DOCUMENT RESUME ED 398 506 CG 027 281 AUTHOR Gordis, Enoch TITLE Alcohol Research: Promise for the Decade. INSTITUTION National Inst. on Alcohol Abuse and Alcoholism (DHHS), Rockville, Md. REPORT NO ADM-92-1990 PUB DATE Aug 91 NOTE 83p. PUB TYPE Reports Descriptive (141) EDRS PRICE MF01/PC04 Plus Postage. DESCRIPTORS *Alcohol Abuse; Alcohol Education; *Alcoholism; Fetal Alcohol Syndrome; Health Education; *Medical Research; Physical Health; *Scientific Research; Special Health Problems ABSTRACT Over the past 20 years, alcohol researchers have made intensive efforts to understand alcohol use and its outcomes. To date, researchers have made much progress toward understanding the causes and consequences of alcoholism and its related problems. This publication attempts to convey the great spirit and promise of alcohol research. Established findings that serve as foundations for future research are presented, and compelling areas for the coming decade that promise to advance understanding of the nature of alcoholism and promote efforts to prevent and treat the disease are highlighted. Extensive illustrations and photographs supplement the text. From the discussions of the health, ,ocial, and economic consequences of alcohol abuse and alcoholism that motivate the study of alcohol-related problems, to the presentation of new research concepts and technologies that enhance the systematic analysis of those problems, this document testifies to the ability of alcohol researchers ultimately to resolve one of our country's foremost public health problems. Chapters are:(1) Alcohol Abuse and Alcoholism;(2) Alcohol and the Brain;(3) Genetics and Environment; (4)Why DoPeopleDrink?;(5) The Medical Consequences of Alcoholism; (6)FetalAlcoholSyndrome; (7) Prevention and Treatment. An additionalchaptercontains information on developing new medications for alcoholism. (JBJ) *********************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. *********************************************************************** . ' £ e ... II . II .. Mk U S DEPARTMENT OF EDUCATION Office of Educational Research end Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) This document has been reproduced as received from the person or organization originating it 2 Minor changes have been made to improve reproduction quality a . II 111 Points of view or opinions stated in this document do not necessarily represent it official OERI position or policy 'i AlTheBrain: The brain governs manyexter of drinking---outcomesthat re hol's actions on manyinternal tures andfunctions. The brain the cranial cavitywithin the s primarily as acommunicatior highly organizedsystems tha thought, guide movement, an Scale Model :'ones functions. In an adult, the brain hasan aver- of highly branched filaments, called den- alco- age weight of 3 pounds. A cross-sectional drites, that receive information from other ;truc- slice of the brain (2) reveals itsmany internal neurons (4). Each neuron has a cell mem- used in structures. The brain has an estimated 100 brane (5) that provides structure andserves ictions billion nerve cells, or neurons (3) of various as a physical barrier between the inside and with sizes and shapes. Most neurons havea long the outside of the cell. These membranesare filament, called an axon, that carries infor- composed primarily of lipids (fatsor fat-like ite body mation away from the cell body, anda series substances) and proteins. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Alcohol Abuse and Alcoholism ALCOHOL RESEARCH: PROMISE FOR THE DECADE Enoch Gordis, M.D. Director National Institute on Alcohol Abuse and Alcoholism August 1991 5 DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Alcohol Abuse and Alcoholism ALCOHOL RESEARCH: PROMISE FOR THE DECADE TABLE OF CONTENTS Foreword v Acknowledgments viii Chapter I. Alcohol Abuse and Alcoholism 1 Chapter II. Alcohol and the Brain 5 Focus on Brain Imaging Tools 15 Chapter III. Genetics and Environment 23 Chapter IV. Why Do People Drink? 33 Chapter V. The Medical Consequences of Alcoholism 41 Chapter VI. Fetal Alcohol Syndrome 51 Chapter VII. Prevention and Treatment 57 Focus on Developing New Medications for Alcoholism 67 Epilog 72 6 ill FOREWORD The importance of research on alcohol date, alcohol researchers have made abuse and alcoholism is unmistakable much progress toward understanding in light of the substantial harm and the causes and consequences of alco- costs that result from these disorders. holism and its related problems. The debilitating effects of alcohol on As we move toward the beginning the physical and social well-being of of a new century, alcohol research has problem drinkers, the far-reaching a preeminent goal:to gather knowl- harm that drinking causes in our com- edge that will enhance the develop- munities, the related costs borne by .:..