. Zucker, M.D., pronouncement, it is even more counl­ admissions ( 4.4% in 1947 and 12% in and Stua1t E. Nichols, M.D. Hanger geous to call attention to the incorrect­ 1962), and noting that the incidence of Amphitheater, Ninth Floor, College of ness of a myth which has been buttressed cirrhosis of the liver has increased at a Physicians and Surgeons, 630 W. 168th. by "evidence." similar rate, Mastrangelo deplores the For this reason it is refreshing to read effect of the notion that if one is Italian APRIL 27-29, 1971 - NCA National Giuseppe Mastrangelo's essay, "Recent he is not likely to be alcoholic. Meetings, Anaheim, Calif. Infonnation Developments in the Struggle against from NCA, 2 Park Ave., New York City. Alcoholism in Italy.""' Masb·angelo says: Unfortunately the force of Dr. Mas­ "In Italy public opinion as a whole con­ trangelo's argument is blunted by his siders that there can be individual alco­ failure either to quote or give a refer­ International Meetings planned for 1971: holics, but that alcoholism does not exist ence for Perrin's work, as well as by the MAY-Vienna, Austria, Drug Depen­ as a national problem. This same belief very general nature of his statistics. dence; JUNE-West Berlin, Alcoholism; is shared in other parts of the world by However, he has made it clear that alcoholism is indeed a growing problem OCTOBER 5-8-Dublin, Ireland, Alco­ many persons who, in good faith, con­ holism and Drug Dependence. For fur­ sider Italians as an example of sober in Italy, and that we cannot consider ther information, contact Archer Tongue, people, whose general habit of drinking Italians immune from the disease. wine in preference to other spirits does FAS Executive Director, International Coun­ cil on Alcohol and Addictions, Case not lead them to alcoholism. It must now 0 In YForld Dialogue on Alcohol and Drug Dqn:n­ be stated that this belief is without foun­ dence. Elizabeth D. \iVhitney, editor, Beacon Press, postale 140, 1001- Lausanne, Switzer­ dation, and common opinion on the sub- Boston, 1970. land.

BOOK REVIEWS

The Prevention of Drinking Problems: American Drinking Practices: Proceedings of the Eleventh Annual Alcohol Control and Cultural Influences A National Study of Drinking Behavior Meeting of the American Association and Attitudes for Automotive Medicine By Rupert Wilkinson. New York: Ox­ By Don Cahalan, Ira H. Cisin, and Helen ford University Press, 1970. $10 Edited by A1thm H. Keeney, M.D. M. Crossley. Rutgers Center of Alcohol Springfield, Ill.: Charles C. Thomas, Condemning "vague utterances about Studies, Monograph No. 6, 1970. 1970. 298 pp. 'alcohol education' and the 'need for This volume presents the results of A collection of papers dealing with research'," Mr. Wilkinson, who was a re­ the work of the Social Research Group the pre-crash phase, analyzing causative search assistant to the Cooperative Com­ of The George Washington University. mission on the Study of Alcoholism, pro­ mechanisms and advancing control mea­ poses specific reforms to prevent drink­ sures. Alcohol is among the specific pre­ Drug Abuse: Data and Debate ing problems. Among his proposals, crash factors brought under statistical which make use of already existing cul­ Edited by Paul H. Blachly, M.D. analysis and correlation. tural trends, are these: that big distillers Springfield, Ill.: Charles C. Thomas, consider marketing a low-proof alcoholic 1970. $12.50. 322 pp. Drunken Comportment: fruit drink and promote it for certain A collection of papers presented at moderate drinking situations; that local the Second Annual Western Institute of A Social Explanation authorities develop probationary "learn­ Drug Problems Summer School held at By Craig MacAndrew and Robert B. ing sessions" for youthful drinking of­ Portland State University, August 11-14, Edgerton. Chicago: Aldine Publishing fenders; that change be stimulated in­ 1969. Company, 1970. 