Domestic violence, separation, and suicide in young men with early onset alcoholism: reanalyses of Murphy's data

Partner violence and partner separation at the time of completed suicide were investigated in 42 male alcoholics originally described by Murphy (1992). Half of the men had domestic violence histories. Partner-violent men were younger, had an earlier age of onset of alcoholism, and were more likely to be separated from their partner at the time of death than partner-nonviolent men. Loss of a close personal relationship, often a domestic partner, is common during the last year of life among alcoholic men completing suicide. Domestic violence appears to typify many of their domestic relationships, particularly among younger men and men with early onset alcoholism.     

Late Onset Alcoholism: Stress or Structure

We studied 60 men (M age = 63.6 years) from six midwest treatment centers to determine whether stress resulting from loss of social-psychological structures was greater for later onset alcoholics. Each subject completed a modified Veteran's Alcoholism Screening Test (V.A.S.T.; Magruder-Habib, Harris, & Franker, 1982) and the Drinking Practices Survey (Adams, 1990). They were then identified as early onset (problem drinking before age 40) and later onset (problem drinking after age 40). Cross tabulations using the chi-square statistic showed that more early onset alcoholics were married than later onset alcoholics. Of the social-psychological structures, only marital status showed a significant relationship with alcoholism. This seemed to confirm that the onset of problem drinking has less to do with stress than with the loss of a spouse who may serve to regulate the older man's drinking.     

Effects of alcohol abuse and familial alcoholism on physical health in men and women

Detoxified alcoholic men (n = 76) and women (n = 72) and nonalcoholic control men (n = 50) and women (n = 51) were given a structured interview that assessed five categories of physical health: medical history, alcohol-related disorders, trauma history, drug use history, and, for females, female-related disorders. Approximately half the subjects in each group were family history positive for alcoholism. Significant differences between alcoholics and controls were found for all five categories; family history effects were significant for four of the five categories, and sex differences were present in two categories. The results indicate that (a) alcoholics suffer pervasive physical health difficulties, (b) a family history of alcoholism is predictive of health problems in both alcoholics and controls, (c) the effects of alcohol abuse and family history of alcoholism on health appear to be independent and additive, and (d) women may be more "illness prone" than men and exhibit an increased vulnerability to the adverse effects of alcoholism.     

Using the Millon Clinical Multiaxial Inventory's Scale B and the MacAndrew Alcoholism Scale to identify alcoholics with concurrent psychiatric diagnoses

The ability of the MacAndrew Alcoholism Scale (MAC) and Scale B of the Millon Clinical Multiaxial Inventory (MCMI) to discriminate independently defined alcoholics with psychiatric diagnoses from other psychiatric patients was examined for males and all alcoholics, using three different criteria of alcoholism. The MAC identified from 80% to 87% of male alcoholics and 76% to 82% of all alcoholics, and from 25% to 52% of male nonalcoholics and 55% to 75% of all nonalcoholics, resulting in a large number of false positives. Scale B identified from 31% to 60% of male alcoholics and 33% to 43% of all alcoholics, and from 73% to 85% of male nonalcoholics and 85% to 94% of all nonalcoholics. The operating characteristics of Scale B showed that it was not as efficient in identifying alcoholics as previous work had indicated. We suggest that Scale B should not be used and the MAC should be used cautiously to discriminate alcoholics with psychiatric disorders from patients without alcoholism.     

Using the Million Clinical Multiaxial Inventory's Scale B and the MacAndrew Alcoholism Scale to Identify Alcoholics With Concurrent Psychiatric Diagnoses

The ability of the MacAndrew Alcoholism Scale (MAC) and Scale B of the Millon Clinical Multiaxial Inventory (MCMI) to discriminate independently defined alcoholics with psychiatric diagnoses from other psychiatric patients was examined for males and all alcoholics, using three different criteria of alcoholism. The MAC identified from 80% to 87% of male alcoholics and 76% to 82% of all alcoholics, and from 25% to 52% of male nonalcoholics and 55% to 75% of all nonalcoholics, resulting in a large number of false positives. Scale B identified from 31% to 60% of male alcoholics and 33% to 43% of all alcoholics, and from 73% to 85% of male nonalcoholics and 85% to 94% of all nonalcoholics. The operating characteristics of Scale B showed that it was not as efficient in identifying alcoholics as previous work had indicated. We suggest that Scale B should not be used and the MAC should be used cautiously to discriminate alcoholics with psychiatric disorders from patients without alcoholism.     

