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.