197 pp. the atmosphere and amenities of taverns. The authors argue that drunken com­ Papers Presented at the 28th portment cannot be explained simply as Alcohol, Alcoholism and Drug Abuse: International Congress on Alcohol a result of alcohol's effect upon the brain; and Alcoholism, Public Health and A Review of VA Sponsored Research instead, changes in behavior under the Health Administration Section Projects and Published A1ticles, 1968-69. influence of alcohol are to be under­ Lausanne, Switzerland: International stood on the basis of social definitions o Compiled by E. Holt Babbitt. Avail­ Council on Alcohol and Addictions, 1970. drunkenness as a state of reduced re­ able from Department of Medicine and A collection of papers presented at the sponsibility, or "time out." However they Surgery, Veterans Administration, Wash­ 28th International Congress, held Sep­ accept the deleterious effects of alcohol ington, D.C. 20420. tember 15-29, 1968, in Washington, D.C. on sensorimotor capabilities. 2 RESEARCH and REVIEW Adult Male Alcoholic More Alcoholism and Social Pathology for the Indian also serves as a form of Successful in Treatment 'mong Urban American Indians symbolic resistance, enabling the indi­ The widespread alcoholism among vidual or a group to assert its indepen­ Than Teenage Drug Abuser American Indians is not the result of any dence from a hostile, alien, and moralistic single factor, even the overwhelming society. The well-motivated adult alcoholic poverty in which most of them live, says AA has had relatively little success who comes to a hospital for treatment Gerard Littman, who worked for several among American Indians, perhaps be- ·' has a much better chance of success than years at the St. Augustine's Center for cause of its emphasis on the alcoholic's an adolescent drug abuser, say Charles American Indians in Chicago. Rather, need to admit his personal weakness. P. Neumann, M.D., Medical Director, Littman believes, "different groups of In­ (Journal of Public Health, Vol. 60, No. and John S. Tamerin, M.D., Director of dians have formed different drinking pat­ 9, September 1970, pp. 1769-87) Research of the Silver Hill Foundation, terns and . . . there are many reasons New Canaan, Conn. In a talk presented which underlie their drinking." He Alcoholism Significant Factor to the 22nd Institute on Hospital and stresses psychodynamic factors as well as in Honduran Mental Illness Community Psychiatry held September economic and cultural ones. Many of the Alcoholism was found to be a signifi­ 21-24, 1970, in Philadelphia, the authors cases seen at St. Augustine's showed an cant factor in a study of 419 outpatients outlined their observations conceming early disruption of the mother-child rela­ and 227 inpatients admitted to the the differences between these two groups tionship, followed by distrnslful with­ National Neuropsychiatric Hospital of that they have found at Silver Hill, a drawal, persistent passjve-dependent Honduras, which is that country's only private, non-profit psychiatric hospital. longings, frustrations, rage, ambi\'alen institution for the care of the mentally The adult alcoholic who does well in dependency relationships, and depres­ ill. Alcoholism was the primary diagnosis treatment is self-referred; the more the sions. Alcohol provides an outlet for in 33% of the new admissions. Of the pressure for referral resides within the these tensions that does not carry any newly admitted male patients, 72% had a individual, the greater the likelihood of social stigma or moralistic reproval current or past history of chronic heavy a successful outcome. The average teen­ among Indians. drinking, but only 8% of the women had age drug abuser at Silver Hill, on the Among the several types of drinkers such a history. Many alcoholics under­ other hand, was forced to come by his Littman has encountered are those who estimated the degree of alcohol abuse, parents because the alternative was jail. drink to: ( 1) cope with internal anxieties compared with the comments of the per­ The adult alcoholic who is likely to im­ and depressions stemming from severe sons accompanying them to the hospital. prove recognizes that his drinking is a trauma in early childhood; ( 2) release The correlation between alcoholism and serious problem and accepts the personal repressed aggressions; ( 3) find a sub­ a history of arrest or prison was statis­ relevance of the problem for himself. At '<.tute outlet for aggression; ( 4) with­ tically significant. The arrests were usual­ the other extreme the adolescent drug __.:.md pain and conflict from accultura­ ly for public drunkenness, fights while abuser neither accepts the problem of tion pressures; ( 5) find a new identity intoxicated, and other direct conse­ drugs in general or the personal rele­ (particularly adolescents); ( 