Women and Alcoholism: A Biopsychosocial Perspective and Treatment Approaches

Viewing alcoholism in women from a biopsychosocial perspective reveals a unique set of circumstances and challenges that women alcoholics face when compared with men. Biologically, women react differently to alcohol ingestion than do men. Women reach higher blood alcohol levels and sustain more somatic and cognitive damage than men when consuming equivalent amounts of alcohol. Psychosocially, women alcoholics face societal rebuke and chastisement of a greater magnitude than do men. Finally, barriers to treatment faced by women, such as the need for child care, cost of treatment, familial opposition, denial of alcoholism, and inadequate diagnostic training of physicians, must be overcome to create successful treatment approaches for the female alcoholic. Obstacles to and implications for treatment are also discussed.     

A retrospective analysis of alcohol consumption on laboratory tasks as related to therapeutic outcome

The relationship between drinking on laboratory-analogue measures at the onset of inpatient alcoholism treatment and abstinence subsequent to treatment was examined. Twenty therapeutically successful and 20 unsuccessful chronic alcoholics were selected and did not differ on age, education, length of problem drinking, and length of follow-up. Retrospective analysis of responding on an operant drinking task and a ‘taste test’ assessment technique revealed significant differences between the groups, with successful patients drinking less than the unsuccessful ones. Implications for screening candidates for alcoholism treatment programs are discussed.     

Alcoholism and morphologic findings of the nervous system in autopsy cases

154 autopsy cases of alcoholics (120 men and 34 women) were investigated from a neuropathological viewpoint. In only 19 cases could typical diseases of the nervous system caused by alcoholism be found (Wernicke's encephalopathy, central pontine myelinolysis, Marchiafava-Bignami's disease and disorders of the peripheral nerves and muscles). In comparison liver diseases occurred almost five times more frequently in our own material. Diseases caused by alcoholism of the nervous system, the question of brain shrinkage and its partial reversibility, the up to now not completely known effects on the neurophil and cortical cytoarchitectonic are discussed according to the literature.     

Application of the MacAndrew alcoholism scale to alcoholics with psychiatric diagnoses

The MacAndrew Alcoholism scale scores of 140 male patients from a large VA hospital were examined to assess whether the MAC scale can detect alcoholism among patients with psychiatric diagnoses. There were five diagnostic groups, each with 28 patients: alcoholics, alcoholics with neurotic disorders, alcoholics with personality disorders, nonalcoholic patients with neurotic disorders, and nonalcoholic patients with personality disorders. The MAC scale was able to differentiate alcoholics and nonalcoholic psychiatric patients, but was unable to differentiate either of the alcoholic psychiatric groups from its nonalcoholic psychiatric counterpart. Thus, it appears that the MAC scale may be unable to identify alcoholism among patients with combined alcoholic-psychiatric diagnoses.     

Application of the MacAndrew Alcoholism Scale to Alcoholics With Psychiatric Diagnoses

The MacAndrew Alcoholism scale scores of 140 mate patients from a large VA hospital were examined to assess whether the MAC scale can detect alcoholism among patients with psychiatric diagnoses. There were five diagnostic groups, each with 28 patients: alcoholics, alcoholics with neurotic disorders, alcoholics with personality disorders, nonalcoholic patients with neurotic disorders, and nonalcoholic patients with personality disorders. The MAC scale was able to differentiate alcoholics and nonalcoholic psychiatric patients, but was unable to differentiate either of the alcoholic psychiatric groups from its nonalcoholic psychiatric counterpart. Thus, it appears that the MAC scale may be unable to identify alcoholism among patients with combined alcoholic-psychiatric diagnoses.     

An appraisal of chemical aversion (emetic therapy) approaches to alcoholism treatment.

