RECENT DEVELOPMENTS IN ALCOHOLISM VOLUME 4 RECENT DEVELOPMENTS IN Edited by MARC GALANTER Alberl Einslein College of Medicine Bronx, New York Associate Editors HENRI BEG LEITER, RICHARD DEITRICH, DONALD GOODWIN, EDWARD GOTTHEIL, ALFONSO PAREDES, MARCUS ROTHSCHILD, and DAVID VAN THIEL Editorial Assistant VIRGINIA PRIVIT AR An Official Publication of the American Medical Society on Alcoholism and Other Drug Dependencies and the Research Society on Alcoholism. This series was founded by the National Council on Alcoholism. ALCOHOLISM VOLUME 4 Combined Alcohol and Drug Abuse Typologies of Alcoholics The Withdrawal Syndrome Renal and Electrolyte Consequences Springer Science+ Business Media, LLC The Library of Congress has cataloged this work as follows: Recent developments in alcoholism: an official publication of the American Medical Soci ety on Alcoholism, and the Research Society on Alcoholism, and the National Council on Alcoholism—Vol. 1 New York: Plenum Press, cl983- v.: ill.; 25 cm. Cataloging in publication. Editor: Marc Galanter. ISSN 0738-422X = Recent developments in alcoholism. 1. Alcoholism—Periodicals. I. Galanter, Marc. II. American Medical Society on Alcoholism. III. Research Society on Alcohol (U.S.) IV. National Council on Alcoholism. [DNLM: 1. Alcoholism—periodicals. Wl REl06AH(P)] HV5001.R4 ôlô.S&VOS—dcl9 83-643791 Library of Congress [8311] AACR 2 MARC-S ISBN 978-1-4899-1697-6 ISBN 978-1-4899-1695-2 (eBook) DOI 10.1007/978-1-4899-1695-2 © Springer Science+Business Media New York 1986 Originally published by Plenum Press, New York in 1986 Softcover reprint of the hardcover 1st edition 1986 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, recording, or otherwise, without written permission from the Publisher Editorial Board American Medical Society on Alcoholism and Other Drug Dependencies Cililirnlllll: Charles S. Lieber, MD. Burton M. Altura, PhD. Presidwl: Herbert Barry III, PhD. Max A. Schneider, MD. Henri Begleiter, MD., Ph.D. Presidenl-Elecl: Floyd E. Bloom, MD. Margaret Bean-Bayog, M.D. Irvin L. Blose, MD. Secrelary: Bernice E. Coleman, M.D. Jess W. Bromley, MD. Paul Cushman, MD. Treasurer: Richard A. Deitrich, Ph.D. Jasper G. Chen See, MD. Richard L. Douglass, M.P.H., PhD. Immediale Pasl Presidenl: Carlton K. Erickson, PhD. Irvin L. Blose, MD. Louis Faillace, MD. Board of Directors: Vernelle Fox, MD. Sheila B. Blume, M.D. Richard Fuller, M.D. Sandra Jo Counts, MD. Donald M. Gallant, M.D. Jean L. Forest, MD. Donald W. Goodman, MD. Marc Galanter, MD. R. Adron Harris, PhD. Donald M. Gallant, MD. Paula L. Hoffman, PhD. Ann Geller, MD. George Jacobson, PhD. Stanley E. GitIow, MD. Charles Kaelber, MD. William B. Hawthorne, MD. Robert Landeen, MD. Roland E. Herrington, MD. Ting·Kai Li, MD. Charles S. Lieber, MD. Peter E. Nathan, Ph.D. Joseph c. MacMillan, M.D. Larissa A. Pohorecky, MD. Al J. Mooney III, MD. Alex D. Pokorny, MD. Anthony Radcliffe, MD. Percy E. Ryberg, MD. Daniel E. Smith, MD. Barry Stimmel, MD. G. Douglas Talbott, MD. Patricia B. Sutker, PhD. Maxwell N. Weisman, MD. George Vaillant, MD. David Van Thiel, M.D. Research Society on Alcoholism Joseph Westermeyer, M.D. Sheldon Zimberg, M.D. President: Boris Tabakoff, PhD. Vice-Presidenl: Ting-Kai Li, M.D. Secrelary: Marc Galanter, MD. Treasurer: Henri Begleiter, MD., Ph.D. Board of Directors: Herbert Barry III, PhD. Floyd E. Bloom, MD. Theodore J. Cicero, PhD. Richard A. Deitrich, PhD. John A. Ewing, MD. Dora B. Goldstein, MD. Charles S. Lieber, MD. Peter E. Nathan, PhD. Carrie L. Randall, PhD. Marc A. Schuckit, MD. Contributors Arthur I. Alterman, Veterans Administration Medical Center, Philadelphia, Pennsylvania 19104; and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104 Thomas F. Babor, Alcohol Research Center, Department of Psychiatry, Uni versity. of Connecticut Health Center, Farmington, Connecticut 06032 Jerome F.X. Carroll, Continuum Program, Eagleville Hospital, Eagleville, Pennsylvania 19408 Richard R. Clayton, Department of Sociology, University of Kentucky, Lex ington, Kentucky 40506 Paul Cushman, Jr., Drug Dependency Treatment Program, McGuire Veterans Hospital, Richmond, Virginia 23249; and Departments of Medicine, Psy chiatry, Pharmacology and Toxicology, Medical College of Virginia, Rich mond, Virginia 23298 Dennis M. Donovan, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98195; and Alcohol De pendence Treatment Program, Veterans Administration Medical Center, Seattle, Washington 98108 Dora B. Goldstein, Department of Pharmacology, Stanford University School of Medicine, Stanford, California 94305 David A. Gorelick, Alcohol and Drug Treatment Program, Behavioral Phar macology Laboratory, Brentwood Division, West Los Angeles Veterans Administration Medical Center, Los Angeles, California 90073; and De partment of Psychiatry, School of Medicine, University of California, Los