6) be or be- quences of alcoholism. vance of the problem to himself. come part of a group. ,~ The study was directed by Richard The alcoholics who do best in treat­ Treatment and rehabilitation are dif­ W. Hudgins, M.D., from June to August ment are those who have a history of con­ ficult, because of the vatiety of drhtking 1967 under the auspices of the Pan siderable independence and the eco­ patterns and the many reasons for exc s­ American Health Organization and the nomic pressure of others dependent on sive drinking. Furthermore, most Indian Department of Psychiatry of Washing­ them. In contrast is the teenage addict alcoholics may not wish to give up their ton University. (Journal of Public who has always been dependent on his excessive drinking for fear that life would Health, Vol. 60, No. 9, September 1970, parents. In this sense, the dependent become even more unbearable. Alcohol pp. 1788-1085) female alcoholic is similar to the teen­ age addict, and is generally less success­ ful than the male alcoholic who is eco­ nomically responsible for his family. Membership Application The alcoholics who responded in treat­ ment generally have had a history of accomplishment or achievement, which American Medical Society on Alcoholism the majority of teenage addicts have c/o Ruth Fox, M.D. never experienced. By using drugs, the 150 East 52nd Street teenager joins a subculture which de­ New York City 10022 fies the standard cultural framework and avoids the status conflict. Name ..•...•...••..••.•.. . .. Degrees ...... •...... • . The adult alcoholic is usually able to perceive the therapist as an ally and to Address ...... ••..•...•....•. Specialty form a meaningful alliance with him. He enters into an implicit contract with his City Nature of Interest therapist to work toward changing the addictive aspects of his personality. The Zip In Alcoholism teenage drug abuser rarely enters into tl1is form of therapeutic contract. The 'generation gap," in which the alcoholics Dues $25 D Enclosed D Bill Me have shared common experiences with (Dues include subscription to Physician's Alcohol Newsletter) the therapists, woxks in favor of the alco­ holic but against the addicted adolescent. 3 Alco-Calculator Helps ANALEPTIC DRUG SPEEDS REGRESSION OF ACUTE Social Drinkers Know ALCOHOLIC PSYCHOSIS, BELGIAN TEAMS REPORT Limits for Alcohol The drug 2-pyrrolidoneacetamide, an chronic patients. Criteria were the drug _ "If you drink, don't drive" is unreal­ analeptic, produces rapid regression of effect on psychic and physical asthenia, istic advice, says Dr. Leon Greenberg, acute alcoholic psychosis, has a favorable memory, intellectual weakening, anor­ executive director of laboratory research effect on clinical symptoms in chronic exia, insomnia, bad temper, aggressive­ at the Rutgers Center of Alcohol Studies. alcoholism, and seems to improve in tel-·' ness, and psychomotor excitement. The real problem, he says, is "knowing lectual efficiency, two separate teams of Dr. Toscano reported using somewhat your limits," and he has developed a researchers have reported. The teams, higher dosages than those reported by device called the Alco-Calculator de­ which presented the results of their work Dr. de Buck in his study of 160 hospital­ signed to help moderate drinkers achieve at the 7th Congress of the Collegium ized patients, including 118 alcoholics this goal. It is a simple slide rule that Internationale Neuropharmacologicum in and drug addicts. Dosages of 4 Gm. per uses data about body weight, number of Prague, were led by Dr. R. de Buck day were maintained for 5 days in the drinks and drinking time to help people of the Psychopharmacology Research alcoholics, and then individual main­ decide whether they would be .safe be­ Institute of Brugmann University Hos­ tenance dosages of between 400 and hind the wheel alter consuming a known pital, and Dr. M. Toscano of lnstitut 2,000 mg. were given. Muscular inco­ quantity o£ alcohol. For example, a Fond'Roy, both in Brussels. ordination, anorexia, disorientation, and couple arrives at a cocktail party and Dr. de Buck noted that all acute confusion all showed improvement, he stays there four hours. He ( 190 lbs. ) signs disappeared within 24 hours in 20 said. A highly significant lessening of drinks four martinis; she ( 120 lbs.) out of 21 alcoholic patients, 17 of whom anxiety