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 (1956)

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Dr. F. W. .Ellis of the School of.Medicine of the University of North Carolina has recently been .given a grant to study the effects of both acute and chronic alcohol intoxication on adrenal function in the dog. He will also study the effects of both acute and chronic alcohol intoxication on carbohy- drate and alcohol metabolism, and will endeavor to determine whether prolonged intoxication over a six-month period can .produce adrenal insufficiency as hypothesized by Smith (36) and by Tintera and Lovell (26).. With the aid of a grant from the Committee on Problems of Alcohol, Dr. J. C. Forbes of the Medical College of Virginia has studied the effects of various vitamin deficiences on the response of the adrenal cortex to alcohol administration in rats and guinea pigs. The adrenal cortex, in addition to its hormones, contains considerable amounts of ascorbic acid (vitamin C). When the normal adrenal cortex is stimulated by a stress - injury, cold, fright, or alcohol Injection - its ascorbic acid content.drops sharply. This drop is assumed to accompany the release of the protective hormones by the adrenal • cortex which enable the body to handle stress effectively. Dr. Forbes (6, 7) has shown that ascorbic acid itself does not protect guinea pigs against lethal doses of alcohol, but it does appear to hasten full recovery in those animals which survive large. doses. • •>•.«.. Using somewhat smaller doses of alcohol, he has studied the effects of severe thiamine (vitamin 83.), pantothenic acid, riboflavin (vitamin 82), and. pyrldoxlne (vitamin B^) deficiencies on the adrenal response to alcohol, ad- ministration as determined by the drop in adrenal ascorbic acid. There was no appreciable change in the amount of this response after alcohol administra- tion in either the thiamine deficient animals or the pyridoxine-deficient ani- mals. The pantothenic-acid-deficient animals showed a variable change in the response, while the riboflavin-deficient animals showed a complete lack of response to the alcohol injection. ''.'.''.'. . ... . VI. CLINICAL RESEARCH IN CHRONIC ALCOHOLISM ... . In recent years the general trend of the Committee on Problems of Alcohol has been away from the support of clinical research in the field ©f alcoholism. This trend has been in part due to the Committee's predominant concern with the metabolic, physiologic, and pharmacologic aspects of chronic alcoholism and in part due to the Considerable expense involved in the support of good clinical research. ... . • , However, two of the six projects which the RCPA had been supporting at the time it transferred its research functions to the NRC were clinical studies. One, under Dr. J. J. Smith, has been described. The other, under Dr. Oskar Diethelm, was a five-year project of considerable scope whose support under the CPA ended in 1953. A full repo'rt of this work has recently appeared in the form of a book, "Etiology of Chronic Alcoholism," edited by Dr. Diethelm and published by C C Thomas in 1955. The work described therein on emotions and biochemical changes in the blood has already been outlined above.

