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Suggested Citation:"I. INTRODUCTION." National Research Council. 1956. Committee on Problems of Alcohol: A Report of Its Activities From 1949 to 1955, the Research Work It Has Supported and the Place of This Work in the Field of Alcoholism. Washington, DC: The National Academies Press. doi: 10.17226/18472.
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Suggested Citation:"I. INTRODUCTION." National Research Council. 1956. Committee on Problems of Alcohol: A Report of Its Activities From 1949 to 1955, the Research Work It Has Supported and the Place of This Work in the Field of Alcoholism. Washington, DC: The National Academies Press. doi: 10.17226/18472.
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Page 2
Suggested Citation:"I. INTRODUCTION." National Research Council. 1956. Committee on Problems of Alcohol: A Report of Its Activities From 1949 to 1955, the Research Work It Has Supported and the Place of This Work in the Field of Alcoholism. Washington, DC: The National Academies Press. doi: 10.17226/18472.
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Page 3
Suggested Citation:"I. INTRODUCTION." National Research Council. 1956. Committee on Problems of Alcohol: A Report of Its Activities From 1949 to 1955, the Research Work It Has Supported and the Place of This Work in the Field of Alcoholism. Washington, DC: The National Academies Press. doi: 10.17226/18472.
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Page 4

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REFERENCE COPY FOR LIBRARY USE OiV.•' NATIONAL ACADEMT OF SCIENCES - NATIONAL RESEARCH COUNCIL 2101 Constitution Avqnue. Washington 25, D. C. • Division of Medical Sciences COMMITTEE ON PROBLEMS OF ALCOHOL A Report of its Activities from 1949 to 1955, • /•• • the Research Work it has Supported and the Place of this Work,in the Field of Alcoholism by '. Jonathan 0. Cole., M. D. Z. INTRODUCTION The problems posed by alcohol have undoubtedly been present to one de- gree or another since man first discovered the prdcess of fermentation. In various cultural settings, of course, alcohol is used to varying extents and for differing purposes. The wild and violent drunkenness of the plains Indian in the early days of the fur trade and the heavily ritualized and quite modest alcohol consumption of the orthodox Jew illustrate well the variations exist- ing in the use of alcohol from one social group to another. '" * The recognition of chronic alcoholism as a social problem goes back at least to the days of Hogarth and the development of distilled liquors, while the great "experiment" of prohibition in this country is probably the most radical attempt ever made to solve the problems presented by alcohol. In re- cent years a variety of organizations, such as Alcoholics Anonymous, the Yale Center of Alcohol Studies, and the National Committee on Alcoholism, have arisen which have attempted in one way or another to help those with serious drinking problems. As of 1955, twenty-seven states and the District of Columbia had state programs concerned with the disease of alcoholism, while several other states have had commissions studying the problem, (38) ** . • The seriousness of the problem in the U.S.A. must to a large extent be related to the proportion of the population suffering from chronic alcoholism. Because of the social stigmata attached to the condition and the frequency with which confirmed alcoholics strenuously deny having any drinking problem at all, direct polling of the population cannot be expected to provide any accurate assessment of the magnitude of the problem. Dr. E, M. Jellinek (20) has developed an indirect method,for. estimating the total number of chronic alcoholics in a given state or country based on the area's autopsy statistics for cirrhosis of the liver and for alcoholism as well as the percentage of active chronic alcoholics suffering from liver disease. By this method, in an article published in 1952 (21), he estimated that in 194•8 there were 3,808,000 chronic alcoholics in the. United States. The prevalence rate was calculated as 3,952 alcoholics per every 100,000inhabitants over twenty-one years of age, a rate which approaches closely four per cent of the adult popu- lation. In comparing this figure with those for other diseases. in tfiat year (39), it becomes evident that there were 130 times as many chronic alco- holics in the U.S.A. as there were cases of poliomyelitis (only 27,726)0

-2- There were, by these calculations, six times as many alcoholics in this country as there were hospitalized psychiatric patients (only 554,454). An alternate method devised by Ipsen, Moore, and Alexander (16), based on the frequency with which medical examiners report alcoholism as a cause of death, arrived at the slightly more modest estimate of 1,240 chronic alco- holics per 100,000 total population (for the State of Massachusetts). These authors felt that the medical examiners1 autopsy diagnoses were sufficiently reliable and unbiased to give an adequate picture of the rela- tive incidence of the problem in the state as a whole. Their figures, al- though lower than Jellinek's, still indicate that a very substantial problem exists. In the best actual survey of a given population made to date, R. J. Gibbins (9), by using very careful case-finding methods, discovered that a county in Ontario had sixteen seriously abnormal drinkers for every 1,000 inhabitants over twenty years of age. 3y using Jellinek's formula the alco- holism rate for Ontario in 1948 was estimated as being 18* per thousand people over twenty, a figure which closely approximated that arrived at by Gibbins in his actual counting of specific individual cases. Gibbins1 work would therefore support the validity of the figures arrived at by Jellinek. Of course, further studies like the one conducted in Ontario are badly needed so that the exact extent of the problem can be reliably determined; but at present it seems at least strongly possible that one out of every 25 adult Americans is a chronic alcoholic. If this is true, it is indeed a problem of mammoth dimensions, urgently needing further study. Recent research aimed at a better understanding of both the etiology of chronic alcoholism and the effects of alcoholism on the individual can be grouped under four main headings: clinical, sociological, psychological, and metabolic-pharmacologic-phy siologic. Clinical research has included studies on the psychopathology of the chronic alcoholic, and studies of the organic diseases commonly found as- sociated with chronic Alcoholism, such as cirrhosis of the liver, polyneuritis, and delirium tremens. In addition, various methods of treatment based on a variety of different rationales have been attempted and have been evaluated with varying degrees of success and reliability. Attempts have been made to cause an aversion to alcohol by producing vomiting immediately after the patient has had a drink. (24, 43) Vitamins have been given in large doses (42) both because chronic alcoholics often show evidences of vitamin defi- ciencies and because certain animal experiments have indicated that rats deprived of certain vitamins may voluntarily increase their alcohol intake, (28, 48) Adrenal hormones and adrenocortiootrophic hormones have been used because some alcoholics show evidence of mild to moderate adrenal insuffi- ciency. (35) The effectiveness of these forms of treatment has varied *The difference between this figure and Jellinek's figure of 1,000 for the U.S.A. in 1948 is due to differences between the autopsy statistics for Ontario and those for the U.S.A. as a whole.