More than 35,000 alcoholics have received chemical aversion (emetic therapy) in at least 75 settings worldwide since the 1930s. This consummatory aversion (CA) treatment, which pairs ethanol ingestion with emetically induced nausea, incorporates the highly efficient variety of learning known as taste aversion (TA) conditioning. The CA literature indicates that emetic therapy should induce conditioned alcohol aversions in many alcoholics. Such aversions have been widely reported by clinicians and have been confirmed by recent psychophysiological evidence. Long standing evidence of treatment effectiveness is found in the results of private hospitals which have consistently produced 1-yr abstinence rates approximating 60%. Diminished alcohol craving is a frequently reported benefit. Few experimental evaluations have been completed, as is generally the case for all alcoholism treatments, but those which used methodologically sound temporal parameters during conditioning have supported the clinical efficacy of emetic therapy. The clear need for more definitive research notwithstanding, there are compelling indications that emetic therapy is a useful component of multimodal treatment within certain alcoholic populations. However, its availability is severely limited. Many alcoholics could probably benefit from expanded treatment availability. The time is ripe for a reevaluation of resistances to the clinical use of emetic therapy alcoholism treatment.     

The Behavioral Genetics of Alcoholism

Twin and adoption studies consistently implicate the importance of genetic influences on alcoholism risk, especially in men. Heritability estimates suggest that approximately 50% to 60% of the variability in alcoholism liability is associated with genetic factors. Although there has been progress in identifying specific genes that predispose toward alcoholism, we know relatively little about the nature of the genetic influence on alcoholism risk. We also know relatively little about how genetic factors combine with environmental factors to affect alcoholism risk. Genotype-environment interaction models posit that alcoholism occurs when individuals both inherit a vulnerability to develop alcoholism and are reared in a provocative environment. Such models hold great promise for understanding alcoholism's etiology.     

Characteristics of children of alcoholics: putative risk factors, substance use and abuse, and psychopathology.

A sample of 253 children of alcoholics (COAs) and 237 children of nonalcoholics (non-COAs) were compared on alcohol and drug use, psychopathology, cognitive ability, and personality. COAs reported more alcohol and drug problems, stronger alcohol expectancies, higher levels of behavioral undercontrol and neuroticism, and more psychiatric distress in relation to non-COAs. They also evidenced lower academic achievement and less verbal ability than non-COAs. COAs were given Diagnostic Interview Schedule alcohol diagnoses more frequently than non-COAs. The relation between paternal alcoholism and offspring alcohol involvement was mediated by behavioral undercontrol and alcohol expectancies. Although gender differences were found, there were few Gender X Family History interactions; the effects of family history of alcoholism were similar for men and women. When gender effects were found, they showed greater family history effects for women.     

On the biomedicalization of alcoholism

The shift in the prevailing view of alcoholism from a moral paradigm towards a biomedical paradigm is often characterized as a form of biomedicalization. We will examine and critique three reasons offered for the claim that viewing alcoholism as a disease is morally problematic. The first is that the new conceptualization of alcoholism as a chronic brain disease will lead to individualization, e.g., a too narrow focus on the individual person, excluding cultural and social dimensions of alcoholism. The second claim is that biomedicalization will lead to stigmatization and discrimination for both alcoholics and people who are at risk of becoming alcoholics. The third claim is that as a result of the biomedical point of view, the autonomy and responsibility of alcoholics and possibly even persons at risk may be unjustly restricted. Our conclusion is that the claims against the biomedical conceptualization of alcoholism as a chronic brain disease are neither specific nor convincing. Not only do some of these concerns also apply to the traditional moral model; above that they are not strong enough to justify the rejection of the new biomedical model altogether. The focus in the scientific and public debate should not be on some massive “biomedicalization objection” but on the various concerns underlying what is framed in terms of the biomedicalization of alcoholism.     

Family Process as a Mediator of the Negative Effects of Parental Alcoholism on Young Adult Dating Relationships

The effects of parental alcoholism on young adult dating relationship quality (trust, intimacy, commitment, and satisfaction) were considered in the context of the mediating variable of family process (cohesion, conflict resolution, and family competence). A model was tested with a sample of 287 young adults (95 were adult children of alcoholics) that suggested that healthier family process mediates the negative effects of having an alcoholic parent on dating relationship quality. Structural equation modeling results showed that the model fit the data. Young adults from alcoholic families in which family process was less negatively affected by parental alcoholism were less likely to report lower dating relationship quality than those from families in which family process was more negatively affected by parental alcoholism. Parental divorce was directly related to lower relationship quality. Clinical implications for working with young adult children of alcoholics are discussed.     

