Recent Developments in Alcoholism

I. Substance Abuse and Posttraumatic Stress Disorder.- Overview.- 1 Posttraumatic Stress Disorder and Substance Abuse: Clinical Issues.- 1. Introduction.- 2. Awareness.- 3. Diagnosis.- 4. Predisposing Factors.- 5. Countertransference.- 6. Treatment Priorities.- 7. The Defenses.- 8. Individual and Group Psychotherapies.- 9. Medications.- 10. Family Therapy.- 11. Conclusions.- References.- 2 The Interrelationship of Substance Abuse and Posttraumatic Stress Disorder: Epidemiological and Clinical Complications.- 1. Behavioral Theories of Alcohol Abuse.- 2. Substance Abuse among Returning Vietnam Veterans.- 3. The Persistence of Substance Abuse Problems in Vietnam Veterans.- 4. A Study of Substance Abuse among PTSD Vietnam Veterans.- 5. The Relationship of Combat Exposure to Substance Abuse.- 6. Findings from the Major Epidemiological Studies.- 7. Methodological Issues in Understanding the PTSD-Substance Abuse Relationship.- 7.1. Sampling.- 7.2. Assessment of PTSD.- 7.3. Assessment of Alcohol and Drug Use.- 8. Clinical Considerations in the Assessment and Treatment of the Dual-Disorder Patient.- 9. Conclusions and Summary.- References.- 3 Biological Mechanisms in Posttraumatic Stress Disorder: Relevance for Substance Abuse.- 1. Introduction.- 2. Biological Findings with PTSD.- 2.1. Psychophysiological Evidence.- 2.2. Biochemical Correlates of PTSD.- 2.3. Hypothalamopituitary Adrenocortical Axis in PTSD.- 2.4. Pharmacological Approaches to PTSD.- 3. Neurobiological Models of PTSD.- 3.1. The Locus Ceruleus and Central Noradrenergic Systems.- 3.2. Alarm Behaviors and Central Noradrenergic Activity.- 3.3. Other Conditioned Arousal States Relevant for PTSD.- 4. Biological Basis for PTSD Symptoms and Substance Abuse.- 4.1. Stress, Inescapable Shock, and Substance Abuse.- 4.2. PTSD and Drug Withdrawal States.- 4.3. Hedonistic Aspects of Drug Abuse.- 5. Conclusions.- References.- 4 Coping and Defending Styles among Vietnam Combat Veterans Seeking Treatment for Posttraumatic Stress Disorder and Substance Use Disorder.- 1. PTSD among Vietnam Combat Veterans.- 2. Addiction and Measuring Ways of Coping.- 3. Peck's (1981) Model of Competence in Coping.- 4. Method.- 4.1. Subjects.- 4.2. Instruments.- 5. Results.- 6. Discussion.- References.- 5 Posttraumatic Stress Disorder in World War II and Korean Combat Veterans with Alcohol Dependency.- 1. Overview.- 2. Literature Background.- 3. Alcohol Effects on PTSD Symptoms.- 4. Incidence and Implications of Combined Substance Abuse and Psychiatric Disorders.- 5. PTSD in Older Alcoholic Combat Veterans.- 5.1. Subjects.- 5.2. Procedure.- 5.3. Results.- 5.4. Discussion.- References.- II. Alcohol and Its Management in the Workplace.- Overview.- 6 The Epidemiology of Alcohol Abuse among Employed Men and Women.- 1. A Theoretical Framework.- 2. Some Methodological Problems.- 2.1. Definition of Job Stress.- 2.2. Mortality Data.- 2.3. Morbidity Data.- 3. The Detroit Study: Methods and Measures.- 3.1. Alcohol Use and Abuse.- 3.2. Job Pressures and Other Conditions.- 3.3. Job Stress and Background Variables.- 4. The Detroit Study: Results and Discussion.- 4.1. Regression Analysis.- 4.2. Alternative Interpretations.- 4.3. Further Research.- References.- 7 Growth and Transformation in Workplace Alcoholism Programming.- 1. Macrolevel Factors and the Emergence of Workplace Programming.- 2. The New Epidemiology of Alcohol Problems.- 3. Variations in Program Structures.- 4. The Core Technology of Workplace Programs.- 5. The Impact of the EAP Model.- 6. Origins of the Self-Referral Emphasis in EAPs.- 7. Research Findings about Workplace Alcoholism Programming.- 8. Needed Research about Alcoholism and Its Treatment in the Workplace.