was found in alcoholic and drug­ drinks three. Who should drive home? were hospitalized with delirium tremens. dependent cases where anxiety was root­ He should, because his blood contains All received 1.5 Gm. of 2-pyrrolideone­ ed in a neurosis of the obsessional or .04% alcohol, hers contained .06%. If they acetade intravenously on the day of ad­ depressive type . mission, the same dosage intramuscularly had left after only three hours (but with The drug's action is not that of a the same number of drinks), his blood during the next 3 to 5 days, and 2.4 Gm. thereafter. Much lower doses of psycholeptic, which masks anxiety, but would have contained more than the rather it appears to produce a strength­ legal minimum of .05%. The Alco-Calcu­ psychosedatives were needed than when ening of internal judgment and control lator is calibrated in terms of common the drug was not given. Similarly, im­ beverages, with settings for martinis, 12- provement was noted in 30 out of 40 of somatic manifestations. oz. bottles of beer; whiskeys of 80, 86, or 100 proof, and table ( 12%) and forti­ fied (20%) wines. ·\c Dr. Greenberg has assigned the right Syrups Improve Condition GITLOW ELECTED to the Alco-Calculator to Rutgers Univer­ sity. Neither he nor Rutgers sells the of Advanced Cirrhotics AMSA PRESIDENT device for a profit, but it can be pro­ cured by mail for $1.95 from the Rutgers Syrups containing lactulose or sorbitol Stanley B. Gitlow, M.D., was elected Center of Alcohol Studies, New Bruns­ may help some patients with far-ad­ President of the American Medical So­ wick, N.J. 08903. vanced cirrhosis to live a more normal ciety on Alcoholism at the business meet­ life, although not necessarily a longer ing held November 1-2, 1970, at the one, Henry Brown, M.D., and William Eagleville (Penn.) Hospital and Rehab­ AMSA-REGION VIII HOLDS V. McDermott Jr., M.D., of the Harvard ilitation Center. Other officers elected Medical School reported to the Tenth were: Vice-President, Ma1vin A. Block, MEETING IN COLORADO Multidiscipline Research Fomm at the M.D.; Secreta1y, Frank A. Seixas, M.D.; Meeting in Colorado Springs in con­ AMA's 119th Annual Convention in Treasurer, Percy E. Ryberg, M.D. The junction with the Colorado Medical As­ Chicago. The sugars decrease hepatic immediate past president is Ruth Fox, sociation, members of the AMSA-Region encephalopathy in the cirrhotic patients, M.D. The Executive Board of Directors VIII heard a talk on September 26 by probably by cathartic effect and by low­ elected at the meeting consists of: actress Mercedes McCambridge outlin­ ering colon pH. In turn, blood levels of LeClair Bissell, M.D.; Luther A. Cloud, ing the need for increased alcoholism re­ ammonia and other nitrogen-containing M.D.; Vemelle Fox, M.D.; Ebbe C. Hoff, compounds absorbed from the colon are search and treatment facilities. Following Ph.D., M.D.; James A. Knight, M.D.; reduced. the meeting, the group visited the Emory David H. Knott, Ph.D., M.D.; Charles John Brady Hospital in Colorado Subjective improvement was noted in S. Lieber, M.D.; Stumt E. Nichols, Springs which for the past 20 years has nine patients out of 20 (three died of M.D.; and Maxwell N. Weisman, M.D. treated alcoholics. The treatment pro­ liver disease early in the study, three Following the business meeting work­ gram was outlined by Richard L. Conde, others were uncooperative, the symptoms M.D. Patients come both voluntarily and of three others were controlled with shops were conducted by Frank A. by Court commitment. After at least 18 moderate protein restriction, and two ad­ Seixas, Stanley B. Gitlow, and LeClair hours of complete sobriety, Antabuse is ditional patients are still being studied). Bissell. administered twice weekly either while Dr. Brown noted the difficulties in judg­ Under the direction of Donald J. Ot­ the patient is hospitalized or on an out­ ing results because the evaluation is sub­ tenberg, M.D., Medical Director of thr patient basis. The success of the pro­ jective. Nevertheless, he believes that center, the participants in the meetidL gram, which is somewhat costly and oc­ these patients benefited from administra­ casionally difficult to administer, has tion of either of the sugars, although experienced the Eagleville program for been due to the cooperation of local "improvement in such a patient must be alcoholics and drug addicts. (For a de­ courts, police, public arrd private social measured in weeks or months (not scription of the Eagleville approach, see agencies, and AA. years)," PAN, Vol. 5, No.3, Summer 1970, p. 5.) 4 LIVER DISEASE MEETINGS HEAR REPORTS ON ALCOHOL RESEARCH (Continued from page 1 )