.15- »•. t In addition to a detailed report 'of that work, the book contains reports on Dr. Mary Jane Sherfey1s clinical classification of chronic alcoholics, Dr. Manfred Bleuler's work on constitution and, heredity lini'pWonic alcohol-" ism, and Dr. Mlton Barnett's work on.alcoholism among the Cantonese in New York City/ ;V'''C- ^U-"^-.;' '.^'^'''^f•^'^vrv'; • .f^'l^V .., ^'.^ • .Dr« Sherfey. presented the results; of her detailed 'study" of the case records of I6l chronljj,alcoholic 'patients who had been treated. at Payn*- Whltney Clinic since" 1932, (27 of' these,. were' treated by The writer and 4•9 ' by her colleagues during the'.period bf her .s^udy),j.'She found^ 1<ha1j 42.8/6 of •'• this group could be given".oonventi6nal psychiatric diagnoses, .as follows t'•''"•' ' .•"••' '.'Paranoid Schizophrenia: '"""/ "'} •...-.. ^H Cases'' ' .J8,75f %/-• • ••!,:::.. •*•"; ...:..•...•. •'••'••" •.•:.: .:;.;. *.. "•' : ?;;., ;,.;;- ,.; .#.&*&•**.* ;•;.;•;'» •v- •.•••'• :•> .•" i:'- , Manic Depressive1 Re^ctib.)^ .,..<;. •:r . Ml-'-;' """';:.'.;;r.6,8jt;;-: -.-.i'^ /";V i>:..'' '••' ;'!' Pporly •Organized -Asbciaii. Psy.ciion.y^l^;-••'"'- •''•''' ' L'.'. •• .V;..;^"^"" ..•*".• pathlc Personality 11 "••• 6,856 .•\'.: Poorly Organized Psychoneuro.tio f '•'' 'j "":. fr t.•.'j-v' v_.. . PayohopatMo PersbnaU^r:;;^',v. ;vr:15; '?" ;; V /-9;3Jt:V- ,-,;•:* •:." '^;- '....'. .-; ,':'I .••'" .'Vr-----.'i .vl:'.'-'-*' :\-""•••• •••:.-.'•''•••"• -v: 'r; . Epilepsy and .Epileptbid Reaction^r.•.v-.?'*••."•"•' ' 4«3^...;.;:.:': -. '•' ,'.. 'Damage —•:•'' '••''• '"'' ".:, ". ..r:<. ../-S• • •• *-;: •;• •'•.. *:jfi( ,'.;. . .:•'•.-•••'. The remaining 59.6/6 (92 cases) fell into /the group'generally .classified under the less exact;" term "character disorder" (meaning people with distorted-" personalities rather than more obvious psychiatric: symptoms). These patients 'i. were•descriptively.classified Into five grpups. The first group qonsisted of ' rigidly organized ^obsessive compulsive" personalities (males,' 22 cases, 13.6/6 , of total groups studied).' These were relatively-successful men i.n the middle • • life period til -60) in whom:the problems of .their age group had,..upset .their" ; • pre-existing rijgid, neurotic life adjustinent» v ;;••..•• \^.ryf«v.••- '••'••' i:- \. The second group was composed of rigidly organized neurotic personalities with paranoid features (females, 17 cases, 1056). These women had.strongly 1 masculine personality strivings which they were unable to satisfy adequately,•'.-••! which resulted in marked resentmentiv/ They were controlling and domineering '••'* .'; women^ given;to suspiciousness'and the mislntrepretation of things happening •' •1 about them.''-' '..'.. . .; :;• i:'! " -'•'• '\'.. .-.,• .••: ••••'••' •''r"*." ••.:••.•; •':'. The third group of poorly organized, inadequate psychbheurptic personali- ties (males, 30' cases, 18.6/0 resembled most closely the frequently described "typical alcoholic". They were passive, dependent, and neurotic, and had vague life goals and poor life achievements despite high intelligence. .. The fourth group consisted' 6f dependent psychoneurotic personalities -.: with depression and tension (females, 12 cases, 7.450* These passive women. '• ! were quite immature and had reacted with depression, tension, and alcoholism when their marked need to be dependent was not satisfied.

The fifth group (5 males, 6 females; .11 cases, 6.8$) consisted of indi- viduals who had developed depressions of.milder lintensity than those usually given formal psychiatric diagnoses and had concurrently• begun to drink ex- cessively, becoming chronic alcoholics. These illnesses'occurred in the said- die or later life periods in reaction to threats to their security. Dr. Sherfey felt strongly that alcoholism was a symptom rather than a single disease, and that it occurred in a variety of psychiatric conditions and personality disorders. She felt that all the patients in her series. showed personality defects prior to the onset of their chronics alcoholism which were causally related to the'development of their alcoholism. There was a high incidence of alcoholism in the families of her patients, this occurring in 6B% of the women and 44.9/6 of the men. In almost all these cases the alcoholism of a family member occurred during the patient's childhood, thereby producing a strong psychological influence in addition to the possible con- stitutional influence. Dr. Manfred Bleuler of the University of Zurich and the Burghb'lzli Psychiatric Clinic, after working in cooperation with Dr. Diethelm for a year at the Payne-Whitney Clinic, reported in this volume on his endocrinol- ogic evaluation of fifty American alcoholics treated at Payne-Whitney Clinic. Of these, fourteen showed mild but distinc't endocrine derangements, while four others showed questionable ones. Some<causal relationship between the endocrine problem.and the alcoholism seemed probable in twelve of these eight- een patients and a questionable relationship existed in three others, while in the remaining three patients the two conditions appeared definitely unre- lated. The endocrine abnormalities found? however, included such diverse con- ditions as questionable hyperthyroidism, hypothyroidism, sexual underdevelop- ment, early menopause, diabetesmellitus, and physical characteristics of the opposite sex. No one condition appeared with any significant frequency, and Dr. Bleuler did not feel able to state definitely that these endocrinologic disturbances were either a cause of the alcoholism or a secondary result of either an accompanying morbid psychological condition or of the alcoholism itself. .. .•. » In his study of familial incidence of various diseases among these fifty American chronic alcoholics, Dr. Bleuler failed to find any evidence that alcoholism in the first generation' led to either epilepsy or feeble-mindedness in the second generation. There was no increase in the frequency of occur- rence of schizophrenia in the relatives of these chronic alcoholics, while the frequency of alcoholism among the relatives of this group was much higher than that found in the general population. In general, he felt that the long-standing scientific hope that the effects of constitution could be separated from those of the environment in the causation of chronic alcoholism was doomed to failure because of the striking interweavings of these factors found in both his Swiss and American patients.