- References.- 8 Constructive Confrontation and Other Referral Processes.- 1. Constructive Confrontation.- 2. Basis for the Strategy.- 3. Occupational Versions.- 4. Evaluation of Constructive Confrontation.- 5. Self-Referral.- 6. Concluding Remarks.- References.- 9 Identification of Alcoholics in the Workplace.- 1. The Supervisory Identification Process: The Model Described.- 2. The Supervisory Identification Process: The Empirical Research.- 3. The Effect of Organizational Factors and Individual Differences among Subordinates and Supervisors.- 4. Summary and Implications: Expansion of the Program Model.- References.- 10 Monitoring the Process of Recovery: Using Electronic Pagers as a Treatment Intervention.- 1. Experience Sampling Method.- 2. The Process of Recovery.- 2.1. The Beeper Project.- 2.2. The Nature of the Groups.- 2.3. Analysis of the Data.- 3. Clinical Application.- 4. Conclusion.- References.- 11 Posttreatment Follow-up, Aftercare, and Worksite Reentry of the Recovering Alcoholic Employee.- 1. Effectiveness of Aftercare.- 2. Relapse Prevention.- 3. Worksite Reentry of Employed Alcoholics.- 4. A Nontraditional Approach to Aftercare.- 5. Role of EAPs in Aftercare and Relapse Prevention.- References.- 12 New Occupations and the Division of Labor in Workplace Alcoholism Programs.- 1. Certification of Employee Assistance Professionals.- 2. Technical Developments.- 3. Social Movement.- 3.1. Consultants.- 3.2. Administrators.- 4. Standards and Boundaries.- 5. Division of Labor.- References.- III. Consequences of Alcohol Abuse Unique to Women.- Overview.- 13 Effects of Moderate Consumption of Alcoholic Beverages on Endocrine Function in Postmenopausal Women: Bases for Hypotheses.- 1. Introduction.- 1.1. Demographic Considerations.- 1.2. Postmenopausal Estrogenization and Disease Risk.- 1.3. Consumption of Alcoholic Beverages by Postmenopausal Women.- 2. Meager Knowledge concerning Alcohol Effects on Postmenopausal Endocrine Function.- 2.1. Acute Effects of Alcohol.- 2.2. Chronic Effects of Alcohol.- 2.3. Summary of Current Information concerning Endocrine Effects of Alcohol in Postmenopausal Women or in Relevant Animal Models.- 3. Study Design Considerations for the Evaluation of Effects of Moderate Alcoholic Beverage Consumption on the Endocrine Function of Normal Postmenopausal Women.- 3.1. Postmenopausal Endocrine Function.- 3.2. Factors that Influence Circulating Steroid Levels in Normal Postmenopausal Women.- 3.3. Summary of the Factors Known to Affect Postmenopausal Steroid Levels and the Need to Incorporate Such Variables into the Design of Future Studies.- References.- 14 Effects of Alcohol Abuse on Reproductive Function in Women.- 1. Clinical Studies of Reproductive System Dysfunctions in Alcoholic Women.- 1.1. Amenorrhea.- 1.2. Anovulation and Luteal Phase Dysfunction.- 2. Clinical Studies of Alcohol Effects on Female Reproductive Function in Social Drinkers.- 3. Survey Reports of Alcohol Effects on Reproductive Function.- 4. Studies of Chronic Alcohol Effects in Animal Models.- 5. Alcohol Effects on Reproductive Function in Primate Models.- 6. Alcohol Effects on Reproductive Function in Rodent Models.- 7. Studies of Acute Alcohol Effects in Women and Animal Models.- 7.1. Alcohol Effects on Basal Hormone Levels.- 7.2. Alcohol Effects on Artificially Stimulated Pituitary and Gonadal Hormones.- 8. Directions for Future Research.- References.- 15 Maternal Ethanol Use and Selective Fetal Malnutrition.- 1. Introduction.- 2. Pathogenesis of Ethanol-Induced Injury.- 3. Maternal Nutrition.- 4. Ethanol and Fetal Tissue.- 5. Placentotoxicity and Selective Fetal Malnutrition.- References.- 16 Ethanol Metabolism and Hepatotoxicity: Does Sex Make a Difference?.