•od Clearance of Ethanol and chondria, perox:isomes, lysosomes and Lymphocyte Reactivity and 1olbutamide in Chronic Alcoholics lipid bodies in the rats fed chow and Ethanol-Induced Liver Injury 25% ethanol in dxinkiug water. All these Abnormalities in lymphocyte reactivi· The blood removal rates of alcohol changes were partially reversed by cho­ ty resulting from either immunologic or and tolbutamide and the liver enzymes supplementation. The sm'fnce are·n of line ,, physiochemical alterations may be im· at various times after alcohol withdraw­ smooth and rough · membnm both ER portant in the development and/or per­ al was studied in a group of six chronic was reduced 50% in the ethanol-treated petuation of ethanol-induced liver in­ alcoholics. The study was conducted at animals. This cho.nge was partially re­ jury, according to a report presented by Lemuel Shattuck Hospital by M. N. YC:lrsed by choline. Ethanol-induced in­ Michael F. Sorrell and Canoll M. Leevy Shah, B. A. Clancy, and F. L. lher or creases in total liver P-lipi.d, lecitlli n, Tufts University. The results showed lh:tl phosphatidyl ethanolamine, and micro­ of the New Jersey College of Medicine this group of alcoholics had both acceler­ somal P-llpid/mg. protein were largely and the VA Hospital of East Orange, ated blood removal of alcohol and tolbu­ reversed by choline. Ani Une hydroxyl1\su N.J. Previous studies had indicated that tamide that decreased with hospitaliza­ increased twofold iu the ethnnol trentetl autologous liver homogenate in short­ tion. The accelerated metabolism cor­ rats when compared to control und term lymphocyte cultmes from patients related closely with increased drug me­ threefold in the rats fed ethanol plus with chronic active hepatitis or alcoholic tabolizing enzymes in liver microsomes. choline. Ethanol increased tl'iglyceridc hepatitis cause a 3 to 5-fold increase in lymphocyte tro.nsfOimntion, interpreted The liver ADH levels did not correlate content twofold and this was partially with tl1e body removal of alcohol, indi­ reversed by choline. ns evidence of immunologic reactivity of cating that other systems are responsible the delayed hypersensitivity type. Inves­ tigations were tlHm undertaken to deter­ for this removal in man. Alcoholic Cirrhosis without mine the effect of the supra-addition of Portal Hypertension Tryptophan Inhibits Toxic Effect ethanol and acetaldehyde to such cul­ Of 88 cinholic patients studied during tures. Lymphocyte cultures were obtain­ of Alcohol on Albumin Synthesis the past fo u1· years at the Hopitul Snint· ed from control subjects and from pa­ According to research reported by Luc nnd University of Montrenl by u tients with chronic nc tive hepatitis or M. A. Rothschild, M. Oratz, and S. S. group led by Andre V!allet, flve did not alcoholic hepatitis. One set of cultures Schreiber of New York University School have pol'tlll hypertensi01 1. Clh io1111y, nil without additions served as a control, of Medicine, the acute effects of alcohol were romm-knbJ.y similnt·. All were alco· phytohemagglutinin was added to a sec­ on albumin production may be moder­ holies wlth an enhll'gecl liver, palpable ond set, autologous liver homogenate to ~ted or completely reversed by trypto- 7 to 10 em. below the costnl margin. n third, ethanol to a fourth, acetaldehyde .an. Furthermore, the chronic effects of None had splenomegnly or a~citos, three to a fi fth, unci eth!mol plus autologous ulcohol on albumin synthesis mny be rap­ had nngiomns. Liver function te~ t s were liver homogenn te to a sixth set. Control idly removed if the aJcohol is not presen t either normal or nenr normal, but two cultures in patients with chronic nctive in the perfusing plasma. The nuthots pntiet ts had n history of jnun.dicu fol­ hepatitis or alcoholic hepatitis exhibited studied al bumin synthesis in isolated per· l.owing heavy drinking. Serum pwtoJn n mean 5% transformntion rate. Trnns· fused rabbit liver. When the perfusate electrophoresis wns no rmal. Trans-t hor· formation increased to a mean of 21% was mulched with l OmMolnr b•yptophtm