Neuropsychological consequences of posttreatment drinking behavior in male alcoholics

Reply to Lilienfeld: why alcoholism is a disease

Lilienfeld's attack on my conceptual examination of the disease concept of alcoholism suffers from erroneous interpretations, fallacious reasoning, and a lack of familiarity with relevant alcoholism research. He offers an alternative nominalist interpretation of the disease concept of alcoholism based on a fuzzy boundary between disease and wellness. He fails to recognize that the basic issue between nominalist and realist accounts of a lower-order concept such as alcoholism is the presence or absence of general principles that may account for the observed signs and symptoms characterizing a specific disease entity, not fuzzy boundaries between higher-order categories. Extensive evidence (which Lilienfeld ignores) of biological bases for the pathognomic signs and symptoms of alcoholism, particularly loss of control, demonstrates that the disease concept of alcoholism refers to a disease entity that has a biological basis. It is not a "mental construct."

Why alcoholism is a disease

Arguments of proponents and critics of a disease concept of alcoholism are reviewed. It is concluded that the disease concept of alcoholism is in accord with modern usage of the concept of disease in the philosophy of science and the practice of biomedical science. Ascription of the term "disease" involves a value judgment by experts that observed lawfully recurring signs and symptoms are a significant deviation from a norm or standard of health. Value judgments of this and other kinds are inherent in biobehavioral science and its application. Criticisms of the traditional conception of the disease concept fail to distinguish empirical questions of etiology, treatment, and the characteristic features of alcoholism from the conventional and evaluative nature of the classification "disease." A critical review of the empirical research purporting to question the signs and symptoms of loss of control in alcoholics is also provided.

Treatment of chronic organic mental disorders associated with alcoholism

Considering the magnitude of the problem, the treatment of alcoholism-associated chronic organic mental disorders has not been extensively studied. Alcoholic organic brain disease is heuristically viewed as the admixture of clinical syndromes of impairment [alcoholic amnestic disorder or Korsakoff's psychosis (KP) and dementia associated with alcoholism (DAA)], each with its distinguishing cognitive, neuropathological, and neurochemical characteristics. Differences between KP and DAA are highlighted by studies that compare KP patients with those having Alzheimer's disease or depression. Furthermore, treatment of cognitive deficits in KP and DAA may be modeled after strategies that have proved effective for these other neuropsychiatric disorders. Although abstinence and proper nutrition remain the cornerstones of treatment, pharmacological modification of neurotransmitter function and/or enhancement of cerebral metabolism combined with behavioral methods may also be beneficial. Serotonergic approaches to improve memory in detoxified alcoholics may also reduce alcohol intake, and this has implication for treatment of less impaired alcoholics.

Alterations and recovery of dendritic spine density in rat hippocampus following long-term ethanol ingestion

Neuronal loss and dendritic pathology are often observed in humans and animals after long-term ethanol ingestion. It is not known, however, if surviving but damaged neurons can recover normal structure during ethanol abstinence. We quantified dendritic spine density in two neuronal populations in rat hippocampus to investigate whether reversibility from the cellular neurotoxic sequelae of chronic ethanol exposure was possible. Male Long-Evans rats were maintained for 20 weeks on an ethanol-containing liquid diet. Controls were pair-fed a liquid diet with sucrose substituted isocalorically for ethanol. One-half of each group was sacrificed at the end of the 20-week treatment and one-half was given a 20-week ethanol-free recovery period period to sacrifice. Analysis of rapid Golgi material revealed a decreased spine density in CA1 pyramidal cells that increased to control level during abstinence, and an increased spine density in dentate gyrus granule cells that was reduced toward control level during abstinence. Thus, despite the fact that chronic ethanol exposure produced differential initial effects, the return toward normal spine density in each region is consistent with the concept of neuronal recovery and reorganization during abstinence from ethanol.

