ALCOHOLISM AND DRUG DEPENDENCE A Multidisciplinary Approach ALCOHOLISM AND DRUG DEPENDENCE A Multidisciplinary Approach Edited by ]. S. Madden Mersey Regional Addiction Unit Chester, England Robin Walker Walton Hospital and Fazakerley Hospital Liverpool, England and W. H. Kenyon Merseyside Lancashire & Cheshire Council on Alcoholism Liverpool, England PLENUM PRESS· NEW YORK AND LONDON Library of Congress Cataloging in Publication Data International Conference on Alcoholism and Drug Dependence, 3d, Liverpool, 1976. Alcoholism and drug dependence. "Proceedings of the third International Conference on Alcoholism and Drug De pendence held in Liverpool, England, April 4-9, 1976." Includes index. 1. Alcoholism-Congresses. 2. Drug abuse-Congresses. I. Madden, John Spencer. II. Walker, Robin. III. Kenyon, W. H. IV. Title. [DNLM: 1. Alcoholism-Congresses. 2. Drug abuse-Congresses. 3. Drug dependence-Congresses. W3 IN166 1976a/ WM274 16123 1976al HV5009.158 1976 362.2'9 76-30574 ISBN-13: 978-1-4684-2339-6 e-ISBN-13: 978-1-4684-2337-2 001: 10.1007/978-1-4684-2337-2 Proceedings of the Third International Conference on Alcoholism and Drug Dependence held in Liverpool, England, April 4-9, 1976 © 1977 Plenum Press, New York Softcover reprint of the hardcover 15t edition 1977 A Division of Plenum Publishing Corporation 227 West 17th Street, New York, N. Y. 10011 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, record ing, or otherwise, without written permission from the Publisher FOREWORD It is for me, as President of the Merseyside Lancashire & Cheshire Council on Alcoholism, a signal privilege to write a brief foreword to these Proceedings of the Third International Conference on Alcoholism and Drug Dependence. During the week experts, from the world over, in all those disciplines which have a contribution to make to the solution of the problems of alcoholism and drug dependence, surveyed recent advances in our knowledge of the aetiology, epidemiology, early recognition, management, and the social and industrial implications of these twin scourges of the contemporary scene. The discussions were most helpful and enlightening even when a wide spectrum of conflicting views and experiences were revealed. The justification for adding yet another volume to the growing literature in this field is two-fold; first, that those taking part in the conference can study at leisure and in depth the transactions of the conference; and secondly, that those who were unable to attend might benefit from the most recent views of international experts in the diverse facets of one of the major current problems in world health. LORD COHEN OF BIRKENBEAD CH, PRSH, MD, DSc, ScD, LLD, DCL, FRCP, DL, JPo CONTENTS Introduction . . • . . . . . . . . . . . . xiii J.S. Madden, R. Walker, and W.H. Kenyon Opening Address to the Conference M. Meacher SECTION I GENERAL Sexual Disorders in Male Alcoholics 3 M.J. Akhtar Vitamin B12 and Folic Acid in Chronic Alcoholics . . . . .. 15 E. Heilmann Porphyria Cutanea Tarda in Chronic Alcoholics 19 E. Heilmann Physical Complications of Alcohol Excess-Metabolism of Alcohol . . . • . . . . . . . . . . • 23 D. Owens Is Illegal Drugtaking a Problem? . . . . . . . . . • • . .. 35 M.A. Plant Alcoholism and Drug Dependence - A Multidisciplinary Problem: The Sociologist's Viewpoint •.•. D. Robinson Alcohol and the General Physician 57 R. Walker Denial of the Hidden Alcoholic in General Practice . . . .. 63 R.H. Wilkins vii viii CONTENTS SECTION II AETIOLOGY AND EPIDEMIOLOGY The Validity of Per Capita Alcohol Consumption as an Indicator of the Prevalence of Alcohol Related Problems: An Evaluation Based on National Statistics and Survey Data ••.•••• 71 A.K.J. Cartwright, S.J. Shaw, and T.A. Spratley On the Need to Reconcile the Aetiologies of Drug Abuse . . •• . • . . • • 85 C. Fazey Drinking Patterns of Young People 95 A. Hawker Alcoholism and Psychology - Some Recent Trends and Methods • • • • • . . • • • . . . • • • • . . • • • 105 G. Lowe A Psychiatric View of Substance Dependency • . • • • . . . • • 115 J.S. Madden How Important is Alcohol in "Alcoholism"? • . . . . . . . . . 123 R.J. McKechnie Social Circumstances of Non-Convicted vs Convicted Drug Users ...••. 139 C.E. Reeves The Pathological and the Subcultural Model of Drug Use - A Test of Two Contrasting Explanations . . . 151 K.H. Reuband Unemployment and Sickness Absenteeism in Alcoholics ..•.. 171 E.S.M. Saad Alcohol Problems in Women . • . . . . . • . . . . . . . . . • 181 A.B. Sclare The Aetiology of Dependency . . . • • • • • . • • . . . • • . 189 F.A. Seixas CONTENTS ix SECTION III TREATMENT A Pilot Controlled Drinking Out-Patient Group . . . . . . . . 