=!nt of methods to prevent and to individuals and society alikeeach of treat ale- iol use disorders. these consequences affirms the need Developing new medications to for greater knowledge about what advance alcoholism treatment is criti- causes alcoholism, how it can be pre- cal to this process. As part of the con- vented, andonce a drinking prob- tinuing pursuit of enhanced treat- lem developshow it can be treated ment measures, researchers now are effectively. Such knowledge will come extending the search to include new only from research. pharmacotherapies that target the Over the past 20 years, alcohol mechanisms of the addiction itself. researchers have made intensive Scientists are armed in this quest efforts to understand alcohol use and with increasing knowledge about the its outcomes. During this time, the brain processes underlying addiction. alcohol research field has developed The discovery of new medications from relatively modest beginnings to will offer fresh hope to those who become one of the most rapidly grow- struggle to achieve and maintain ing areas of scientific investigation. To long-term sobriety. Some of these Alcohol Research: Promise for the Decade new drugs may ease the intense crav- care among alcoholic patients. Yet, sci- these features. In turn, the animal ing for alcohol experienced by many entists have observed that these models can serve as fundamental recently abstinent alcoholics or pathologies are not distributed equally tools for developing and assessing improve alcohol-induced cognitive throughout the alcoholic population. treatment measures for the various impairments that can affect a patient's Recent studies suggest that different elements of alcoholism. potential to benefit from traditional underlying genetic factors in people As one of the first steps in medica- therapies. exposed to high levels of alcohol may tions development, animal studies can It is unlikely that a single agent be responsible for the development of ensure that further tests can be con- will be developed to treat this com- such disorders as fetal alcohol syn- ducted in humans without danger. plex disease. However, coupling drome, liver cirrhosis, and Wernicke- Nonetheless, animal studies alone pharmacotherapies that control spe- Korsakoff s syndrome. cannot confirm the efficacy of poten- cific clinical events in the disease Future studies potentially can tial pharmacological therapies in alco- course with traditional behavioral identify the physiological bases for holism treatment. Clinical trials of and verbal therapies will enhance genetic susceptibility to alcohol-related new pharmacotherapies are indis- treatment outcome immeasurably. pathologies. Such knowledge can pensable for determining dose, effica- Refined therapies will benefit help scientists to develop specific cy, and safety of medications in many people. For alcohol dependent techniques to prevent the onset of humans. Such trials will serve as inte- individuals, who face the realistic fear alcohol-related illnesses. In addition, gral tools for developing new medica- of relapse to drinking, improved inter- this knowledge can enable clinicians tions for alcoholism treatment. ventions can abateand, optimally, to identify individuals at risk for Advances in technology also will preventrelapse occurrences and halt developing these disorders, allowing enhance the research efforts in the continuing disease that ultimately can for early identification of alcohol- next 10 years. During the past decade, lead to death. For society, which car- related pathologies. Finally, knowl- a number of noninvasive imaging ries the weight of the enormous eco- edge of the etiologies of genetically- techniquescomputerized tomogra- nomic and social costs of problem influenced consequences can aug- phy, magnetic resonance imaging, drinking, improved treatment strate- ment efforts to generate more effec- positron emission tomography, elec- gies that heighten the potential for tive therapies for such disorders. troencephalographywere enhanced. long-term abstinence can lessen this Ultimately, these advances can effect These techniques offer scientists the burden and enhance overall quality of large reductions in health care costs unprecedented and exciting opportu- life. New therapies promise to reduce and save countless lives. nity to look inside the living brain the billions of dollars lost annually Two primary prerequisites must be without