PUBLISHED· BY THE N. Y. C. MEDICAL SOCIETY PHYSICIAN'S ON ALCOHOLISM, Inc. 167 East 80 St. New York 21, N.Y. A MARCH 1966 VOL. I, NO.2 ©Copyright 1966 The N.Y.C. Medical. NEWSLETTER Society on Alcoholism, Inc. I -HISTORIC RULING I 'TOTAL ABSTINENCE' TERMED A U.S. Court of Appeals tribunal in OBJECTIVE OF TREATMENT Richmond, Va., has rulee unanimously Alcoholic patients whose treatment led to total abstinence had the best chance that it is "cruel and unusual punish­ of marked improvement of social adaptation, according to Dr. D. L. Davies, director ment" to arrest and treat a chronic alco­ of psychiatry at Maudsley Hospital, London, England, a major teaching center. He holic as a criminal; he might, however, spoke at a seminar at Norwalk Hospital, Norwalk, Conn., about an. article .of. :I.Jis · be held for medical treatment. which had been widely thought to endorse treatment directed at·a return to so6Ial­ The case involved an individual who drinking. had been convicted of public intoxica­ Misunderstandings had arisen as a result of his report, "Normal Drinking tion more than 200 times and who esti­ in Reversed Alcoholics" published last mates that he has spent more than two­ year in the Quarterly Journal of Alcohol thirds of his life in jail. Studies. The article reports the elabo­ CENTRAL ISLIP OPENS Crux of the decision, which set aside rate follow-up studies of patients treated ALCOHOL FACILITY a 2-year sentence, was the court's state­ for alcoholism in Maudsley Hospital, in Dedication of the Charles K. Post Cen­ ment that alcoholism was "now almost an attempt to delineate the natural his­ ter for the rehabilitation of women alco­ universally accepted medically as a tory of alcoholism. Seven of the fifty pa­ holics at Central Islip Hospital on Feb. disease." tients, and four of sixty two controls 23, 1966 calls attention to the unique (alcoholics who had refused treatment) facilities provided for both male and had returned to social drinking seven to female patients with alcoholism at this eleven years after being first seen. state hospital. .... NKS ADH DIVERSION However, of the treated patients, ten A key feature of the program is the who continued to drink were either dead, inclusion of the patient in decisions re­ TO ALCOHOL DAMAGE in prison, had committed suicide, or had garding his length of stay and treatment otherwise deteriorated markedly. Eight­ procedures. Diversion of the enzyme, alcohol de­ een were abstinent, five of whom made All admissions, however, are voluntary hydrogenase, from its usual function­ marked improvement in social adapta­ and the patient must show a sufficient as yet unknown-to the task of detoxi­ tion. The twenty-two who were rated degree of motivation to enter the fying alcohol may produce the damage no worse or who managed some improve­ program willingly and to stay for a known to occur in alcoholism, postulated ment in drinking or social adaptation reasonable length of time. He must be Dr. Hugo Theorell, director of the included the "social drinkers". sober and free of serious mental or Nobel Institute of Biochemistry, at a Dr. Davies pointed out that the few physical disability. Harvey Lecture at the New York Acade­ patients who returned successfully to The hospital will accept acutely in­ my of Medicine. social drinking had, at the time of their toxicated alcoholics if :they are in suffi­ Although alcohol dehydrogenase had alcoholism, some unacceptable situation cient contact to sign a voluntary paper, been isolated from yeast in 1937, it was in their lives-such ,as , an \ffiSUccessful. according to Dr. Robert F. Wagner, As­ first extracted from horse liver by Bon­ marriage Or an inapproprif!te: job-which sistant Director in charge of the new pro­ nichsen and Wassen in 1948 in Dr. had been corrected by the time of fol­ gram. It will also accept both certified Theorell's Nobel Institute Laboratory in low-up. According to the· American ex­ alcoholics who have complicating psycho­ Stockholm. It has been scrutinized ex­ perts present at the conference, includ­ ses and unwilling alcoholics on a two-phy­ tensively there and elsewhere and is a ing Dr. Ruth Fox, Dr. Adele Streeseman, sician certificate in accordance with cur­ model for studying the kinetics of en­ and Marty Mann, these correspond to rent state regulations. "However," said zymes. Changes in light absorption and what is termed in J\.inerica, "situ,ational Dr. Wagner, "the latter types of cases are .. fluorescence, crystallography and analy­ drinkers". retained on the admission or infirmary ses using competitive inhibition with Although extensive psychiatric evalu­ services until well enough to be con­ pyrazole have all been possible. ation was performed, neither on ad­ verted to. voluntary patients before ad­ ,, In spite of the fact that liver alcohol mission to the hospital nor on discharge mission to the rehabilitation units." ·. dehydrogenase is one of the most in­ could it be predicted who would do well The rehabilitation procedure consists tensely studied of all enzymes, we have or who poorly. This would make it im­ of a· week of intensive orientation using at present no idea about its real role in possible to select patients to be advised lectures, demonstrations and visual aids. ~tabolism. Dr. Theorell noted that that they could return to social drinking.