199 D. Cameron Programming Alcoholism Treatment: Historical Trends . . . . . . . . . . . . . . . . . . . 209 R.M. Costello A Young Problem Drinkers Programme as a Means of Establishing and Maintaining Treatment Contact .................. 227 B. Coyle and J. Fischer Family Focused Treatment and Management: A Multi-Discipline Training Approach . . . . . . . . . . 239 J.P. Flanzer and G.M.St.L.O'Brien The Young Alcoholic - Approaches to Treatment . . . . . . . . 263 P.D.V. Gwinner Detoxification - The First Step . . . . . . . . . . . . . . . 271 J.R. Hamilton The Treatment of Drug Dependence - A Taxonomy of Approaches. .............. 277 I. Hindmarch Aims of Treatment . . . . . . . . . . . . . . . . . . . . . .. 293 B.D. Hore Controlled Drinking in the Alcoholic - A Search for Common Features. ............ 297 T. Levinson A Programme of Group Counselling for Alcoholics . . . . . . . 309 J. S. Madden The Ontario Detoxication System: An Evaluation of its Effectiveness 321 R.G. Smart x CONTENTS SECTION IV REHABILITATION The Role of the Probation Service in the Treatment of Alcoholism . . . . . . . . . . . 331 T. Crolley An Analysis of Clients Using Alcoholic Agencies within One Community Service • . . . . . . . . . . . . . 335 S.D. Delahaye Co-ordination and Co-operation . . . . . . . . . . . . . . . . 351 B.D. Hore The Problem - Its Magnitude and a Suggested Community Based Answer to Alcoholism . . . . . . . . . . 355 W.H. Kenyon Methodological Problems in Evaluating Drug Misuse Intervention Programmes .. . . . . . . . . . . . . . . 369 M.A. Lavenhar Planning for the Future - Developing a Comprehensive Response to Alcohol Abuse in an English Health District . . . . . . . . . .. .......... 379 T.A. Spratley, A.K.J. Cartwright, and S.J. Shaw The Featherstone Lodge Project - Phoenix House. One Method of Rehabilitation . . . . . . . . . . 387 D. Warren-Holland and S. Warren-Holland The Co-ordination of Care in the Field of Alcoholism . . . . . 395 E. Wilkes SECTION V PREVENTION AND EDUCATION The Role of Legislation in Diminishing the Misuse of Alcohol ...... .......... 401 C. Clayson The Need for and Some Results of Evaluation of English Drug Education . . . . . . . . . . . . . . . . . 409 N. Dorn CONTENTS xi Developing a Co-ordinated Approach to Interprofessional Education ...•........ 417 M. Grant Alcohol Control Policy as a Strategy of Prevention: A Critical Examination of the Evidence . • . . • . • . • • . . • • . . . . . . 425 J. de Lint Parents, Children and Learning to Drink . . . • . . . . . . . 451 R.J. McKechnie Alcohol and Education . . . . . . . . . . . • • . . . . . . . 457 E.B. Ritson Chairmen . . 465 Contributors 467 Index 471 INTRODroTION The allied conditions of alcoholism and drug misuse are attracting increasing attention in an expanding number of countries. In Liverpool a tradition has been established of holding conferences on these subjects at local, national and international level. The list of sponsoring organisations for the larger conferences includes the International Council on Alcohol and Addictions, Lausanne and Liverpool University Department of Psychiatry and was strengthened for the third international conference held in 1976, by the Alcohol Education Centre, London. This conference drew participants from 18 countries. Its theme centred on the importance of a multidisciplinary approach, and so allowed a wide spread of subjects to be covered by lecturers from ma;ny professional backgrounds, who sometimes held challengingly diverse points of view. The speakers included a legislator, psychiatrists, specialists in internal medicine, general medical practitioners, psychologists, social workers, sociologists and an anthropologist. Their topics were ranged from causation and prevention, education, and prevalence patterns of alcohol and drug usage, to treatment and rehabilitation. The reader will find much evidence to support the view that the per capita rate of alcohol consumption of a nation intimately affects its incidence of alcohol problems. The hopeful corollaxy of this concept is that the amount of beverage alcohol consumed wi thin a state is amenable to government intervent ion by legal and fiscal measures. But the situation is not clear cut; contributors from Scotland point out that their country has a distinctly more extensive alcoholism problem than neighbouring England and Wales, yet Scotland has more restrictive licensing laws and only a marginally higher level of alcohol consumption. Different attitudes and culturally determined reactions to the taking of alcohol contribute to the differing incidences of alcoholism between communities, and must not be overlooked in the search for preventative devices. xiii