- 1. Pharmacology of Ethanol.- 1.1. Absorption.- 1.2. Ethanol Pharmacodynamics.- 1.3. Ethanol Metabolism.- 1.4. Summary.- 2. Specific Differences between Males and Females.- 2.1. Sex Differences in Various Ethanol Pharmacokinetic Parameters.- 2.2. Sex Differences in Ethanol Metabolism.- 3. Sex Differences in Ethanol Ingestion Rates and Ethanol-Induced Liver Disease.- 4. Summary.- References.- IV. Markers for Risk of Alcoholism and Alcohol Intake.- Overview.- 17 Physiological and Psychological Factors as Predictors of Alcoholism Risk.- 1. Introduction.- 2. The Intensity of Reaction to Ethanol.- 3. Neuropsychological Differences between Higher-Risk and Lower-Risk Populations.- 4. Personality Test Differences.- 5. Enzymes and the Risk for Alcoholism.- 6. Discussion.- References.- 18 Brain Evoked Potentials as Predictors of Risk.- 1. Evoked Potentials and Brain Function.- 2. Evoked Potentials and Heritability of Alcohol Response.- 3. Evoked Potentials in High-Risk Subjects.- 4. Strengths and Possible Pitfalls.- References.- 19 Molecular Markers for Linkage of Genetic Loci Contributing to Alcoholism.- 1. Introduction.- 2. Linkage Analysis Using Panels of Random Protein and DNA Genetic Markers.- 2.1. DNA and Protein Polymorphic Markers.- 2.2. Restriction Fragment-Length Polymorphisms.- 2.3. Protein Polymorphisms.- 2.4. Markers for Loci Expressed in Brain.- 3. Strategies for Use of Markers and the Probability of Establishing Genetic Linkage.- 3.1. Probability of Establishing Genetic Linkage.- 3.2. Contrasting Strategies for Genetic Linkage in the Human.- 4. Linkage Studies with Nonspecific Genomic Markers.- 4.1. Human Studies.- 4.2. Mouse Studies.- 5. Genetic Mapping of Behavioral Traits Related to Alcoholism in the Mouse.- 6. Specific Locus Functionality and Probes.- 6.1. Neurochemical and Receptor Differences.- 6.2. Alcoholism, Impulsivity, and Central Serotoninergic Activity.- 6.3. Platelet Monoamine Oxidase.- 6.4. Benzodiazepine Receptor.- 6.5. Enzymes of Ethanol Metabolism.- 7. Conclusions.- References.- 20 Blood Markers of Alcoholic Liver Disease.- 1. Genetic Markers.- 2. Empirical Markers.- 2.1. Precirrhotic Markers.- 2.2. Markers of Inflammation and Necrosis.- 3. Markers of Alcohol Intake.- References.- 21 Discriminant Function Analysis of Clinical Laboratory Data: Use in Alcohol Research.- 1. Introduction.- 2. Sample Definition.- 2.1. Diagnosis, Homogeneity, and Generalizability.- 2.2. Subject Sample Size/Number of Predictor Variables/Choice of Variables.- 3. Linear versus Quadratic Function Methodology and Conceptual Issues.- 3.1. Measuring Mean Differences and Variability.- 3.2. Scientific Validity.- 3.3. Function Validation.- 3.4. Interpretation of Classification Results.- 4. Discussion.- 4.1. Ethical Issues.- 4.2. What Do We Know and Where Do We Go?.- 5. Summary and Recommendations.- 5.1. Diagnosis.- 5.2. Sample Size.- 5.3. Assessment of Other Variables.- 5.4. Goals and Intentions.- 5.5. Prior Probabilities.- 5.6. Scientific Validity.- 5.7. Validation of Discriminant Function Results.- 5.8. Ethical Concerns Involving Disciminant Function Analysis.- 6. Future Directions.- References.- 22 Acetaldehyde and Its Condensation Products as Markers in Alcoholism.- 1. Urinary Condensation Products or Oxidized Derivatives in Human Subjects: TIQs in Alcoholics.- 2. Urinary THBCs and B Carbolines in Alcoholic Subjects.- 3. TIQ Excretion in Nonalcoholic Human Volunteers.- 4. THBC and BC Excretion in Nonalcoholic Human Volunteers.- 5. Urinary Condensation Products in Untreated and Ethanol-Treated Rats.- 6. Condensation Products in the CSF of Human Subjects and Nonhuman Primates.- 7. Assays of Condensation Products in Blood Components of Humans and Rats.- 8. Summary and Conclusions.- References.