thefacts Alcoholism 06 also available in thefacts series Eating disorders: thefacts Lupus: thefacts SIXTH EDITION SECOND EDITION Abraham Isenberg and Manzi Epilepsy: thefacts Ankylosing spondylitis: thefacts THIRD EDITION Khan Appleton and Marson Borderline personality disorder: thefacts Osteoarthritis: thefacts Krawitz and Jackson Arden, Arden, and Hunter Infl ammatory bowel disease: thefacts Asthma: thefacts Langmead and Irving Arshad and Babu Stroke: thefacts Sexually transmitted infections: thefacts Lindley SECOND EDITION Diabetes: thefacts Barlow Matthews, Meston, and Dyson Autism and Asperger syndrome: thefacts Essential tremor: thefacts Baron-Cohen Plumb and Bain Epilepsy in women: thefacts Huntington’s disease: thefacts Betts and Clarke SECOND EDITION Living with a long-term illness: thefacts Quarrell Campling and Sharpe Panic disorder: thefacts Chronic fatigue syndrome: thefacts SECOND EDITION SECOND EDITION Rachman Campling and Sharpe Osteoporosis: thefacts Head injury: thefacts Reid and Black et al Daisley, Tams, and Kischka Tourette syndrome: thefacts Falls: thefacts SECOND EDITION Darowski Robertson and Cavanna Infertility: thefacts ADHD: thefacts Davies, Overton, and Webber Selikowitz Prenatal tests: thefacts Down syndrome: thefacts De Crespigny and Chervenak THIRD EDITION Obsessive-compulsive disorder: thefacts Selikowitz THIRD EDITION Childhood sleep disorders: thefacts de Silva Stores Polycystic ovary syndrome: thefacts Motor neuron disease: thefacts Elsheikh and Murphy Talbot and Marsden Muscular dystrophy: thefacts Thyroid disease: thefacts THIRD EDITION FOURTH EDITION Emery Vanderpump and Tunbridge Psoriatic arthritis: thefacts Depression: thefacts Gladman and Chandran Wasserman The Pill and other forms of hormonal Cosmetic surgery: thefacts contraception: thefacts Waterhouse SIXTH EDITION Guillebaud Cystic fi brosis: thefacts FOURTH EDITION Harris and Thomson thefacts Alcoholism FOURTH EDITION Ann M. Manzardo PhD Assistant Professor and Pharmacologist Donald W. Goodwin MD University Distinguished Professor, Emeritus Jan L. Campbell MD Professor of Director of Addicition Psychiatry Elizabeth C. Penick PhD Professor and Director of Psychology William F. Gabrielli, Jr MD, PhD Professor and Chair of Psychiatry Professor of Internal Medicine Department of Psychiatry and Behvioral Sciences, University of Kansas Medical center, Kansas, USA 1 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press 2008 The moral rights of the authors have been asserted Database right Oxford University Press (maker) First edition published 1981 Second edition published 1994 Third edition published 2000 Reprinted 2000, 2002, 2003, 2004 (twice), 2005, 2006 Fourth edition published 2008 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloguing in Publication Data Data available ISBN 978-0-19-923139-3 10 9 8 7 6 5 4 3 2 1 Typeset in Plantin by Cepha Imaging Pvt. Ltd., Bangalore, India Printed in China on acid-free paper by Asia Pacifi c Offset Whilst every effort has been made to ensure that the contents of this book are as complete, accurate and up-to-date as possible at the date of writing, Oxford University Press is not able to give any guarantee or assurance that such is the case. Readers are urged to take appropriately qualifi ed medical advice in all cases. The information in this book is intended to be useful to the general reader, but should not be used as a means of self-diagnosis or for the prescription of medication. This book is dedicated to the late Donald W. Goodwin MD and his wife Sally. Don touched all of our lives in many different ways over many, many years as a friend, colleague, mentor, and Chair of the Department of Psychiatry and Behavioral Sciences at the University of Kansas Medical Center. His good humor, his modesty, his vast knowledge of alcoholism, and his remarkable ability to focus on essentials without getting lost in trivia remain, even today, important lessons for us all. v This page intentionally left blank Preface to the fourth edition It has been nearly a decade since the death of Donald W. Goodwin, the orig- inal author of The Facts series on alcoholism and co-author of the current work. The third edition was the last original work from Donald Goodwin and still today stands as an honest accurate commentary on the devastating nature of this disease as well as the unique challenges it presents to research- ers, health-care providers, affected individuals and their families. Donald was a world-renowned expert and a pioneer in alcoholism research. He helped the world to focus on the importance of genetics and family history in the development of alcoholism. As a psychiatrist, distinguished professor, jour- nalist, and novelist, Donald Goodwin had a special gift for language. His words captured the very essence of alcoholism … from the perspective of the scientist and the eyes of the drinker. He always knew just the right quote to capture the heart, soul, and genuine suffering associated with this disease. Donald Goodwin knew his facts on alcoholism, and the information in his books was spot on accurate … for its time. But considerable time has passed since his death and some things have now changed. The facts are due for an update and we, his followers at the University of Kansas Medical Center, have tried to carry on his tradition. In the years since Donald Goodwin’s death in 1999, we have seen an explo- sion of new technologies available for the study of the brain and behavior. These technologies have given scientists and clinicians the opportunity to ‘look inside’ and better understand the brains of people who drink. These advances offer dramatic changes for research on alcoholism. They may open the door to the development of useful treatment strategies designed to help recovering alcoholics resist the powerful urges to drink again. The fourth edi- tion benefi ts from some of these nascent advances and comments upon the nature of the disease and strategies for treatment. Although we continue to use the term ‘alcoholism’ in this book—that is historical. Doctors now refer to alcohol abuse and alcohol dependence, making a distinction between the two. We also save the use of the term ‘alcoholic’ for the same reason, but our vii Alcoholism · thefacts research leads us to more properly refer to ‘the person who suffers from alco- hol abuse or alcohol dependence’. For now, we have retained the format of the original work and have attempted to retain much of the ‘Goodwin charm’. A fi fth edition will no doubt look very different. University of Kansas Medical Center 2008 viii Contents Section one Alcohol 1 Alcoholic beverages 3 2 Alcohol in the body 7 3 Alcohol and its effects 11 4 Alcohol through the ages 17 Section two Alcoholism 5 What is alcoholism? 27 6 The symptoms 35 7 The course 51 8 Women and alcohol 63 Section three Understanding alcoholism 9 Risk factors 77 10 Alcoholism and co-occurring mental illness (dual diagnosis) 83 11 Heredity 91 12 Drinking ‘rewards’ 97 13 Judgment and self-control 101 ix