Why alcoholism is a disease

Genetic markers of alcohol abuse

In this paper, we review the current status of genetic markers for the development of alcohol abuse. Family, twin, half-sibling and adoption studies of alcoholic subjects suggest that the heritability of liability to alcoholism is at least 50%. These findings have fuelled intensive investigation in the fields of neurology, biochemistry, genetics and molecular biology aimed at the identification of markers for the risk of alcoholism. The most promising of these are discussed in detail. Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) polymorphisms, specifically the ADH3*1, ADH2*2, and ALDH2*2 genotypes appear to confer a protective effect against alcoholism, most notably in Oriental subjects. Caucasian alcohol abusers and their first-degree relatives exhibit depressed platelet monoamine oxidase activity, the degree of which is greater in Type II than Type I alcoholics. Electrophysiological characteristics of alcoholics and those at risk for developing alcoholism have also been identified, including the reduced amplitude of the event-related brain potential and, after ethanol ingestion, characteristic EEG alpha-wave activity. Lower platelet adenylate cyclase activity is seen in alcoholics compared to controls, presumably as a result of over-expression of an inhibitory G-protein. Markers related to other signal transduction pathways of the central nervous system including the serotoninergic, muscarinic and dopaminergic systems are also discussed. In this group of markers, the putative association between the inheritance of the AI allele of the D2 dopamine receptor and the susceptibility to alcoholism provides the most dramatic illustration of the challenges presently existing in this field of scientific investigation. Current limitations in the definition, diagnosis and classification of alcoholism, the confounding influences of race and gender on association studies, as well as the statistical approach of linkage studies are discussed as they relate to the endeavor to uncover valid genetic markers for the risk of alcoholism.

The social body and the biomechanical body: can they coexist in nurse education?

The curricula of tertiary nursing courses usually involve a number of complementary strands. These include biological sciences, social sciences, behavioural sciences, other support subjects and clinical units. These different strands each, to some extent, present the nursing student with a dilemma as they may present entirely different models of the body. Explorations of this dilemma show that students are also being presented with different models of illness and different conceptions of appropriate health care response to illness. The question is then raised as to which of these approaches most accurately reflects the realities of nursing practice.

Benno Pollak Lecture 1992. Alcohol dependence--an illness with a treatment?

Unlike some countries, Britain may have experienced a rise rather than a fall in alcohol-related illness during a decade when consumption has not risen. Objections to the "illness concept" may impede our vision and the range of services we develop. It is possible to agree with objectors to the illness concept that a unidimensional view is unhelpful; that explanations are often only attributions; that the construct "illness" is not needed for help to be offered, its use could undermine self-mastery, and its misuse can breach civil rights. Learning can explain much over-drinking. However, the concept need not imply bimodality of drinkers; the syndrome of alcohol dependence has uses and does not imply a cause; physical and mental explanations are not incompatible; genetic and biochemical research has promise. Developments in treatment are still limited, but the mysteries of the free-will dilemma should not prevent us seeing physiological, psychological and social contributants as partners rather than rivals.