acic liver biopsy wns petformod in nil with nutologous Hvor and 17% with 1,1lus alcohol, albumin synthesis lncreased nnd revealed typical features of dnho­ hnuol or acetaldehyde. These agents hom the low level of 8 mg to 22 ± 2 sls . Alcoholic cirrhosis of the li ver cun hntl uo olfoct on lymphocytes from con­ mg/100g/2l' hotu:s. While this pharma­ therefore occur without hcmodynumic or tml subjects. After subsidence of nlco­ cologic dose of tryptopbau did not re· radiological signs of portal hypertension. holic hepnllHs, neither autologous liver tum albumin synthesis to normal in all not· othnno1 lncrensed lymphocyte tmns­ studies, the liver synthesized albumin nt Ethanol Effects on Lipid formlltion. In contrast, a 20% transforma­ ~ or more of the n01m nl n1te. Metabolism in Small Intestine tion rate was noted in such patients when a combination of autologous liver The effects of ethanol on lipid metab­ and ethanol was used. Quantitative Morphologic Analysis olism in the intestine of male nlbino rats of Ethanol Effect on Rat Liver were examined by S. P. Mistilis and Effects of Barbiturates on W. 0. Dobbins III and H. J. Fallon of R. K. Ockner of the University of Cnli­ the George Washington University Medi­ fomia in Snn Francisco. The rats under­ Ethanol Metabolism cal Center in Washington, D.C., and the went cannulation of duodenum, bile duct Barbiturate treatment enhances both University of North Camlina School of nnd/or intestinal lmpyh dyct, nnd were MEOS activity and blood ethanol dis ­ Medicine described combined quanti­ then gjven ethanol or isoca loric gl~tcostl appearance when suffloiei1t tlme elapses tative morphometric nnd biochemical lntraduodennlly over 8 lu·. Tho results to allow the dn tg to be cleared from the analyses of ethanol effects upon t'l\t liver. showed thnt ethnnol nbsorp Ion nngmC:lnls blood before ethanol ndminlsl!•nt!on, re· 24 rats were divided into three pai r­ intestinal mucoasnl TG ooncentl'ntion nnd ported C. S. Lieber ~md L. M. DeCarli fed groups-chow control; chow and 25% intostinnl production of TC-rid1 lipo· of the Bronx VA Hospitnl and Mount ethanol in drinking Wtttel'; and 25% ethtl· pn>tC:lins. Tliis lnc rensed delivery of enclog­ Sinai School of Medicine. However, if no1 in water and chow supplemente1l genous intesti.nnl IJpoproteln to plus mn the hnrbitumte is still present ln the with 2% choline. After 35 days, n pOr· contributes to ethanol-induced hyperlip­ blood, Inhibition of ethnnol metabolism 'on of liver was prep tuC:ld fo r oloctron idemln. The adcl ltioMI mucosnl nnd provnils over the inductive process. Tho .dcroscopy. Subjective analysis of elec­ lymph li pids 11re not derived fwm ll v r study wns conducted by injecting 4,2 Lron micrographs failed to distinguish nil via bilo. TJtese Smlings lmlJcnte thnt the female mts lntmperltoneally for 4 days controls from b·ented rats. Lineal analy­ in test!no pnrtici.pntcs In the el'h nnol­ with either saline, P:U ( 80 mg/kg/ clny ) sis showed increased hepRtio cell size iuduced changes in the metnbolls m of or the more mpidly metnbolized hoxo­ (p < .001) nnd total volume of mito- nom.llatm·y lipids. bnt·bitnl (HB) , 100 mg/kg/twlce dully. 5 Alcohol Abuse Discussed at Eastern Psychiatric Research Meetings (Continued from page 1 ) only 1,716 cases were so indicated on effect, which is more similar to that of pitaI. The parameters are: ( 1 ) toxicity· the death certificate. Two factors are intravenously administered heroin than ( 2) temporary and pe1manent destrut responsible: fears of stigmatization and to omlly administered barbiturates or tiveness to self; ( 3) temporary and per­ the nature of the death certificate. When tranquilizers. Tl1is may account in part manent destructiveness to others; ( 4) an older alcoholic dies, his physician for the universal pop ularity of ·ethanol. incidence, prevalence, epidemic, and often lists another cause of death, such In addition, the pharmacologic action of ,1 endemic character; ( 5) bloodstream and as heart disease, which is more accept­ alcohol differs from those of t.he other mental atmosphere sludging and deterio­ able to the fnm fl y. Even when a diagno­ depressant drugs in that the disinhibit­ ration, and its effect and relationship to sis of o1n·hosis is listed without including ing effect is usually quicker and more environmental pollution; ( 6) the effect alcoholism, perhaps