Angeles, California 90024 Edward Gottheil, Department of Psychiatry and Human Behavior, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsyl vania 19107 Michie N. Hesselbrock, Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut 06032 vii viii Contributors Daniel R. Kivlahan, Department of Psychiatry and Behavioral Sciences, Uni versity of Washington, Seattle, Washington 98195; and Alcohol Depen dence Treatment Program, Veterans Administration Medical Center, Se attle, Washington 98108 Richard J. Lauerman, Alcohol Research Center, Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut 06032 Roger E. Meyer, Alcohol Research Center, Department of Psychiatry, Uni versity of Connecticut Health Center, Farmington, Connecticut 06032 Leslie C. Morey, Department of Psychology, Vanderbilt University, Nash ville, Tennessee 37240 Claudio A. Naranjo, Clinical Pharmacology Program, Addiction Research Foundation Clinical Institute, and Departments of Pharmacology and Medicine, University of Toronto, Ontario M5S 2S1, Canada Alfonso Paredes, Department of Psychiatry, The Neuropsychiatric Institute, Alcohol Research Center, University of California, Los Angeles, Califor nia 90024 Thomas O. Pitts, Renal-Electrolyte Division, Department of Medicine, Pitts burgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsyl vania 15261 Eugene P. Schoener, Department of Pharmacology, Wayne State University School of Medicine, Detroit, Michigan 48201 Edward M. Sellers, Clinical Institute, Addiction Research Foundation, and Departments of Pharmacology and Medicine, University of Toronto, On tario M5S 2S1, Canada Harvey A. Skinner, Addiction Research Foundation, Toronto, Ontario M5S 2S1, Canada Ralph E. Tarter, Department of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213 David H. Van Thiel, Division of Gastroenterology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261 Contributors ix R. Dale Walker, Department of Psychiatry and Behavioral Sciences, Univer sity of Washington, Seattle, Washington 98195; and Alcohol Dependence Treatment Program, Veterans Administration Medical Center, Seattle, Washington 98108 Jeffery N. Wilkins, Crisis Oriented Psychiatric Evaluation Service, Clinical Psychopharmacology Unit, Brentwood Division, West Los Angeles Vet erans Administration Medical Center, Los Angeles, California 90073; and Department of Psychiatry, School of Medicine, University of California, Los Angeles, California 90024 Preface From the President of the Research Society on Alcoholism In recent years the alcohol research field has matured and is attracting a substantial number of eager and technically sophisticated researchers. There is a feeling of excitement and premonitions of breakthroughs as more and more of alcohol's actions are being detailed. I, however, have at times been sobered by the perception that the lure of parsimonious explanations and the appeal of studying easily demonstrable effects obscure the critical issues re garding alcohol abuse and alcoholism. Central questions regarding (1) the reinforcing properties of ethanol and other factors responsible for inappro priate consumption of alcohol, (2) the heterogenous characteristics (both bi ologic and sociologic) of the alcoholic population, and (3) the differential predisposition of individuals to alcohol-induced medical problems needed to be vigorously pursued. Researchers who used animals as models for the human condition needed to become more intimately aware of the variety of factors that are of importance in the development of alcoholism in an indi vidual. On the other hand, researchers studying humans needed to attempt to more clearly define and categorize diagnostic criteria and characteristics of various alcoholic populations. Such categorization and continued character ization of alcoholism allows not only for a framework of concepts within which proper animal models for studies of biologic mechanisms can be de veloped but also allows for consideration of the most apt treatment approaches. I have been most heartened during the last two years by the increased attention being paid to the development of appropriate concepts for studies of alcoholism. This increase in attention to concepts has certainly been evi denced in the presentations at the annual meeting of the Research Society on Alcoholism (RSA) and in the published material appearing in the AMSAODDI RSA journal and in this book series. I would hope that continued insight will be displayed by the experienced researchers in the alcoholism field and that this insight will be used to guide those newly entering alcohol research. Science is the testing of hypothesis, but hypothesis should be firmly grounded. Progress toward the solution of the major problems in the alcoholism field will be swift with adherence to proper concepts and good scientific methods. Boris Tabakoff, Ph.D. xi