Time course and reversibility of ethanol's suppressive effects on axon sprouting in the dentate gyrus of the adult rat

Ethanol was administered chronically to adult rats in a liquid diet for 14 days preceding and for 5, 7, 8, 9, or 10 days following the unilateral destruction of the entorhinal cortex. Control groups received a diet of lab chow and water and were sacrificed at comparable survival times. An additional experimental group was given ethanol until 9 days after the lesion, then switched to lab chow and water and sacrificed 1 day later. Coronal sections through the dorsal hippocampal formation were stained and analyzed histochemically for the localization of acetylcholinesterase (AChE). Quantitative measurements of the histochemical patterns in the molecular layer of the dentate gyrus were obtained. Ethanol exposure inhibited the withdrawal of the acetylcholinesterase-stained septohippocampal fibers and limited the typical lesion-induced expansion of the pale-staining commissural/associational zone in the molecular layer of the denervated dentate gyrus. However, abstinence from ethanol for just 24 h released the inhibitory effect on the acetylcholinesterase-staining fibers, resulting in a significant expansion of the commissural/associational zone.

A study of sex differences in cognitive impairment in alcoholics using traditional and computer-based tests

Female alcoholics were found to report a similar pattern of cognitive impairment to male alcoholics immediately prior to discharge from an inpatient unit. Yet females reported a shorter history of heavy drinking and lower habitual levels of consumption. Clinical implications are discussed.

Alcoholic organic brain disease: nosology and pathophysiologic mechanisms

Study of alcoholic chronic organic brain syndrome may have applicability to the large population of alcoholics with less severe cerebral dysfunction. Brain impairment in alcoholics may be conceptualized as two clinically and neuropathologically distinguishable organic brain syndromes: alcohol amnestic disorder or Korsakoff's psychosis (KP) and alcoholic dementia. Alcoholic organic brain disease may result from two interacting pathophysiological processes: nutritional (thiamine) deficiency and ethanol neurotoxicity. Subcortical periventricular lesions associated with KP result primarily from thiamine deficiency, whereas ethanol neurotoxicity and various secondary effects of alcoholism may contribute to the cortical neuropathological changes associated with alcoholic dementia. These two patterns of brain damage may be differentiable in individual alcoholics using cognitive tests and other measures of CNS function and, therefore, allow selection of a treatment strategy based on pathophysiological considerations. Studies in animals and humans suggest that a genetic predisposition to thiamine deficiency may contribute to alcoholism-associated dysfunction of brain and other organ systems and possibly have a causative role in the development of alcoholism.

Lack of recovery in male alcoholics' neuropsychological performance one year after treatment

Thirty-seven middle-aged alcoholics and 20 nonalcoholic controls equated for age and education were examined on measures of verbal, learning/memory, abstracting/problem-solving, and perceptual-motor abilities 7 weeks after beginning detoxification and 13 months later. At 7 weeks, the alcoholics were significantly different from the controls on the verbal, abstracting/problem-solving, and perceptual-motor clusters and tended to differ on the learning/memory tests. At 13 months, the same pattern of differences was found except the groups no longer differed on the verbal tests. Alcoholics who resumed drinking during the 13 months differed from the controls to a greater extent than did abstainers on both the initial and final testings. These results have implications for treatment programs and recidivism.

Cognitive impairment and other psychological scores derived from the content analysis of speech in detoxified male chronic alcoholics

Sober chronic alcoholic males, sober nonalcoholic males, and intoxicated nonalcoholic males were assessed along several psychological dimensions by means of the content analysis of speech. Average cognitive impairment scores were significantly greater among intoxicated nonalcoholics than sober chronic alcoholics and significantly greater in sober chronic alcoholics than in sober nonalcoholics. Sober chronic alcoholics, also, had a significantly higher score than sober nonalcoholics on depression, social alienation-personal disorganization (schizoid traits), separation, guilt, and diffuse anxiety, and hostility inward. The general mental health, including cognitive function, of sober chronic alcoholics is clearly impaired when compared to sober nonalcoholic individuals.