The Biology of Alcoholism, Softcover reprint of the original 1st ed. 1983 Volume 6: The Pathogenesis of Alcoholism Psychosocial Factors

Pathogenesis is defined in Blakiston's Medical Dictional), as "the course of development of disease, including the sequence of processes or events from inception to the characteristic lesion or disease. " The central position of the word "pathogenesis" in the titles of Volumes 6 and 7 in itself connotes a bias on the part of the editors in favor of the disease concept of alcoholism, inasmuch as the end product of the pathogenetic process is presumed to be a disease. But the disease model as here conceptualized is vastly different from that of Jellinek, or of Alcoholics Anonymous, or of psychoanalysis. In those theories, alcoholism is seen as the inevitable consequence of some specific flaw in the heredity or the experience of the afflicted individual that inexorably leads to alcoholism. In these present volumes, the alcoholic syndrome is viewed rather as the outgrowth of the interaction of a variety of biological, psychological, and social influences which, depending on the predom­ inance of one or another, may lead to different types of alcoholism. This view, which has been labeled the bio-psycho-social perspective, encompasses a larger view of the dynamics of the development of alcoholism, incorporating data from each of the phenomenologic levels involved. An additional complication arises from the fact that the physiolog­ ical and psychosocial stigmata of alcoholics, which are probably most often the result of prolonged drinking, frequently have come to be considered as causes of the disease.

of Volume 6.- 1 Types of Alcohol Dependence.- Factors of Change.- Consumption.- Interactions of Alcohol with Other Chemicals.- The Functions and Liabilities of Alcohol.- Knowledge about Alcohol and Human Beings.- The Need for a Unifying Concept.- Individual Variability.- The Problems of Alcohol.- Intoxication.- Diseases of Alcohol.- Dependence.- Withdrawal.- Types of Alcohol Dependence.- Physical Dependence.- Psychological Dependence.- The Concept of Social Dependence.- Summary and Some Implications for Research, Prevention, and Treatment.- 2 The Natural History of Alcoholism.- Historical Aspects.- Natural History Studies.- Comparisons with Jellinek’s Phases.- Studies on Minimally Treated or Untreated Alcoholics.- The Influence of Age on Natural History.- Alcoholism in Females.- Spontaneous Remission.- Social Drinking in Ex-Alcoholics.- Abstinence.- Morbidity.- Mortality.- Conclusions.- References.- 3 Psychiatric Characteristics of Alcoholics.- Acute Alcohol Psychoses: Intoxication and Withdrawal.- Acute Alcohol Intoxication.- Idiosyncratic or Pathological Intoxication.- Alcohol Withdrawal Syndromes.- Alcohol Hallucinosis.- Alcohol Amnestic Disorder.- Alcoholic Dementia.- Alcoholism and Affective Disorders.- Alcoholism and Suicide.- Alcoholism as a Cause of Suicide.- Alcoholism as a Form of Suicide.- Alcoholism and Suicide as Manifestations of a Common.- Etiology.- Alcoholism and Schizophrenia.- Alcoholism and Sociopathy.- Alcoholism and Neurosis.- Treatment Implications.- Summary.- References.- 4 Clinical and Prealcoholic Personality Characteristics.- History of the Alcoholic Personality Concept.- Methodological Problems in Alcoholic Personality Research.- Strategy Used in the Preparation of This Chapter.- Objective Personality Batteries.- Minnesota Multiphasic Personality Inventory.- Sixteen Personality Factor Questionnaire.- Eysenck Personality Inventory.- Edwards Personal Preference Schedule.- Jackson Personality Research Form.- Internal-External Locus of Control.- Projective Personality Tests.- The Rorschach.- The Thematic Apperception Test.- Drawing Tasks.- Perceptual Tests.- Field Dependence-Independence.- Stimulus-Intensity Modulation.- A Clinical Alcoholic Personality Model.- Neuroticism.