A Comparison of Primary Alcoholics,Secondary Alcoholics,and Nonalcoholic Psychiatric Patients on the MacAndrew Alcoholism Scale

The MacAndrew Alcoholism (MAC) and Sc scales of the Minnesota Multiphasic Personality Inventory (MMPI) were examined in four groups of 20 male patients. Comparisons were made among primary alcoholics, secondary alcoholics (i.e., alcoholic psychiatric patients), nonalcoholic psychiatric patients (mixed diagnoses), and conservatively defined, nonalcoholic schizophrenics. Primary alcoholics scored higher on the MAC scale than did secondary alcoholics and other groups; schizophrenics scored lower than all other groups. Primary alcoholics were lower on the Sc scale than schizophrenics but did not differ from other groups. The results support MacAndrew's (1981) distinction between primary and secondary alcoholics and suggest that the MAC scale may enhance differentiation among diagnoses other than alcoholism.     

A comparison of primary alcoholics, secondary alcoholics, and nonalcoholic psychiatric patients on the MacAndrew Alcoholism Scale

The MacAndrew Alcoholism (MAC) and Sc scales of the Minnesota Multiphasic Personality Inventory (MMPI) were examined in four groups of 20 male patients. Comparisons were made among primary alcoholics, secondary alcoholics (i.e., alcoholic psychiatric patients), nonalcoholic psychiatric patients (mixed diagnoses), and conservatively defined, nonalcoholic schizophrenics. Primary alcoholics scored higher on the MAC scale than did secondary alcoholics and other groups; schizophrenics scored lower than all other groups. Primary alcoholics were lower on the Sc scale than schizophrenics but did not differ from other groups. The results support MacAndrew's (1981) distinction between primary and secondary alcoholics and suggest that the MAC scale may enhance differentiation among diagnoses other than alcoholism.     

A community-reinforcement approach to alcoholism

Several theoretical approaches to alcoholism exist. An opérant reinforcement approach was used in the present study to develop a new procedure that rearranged community reinforcers such as the job, family and social relations of the alcoholic such that drinking produced a time-out from a high density of reinforcement. The results showed that the alcoholics who received this Community-Reinforcement counseling drank less, worked more, spent more time with their families and out of institutions than did a matched control group of alcoholics who did not receive these procedures. This new approach appears to be an effective method of reducing alcoholism. An analysis in reinforcement terms is presented of the etiology, epidemiology, and treatment of alcoholism.     

Control orientation as a personality dimension among alcoholic and obese adult men undergoing addictions treatment.

Rotter's (1966) I-E Locus of Control Scale was administered to 18 men in residential treatment for alcoholism and 13 men in intensive outpatient treatment for obesity. The obese sample scored significantly higher in internal locus of control, whereas the alcoholic sample was comparatively external in control orientation. These findings contradict currently held assumptions on the directionality of control orientation among both alcoholic and obese adults and suggest that internally oriented obese adults may feel that they have little control over their weight and eating behavior but more control over other aspects of their lives. In contrast, externally oriented alcoholics appear to be aware of their inability to control their drinking and their limited control over many factors influencing their lives. Implications for treatment are also discussed.     

Abstinence or control: The outcome for excessive drinkers two years after consultation

This report presents the two-year follow-up results for a sample of married male alcoholics who had been the subjects of a controlled treatment trial. Cumulative relapse curves for the two-year period were found to be similar in form to those which Hunt and Matarazzo (1970) have drawn for drug addicts, alcoholics and smokers. Outcome at 12 and 24 months were compared: changes from good to bad outcome, or vice versa, were rare. The degree of hardship reported by wives remained predictive of outcome two years later. Not all drinking reported at two years was uncontrolled. Of 26 men with a good outcome. 11 were agreed by husband and wife to be abstaining, and 10 were agreed to be controlling their drinking. Most of the latter had not shown lengthy periods of abstinence prior to resuming drinking. Controlled drinkers reported fewer symptoms at intake (morning drinking, shakes, secret drinking, hallucinations etc.), were more likely to have been sub-diagnosed as Alpha alcoholics (psychologically dependent), and were more likely to have been only briefly counselled. Abstainers reported more symptoms at intake, were more likely to be sub-diagnosed as Gamma alcoholics (physically dependent), and were more likely to have been intensively treated. These results suggest an interaction between degree of dependence, type of treatment, and goal of treatment. If confirmed by future research this would have strong implications for the planning of comprehensive alcoholism treatment services.