because the physi­ marked. and interaction of the addiction with cian feels that nlooholism is implictt, this Psychologically, alcohol may have a warfare and other chronic behavioral relationship is not understood by the broader spectrum of effects than aberrations of mankind. statist:icians, epidemiologists, and pl'O· other drugs. The stimulants usually (but grnm planners who interpret the data. Multiple Drug Use Among not always) stimulate. The hallucinogens University Students Lnst yonr 1,383 deaths were recorded as cause perceptual and thinking disturb­ due to chThosis associated with alcohol­ ances. The depressants tend to relax. Alcohol was the most commonly used ism and 1,746 as due to cirrhosis not Alcohol can do all these things in dif­ drug in a sample of 7,000 students from associnted with alcoholism-patently mis­ ferent people and sometimes in the same ten undergraduate and three graduate leading data, nccording to Dr. Baden. person at different times. Consequently, campuses of a state university. -over 90% FUlthermore, the death certificate re­ the psychological effects of alcohol are of the students surveyed used alcohol, reported Doris H. Milman, M.D., Asso­ quires that when a chronic alcoholic dies probably less predictable than those of ciate Professor of Pediatric Psychiatry at in an automobile accident, the cause of other drugs but by the same token are death must be listed as the traumatic in­ mr>re varied and versatile. the Downstate Medical Center in Brooklyn. The second most prevalent juries received, without any provision for The social p attems associated with the contribution of alcoholism. Last year drug was marijuana, with which 33% alcoholism are radically different from of the undergraduates and 48% of the alcoholism was n significant factor in those nssociated with heroin, barbitu­ approximately 50% of nil violent deaths graduate students have had some ex­ rates, Ol' hallucinogens. The present legtll­ in Naw York City, including nulomohik' perience. The survey showed a positive ity of drinking as opposed to the il­ association between illicit drug usage and fatnlit!es, homlc!tlcs, and dea hs due to legality of other drug hnbits probably narcotism, accidental falls, flres, and the use of alcohol for intoxication, as nccounts in part for the difference.s. The well as a positive association between drownings. In none of these dm~tbs was .intemction of the pharmacological, psy­ cigarette smoking and illicit drug usag• alcoholism indicated on the death cer­ chological, and social effects of alcohol tificate. in a pnrticular person in a particular so­ Measurement of Addiction ciety accounts for the remninder of the Potential in Monkeys Alcohol Compared to Other difference/!. In studies with the rhesus monkey, Addictive Substances c;, A. Denaue, Ph.D., Head of the Drug Alcohol differs pharmacolog!cnlly even Parameters Suggested for Abuse Division of the Southem Research fmm the other depressnnt ch·ugs, report­ Comparative Addiction Institute of Birmingham, Alabama, found ed Benjamin Kissin, M.D., Director of Several parameters for comparing the that some, but not all, monkeys will the Division of Aloohulism and Drug differences and similarities of abused voluntarily initiate and maintain a pat­ Dependonce of the Downstate Medical substances were suggested by Esra S. tern of self-administration of alcohol, Center Jn Brooklyn. Its rapid absorption Petursson, M.D. of the Drug Addiction narcotic analgesics, barbiturates, cocaine process pi'Oduces nn almost immedinto Research Unit of Manhattan State Hos- and amphetamine. 6

Published quarterly by American Medical PHYSICIAN'S ALCOHOL NEWSLETTER Ncn·Proflt Org. Society on Aloohollsm, Inc, Publloatlon has Two Park Avenue U. 5. POSTAGE been made possible by a irant from the PAID Chrlatopher D, Smlthera Foundation. New York, New York 10016 Permit No. 6929 New York, N.Y. EDITORIAL BOARD Edltor·ln-Chlef - Frank A. Selxas, M.D.­ Intern!st. Associate Editors-Luther Cloud, M.D.-Internlst, Aut. Medical Director, EC]ui­ table Life Assur. Co., Ruth Fox, M.D.-Psy­ chlatrlat., President, American Medical Soci­ ety on Alcoholism, Stanley Gltlow, M.D.­ Auo. Clinical Prof, Medicine, New York Medical College, Sidney Greenberg, M.D.­ Internlst, Consultation Center for Alcohol­ ism, P•roy Ryberg, M.D.-Psychl11tr!st. Don­ ald G. Mackay, M.D.-Montreal, Quebec.