- Weak Ego.- Field Dependence.- Stimulus-Intensity Modulation.- Dynamics.- Prealcoholic Personality.- Conclusions.- References.- 5 Why Do Alcoholics Drink?.- The Evolution of “Addictive” Drinking Behavior.- The Opponent Process.- Craving.- Modifiers of Alcohol Consumption.- Predictors of Alcohol Acquisition and Consumption.- The First Drink.- The Issue of Loss of Control.- Individual Drinking Patterns.- Summary.- References.- 6 Alcoholism in Women.- Some General Comments.- Important Methodological Elements in Etiological Studies.- Interpretation of Results.- The Causative Theories.- Genetics.- The Relationship between Alcoholism and Other Psychiatric Disorders.- Hormonal Influences.- Feelings of Femininity.- Sexuality.- Sex Roles.- Family and Spouse.- Personality Characteristics.- Tension and Anxiety.- Social Factors.- General Conclusions.- References.- 7 The Alcoholic Family.- Family Assessment and Measurement Techniques.- Family Assessment.- Family Measurement Techniques.- Family Environment and the Development of Alcoholism.- The Family Structure Studies.- Studies of the Cross-Generational Transmission of Alcoholism.- Family Determinants of the Course of Alcoholism.- Naturalistic Studies of the Alcoholic Family.- Laboratory Studies of Alcoholic Families.- Family Factors as They Influence the Course of.- Treatment.- The Impact of Alcoholism on the Family: Family Violence.- A General Overview of the Alcoholism and Family Violence Literature.- Representative Studies Relating Alcohol Use and Abuse to Family Violence.- Conclusions.- References.- 8 Ethnicity and Nationality in Alcoholism.- Drinking Subcultures.- Grandparents.- Parents.- Adolescents.- A Socialization Model of Drinking.- The Dynamics of Drinking Socialization.- The Effects of Assimilation on Ethnic Drinking Patterns.- Conclusion.- References.- 9 Religion and Alcoholism.- Theories of the Moral and Symbolic Dimensions of Drinking.- Religion and Drunkenness in Primitive and Traditional Societies.- Religion and Alcoholism in Modern Societies.- Rates of Drinking Problems by Religion.- Jewish American versus Irish-American Drinking Patterns.- The Temperance Movements.- Anomie, Ambivalence, and Structural Contradictions.- Private Secular Religion and Alcoholism.- References.- 10 Social-Class Factors in Alcoholism.- Historical Background.- Institutional Rates.- Statistics of Troubles.- Drunkenness Arrests.- Traffic Violations.- Direct Measures of Drinking.- Measures of Drinking Problems.- Summary, Discussion, and Conclusion.- References.- 11 Occupational Factors in Alcoholism.- Review of the Literature.- Differences across Occupations.- Clinical Populations.- Data on Mortality.- Household Surveys.- Studies within Occupations.- Population Surveys.- Experimental and Quasi-Experimental Designs.- Structural Characteristics of Occupations.- Methodology.- Results.- Discussion and Conclusions.- References.- 12 Region and Urbanization as Factors in Drinking Practices and Problems.- Geography and Drinking.- Alcohol Measures and Geographic Variables.- Geographic Units and Alcohol Studies.- Cities.- Counties.- States.- Census Tracts.- U.S. Census Regions.- Urbanicity or Urbanization.- Variation by Region and Urbanicity in Drinking Practices and Problems in the United States.- New Data on Drinking Patterns.- Alcohol-Related Problems.- Regional Differences in an International Perspective.- Urban-Rural Differences in an International Perspective.- Alcohol and the Process of Urbanization.- References.- 13 A Comprehensive Theory of the Pathogenesis of Alcoholism.- A Case History.- Traditional Tools of Inquiry.- Partial Solutions.- System Dynamics.- A Theory of Alcoholism.- Overview.- Scope of the Study.- Reference Modes of Drinking Behavior.- Dynamics Hypothesis.- Major Feedback Loops.- Model Summary.- Investigating Ways to Deal with Alcoholism.- Prevention.- Treatment.- Conclusion.- References.