-3- somewhat from one unit to another, and the rationales behind them remain unclear, since it is not known whether any observed phenomenon such as ad- renal insufficiency is a predisposing factor in chronic alcoholism or a secondary effect of prolonged heavy drinking. Formal psychoanalysis of a relatively small number of patients has been only moderately effective, (22, 33) while other forms of psychotherapy, in- cluding group therapy, have achieved some measure of success. Antabuse, the drug which can make those taking it vomit violently if they drink alcohol, has been widely used with some success since its intro- duction from Denmark in 1949. (12, 18) Institutional treatment, varying from simple confinement within a state hospital (3) to hospitalization in units organized specifically for the re- habilitation of the chronic alcoholic, is being carried out in various parts of the country, but detailed studies evaluating the effectiveness of the various aspects of such programs are badly needed. Lurking beneath all these methods of treatment, as well as beneath the nonmedlcal and relatively non-research-oriented AA movement, is the problem of motivation for cure in the alcoholic. Whether this motivation is de- pendent on biochemical, hormonal, or psychological factors, its presence is often considered the sine qua non of successful treatment in the chronic alcoholic. (10) Sociological research into the drinking habits and attitudes toward alcohol of various cultural groups has been being actively carried but. There seems to be no doubt concerning the effect of such factors on the incidence of alcoholism within various subgroups, although this approach does not ex- plain the occurrence of alcoholism in specific individuals with a given cul- tural group. (2, 8) . •. . Psychological research in chronic alcoholism has been relatively active, but has been handicapped by at least two major difficulties. There have been attempts to differentiate alcoholics as a group from normal individuals as a group by means of various psychological tests, and there have been attempts to define "the alcoholic personality". Because of the considerable varia- bility in personality and behavior found in any large series of chronic alco- holics such attempts have met with little success. The other major problem has been the interpretation of such abnormal personality traits as are found in some chronic alcoholics. Are these traits the reason for the patient's drinking, or are they the result of prolonged alcohol consumption? (8, 40) This question of "which came first, the chicken or the egg" pervades metabolic and physiological studies of the alcoholic as well. Whenever ab- normalities of any sort are found in chronic alcoholics the same problem arises. Attempts have been made to study incipient or "early" alcoholics, but these cases are hard to define or identify and are open to some of the same doubts. Perhaps large-scale studies of great numbers of "normal" adolescents or young adults will be necessary, utilizing prolonged follow-up

-4- studies of these individuals to determine which ones become alcoholics in later life. The various psychological and physiological findings obtained at the inception of the study could then be statistically evaluated to de- termine their association with the eventual development of chronic alcoholism. On the biochemical side, despite the importance of the problem and the considerable amount of work devoted to it, a number of gaps exist in our knowledge concerning the process by which alcohol is metabolized in the normal human body. Such knowledge is vitally necessary before one can even begin to investigate the often-suggested possibility .that the bodies of chronic alco- holics may handle alcohol in an abnormal manner. Our knowledge of the effects of alcohol consumption on salt and water balance in the body, on the secretions of the endocrine glands, and on the functioning of the central nervous system contains equally large loopholes. From the time of its organization within the National Research Council, the Committee on Problems of Alcohol has been acutely aware of these defects in our knowledge of the metabolic, physiological, and pharmacological effects of alcohol, and has felt that knowledge in these areas must be expanded and solidified before possible metabolic or physiologic factors in the etiology of chronic alcoholism can begin to be explored. Since other organizations in the field of chronic alcoholism, both state and national, tend, because of their charters and the groups which they serve, to place emphasis on clini- cal, sociological, and psychological aspects of the problem, the Committee on Problems of Alcohol has felt even more strongly that the encouragement and support of work in the metabolic, physiological, and pharmacological aspects of the problems was a useful and even vital function for the National Research Council's Committee on Problems of Alcohol to perform. This general theoretical approach to the problem fitted in well with the specific research projects which the Committee inherited from its predecessor, the Research Council on Problems of Alcohol, in 1949. Four of these were of this naturet Dr. R. J. Williams' work on biochemical individuality in alco- holism, Dr. J. J. Smith's work on adrenal insufficiency in chronic alcoholics, Dr. W. L, Voegtlin's work on allergies to alcohol, and Dr. 0. Diethelm's study of the relationship between certain biochemical components of the blood, certain emotions, and chronic alcoholism. Within its general area of interest the Committee on Problems of Alcohol has supported a variety of projects ranging from studies of the enzymes which metabolize alcohol to the factors influencing the spontaneous drinking of alcohol by laboratory animals. The general state of knowledge in the field, together with the place of the various studies supported by this Committee with the generous gifts of the Licensed Beverage Industries, will now be re- viewed. The specific studies supported are also listed in Appendix A. The descriptions of the work and ideas of the various grantees which are presented in this report are taken from either the progress reports sub- mitted to the Committee or from their comments at the Colloquium on the Metabolic and Pharmacological Aspects of Alcoholism held by the Committee on

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