· The period is designed to acquaint the Jre is a Wide distribution of alcohol When evaluations were made six months alcoholic with the nature of his problem, dehydrogenase in organisms which never after discharge, 80% correlated with later to' stimulate his interest by identification -' come into contact with ethanol, so that follow-up. with· the group and to reassure him by (Continued on page 2, col. 3) (Continued on page 2, col. 1) ·(Continued on page 2, col. 2) Editorial: IN-PATIENT PERSPECTIVE ON FLAGYL FACILITIES Recent press reports of a drug claimed In a letter to PHYSICIAN'S ALCO­ to cure alcoholism, and called by the HOL NEWSLETTER, the manufachu­ New York Times, "a venereal disease er, G. W. Searle Co., says it is confining (If you have a patient who needs in­ drug", gave exaggerated hope to many its investigation to in-depth studies and patient treatment for alcoholism, these alcoholics and caused dismay among points out that it has no present license hospitals have open facilities.) those who treat them. for the distribution of metronidazole Central Islip State Hospital The first use of the drug, metroni­ other than for trichomoniasis. Central Islip, L.I., New York dazole (or Flagyl) , for alcoholism was Dr. Ruth Fox, director of medical re­ .516 CE 4-6262 reported in a single case by Jo Ann T. search for the National Council on Alco­ For admission, call Ward D-4 for men­ Taylor, Associate Clinical Professor of holism, states that Flagyl "is a little like Dr. S. Blume; Ward G-5 for women. Clinical Pharmacology of California Col­ calcium cyanamide which is used in lege of Medicine, U.C.L.A., in the Bul­ Japan. With either, a person can take Mt. Carmel Guild Hospital letin of the Los Angeles Neurological one or two drinks without becoming ill. 396 Straight Street Society ( 29: 158-62, Sept. 1964) . More than this produces a real Anta­ Paterson, New Jersey The dramatic report presents the ob­ buse-like effect. I cannot say that these 201 LA 5-1858 servations of the wife of an alcoholic are any improvement over Antabuse. For admission, call Father William Hall; treated with metronidazole. She records It has not yet been demonstrated that accepts both men and women. her husband's decreased interest in alco­ Flagyl takes away the desire for drink­ Trafalgar Hospital hol during the admini~tration of the ing." 161 East 90th Street drug for trichomonal urethritis and his With the memory of thalidomide fresh New York, New York later Antabuse-like reaction to it while in mind, wise physicians will be cau­ TR 6-6600 on a binge. She describes his rapid re­ tious in administering metronidazole, For admission, ask for Mrs. Kennedy, covery from delirium tremens after its used at present in short courses for Dr. Fisch, Dr. Dienstag. administration (four days later he was trichomoniasis, to alcoholics on a wide, back at work) and his aversion to alco­ long term or uncontrolled basis. We Westchester Division, New York hol thereafter during treatment with the await with interest careful double-blind Hospital drug. A three month period of sobriety studies on its usefulness. White Plains, New York ensued. 914 White Plains 9-8300 Dr. A. W. Pearson, in a preliminary CENTRAL ISLIP Will accept alcoholic patients only on a (Continued from page 1) study on acute withdrawal trials in 53 voluntary basis and those who are will­ a non-critical acceptance of his problem. patients, indicated Antabuse-like effects ing to accept six months treatment. At the end of this time he meets with in 2.5 per cent; subjective improvement $325.00 a week covers all charges. the staff and decides with them whether and tranquilization were the rule. Dr. or not he will stay and what forms of Freeport Hospital Philip Friedland, chief of the alcoholic treatment seem most appropriate to his 267 South Ocean Avenue unit at Meadowbrook Hospital, and Dr. case. In subsequent weeks the' alcoholic Freeport, L.I., New York Herbert Walzer of Queens General Hos­ is exposed to any or all modalities of Admission through AA Intergroup. Call pital have found promising results in rehabilitation including individual and OR 9-3355 and ask for Hospital Desk. 100 patients. group psychotherapy, group counselling, Doctors Hospital Evidence has been presented that occupational and recreational therapy 275 Warner Avenue metronidazole inhibits alcohol dehydro­ and pharmacological therapies.