Benjamin Kissin

Social and psychological factors in the treatment of chronic alcoholism

Abstract In order to study the effects of pre-treatment patient characteristics on the response to different treatment programs, 458 chronic alcoholics were randomly assigned to four groups involving (1) drug therapy, (2) psychotherapy plus adjunctive drug therapy, (3) in-patient rehabilitation ward therapy, and (4) control. An attempt was made to find patterns of social and psychological factors which differentially predict acceptance vs. rejection of different forms of treatment, as well as variables which differentially affect outcome once a treatment program is accepted by the patient. Prior to starting treatment, all patients received a social history interview and were given a battery of psychological tests and the Wecheler Adult Intelligence Scale.One year after intake patients were evaluated on the degree of abstinence and the quality of their social and vocational adjustment over the preceding 6 month period. Several patterns emerged which appear to affect treatment acceptance and outcome. In general, the more socially and psychologically intact alcoholics were more likely to accept psychotherapy, while the less socially and psychologically intact patients tended to accept treatment on the inpatient rehabilitation ward. These factors were not related to acceptance or rejection of outpatient drug therapy. In terms of treatment outcome, socially and psychologically stable patients do best in psychotherapy; the socially intact but psychologically less sophisticated patient does better under drug therapy; and, the socially unstable but intellectually intact patient does best on an impatient rehabilitation program. These data indicate that different types of alcoholics do better under different programs, and that the overall success rate in the treatment of alcoholics could be improved by offering a variety of treatment programs and allowing the patient some choice in the treatment he receives.

The N2 component of the event-related brain potential in abstinent alcoholics☆

The latencies of the N2 component of the ERP and reaction time were manipulated in abstinent alcoholics and controls. The experimental design consisted of visual stimuli that differed in difficulty of discrimination. N2 latencies were found to be significantly delayed in alcoholics compared to controls, particularly for the easy discrimination. While controls manifested significantly earlier N2 latencies for the easy discrimination compared to the difficult discrimination, alcoholics did not manifest any significant difference in the latency of N2 as a function of the level of difficulty. There were no significant differences between groups in terms of RT or number of errors. In addition, alcoholics displayed significantly reduced P3 amplitudes to target stimuli compared to controls. These results suggest that match/mismatch processes are impaired in alcoholics and that they have difficulty evaluating the potential significance of a stimulus.

A case-control investigation of alcohol, tobacco, and diet in head and neck cancer.

Abstract The importance of both smoking and drinking as risk factors in head and neck cancer was confirmed in a case-control investigation of 150 patients with cancer of the head and neck and 319 with other cancers diagnosed during the prior 2-yr period at five selected hospitals in New York City. Nonsmoking drinkers were at only slightly higher risk to head and neck cancer, whereas nondrinking smokers had 2 to 4 times the risk of abstainers of alcohol and tobacco. The risk for a heavy drinker who smoked was from 6 to 15 times greater than for the nondrinker and nonsmoker. Smoking and drinking appear to be less important risk factors in head and neck cancer that occurred in individuals age 65 and over. The average age of nonsmokers and nondrinkers with head and neck cancer was about 15 yr older than for nonabstaining head and neck cancer patients or for patients with nonsmoking-related cancer sites. A significantly greater proportion of head and neck cancer patients reported use of multiple alcoholic beverages than “other” cancer patients during the 5-yr period prior to diagnosis. Comparison of reported dietary intake between head and neck cancer and the control patients revealed little difference. Almost one-half of the total group of cancer patients were apparently unaware of their diagnosis or its implications.

Auditory evoked response comparison during counting clicks and reading

Abstract The shift from a casual task directed away from auditory stimuli to a task requiring a low order of effort directed to the auditory stimuli produced significant changes in the 4 major amplitudes and the total duration of the auditory evoked response.

Social aspects of alcoholism

of Volume 4.- 1 Alcohol Use in Tribal Societies.- 2 Anthropological Perspectives on the Social Biology of Alcohol: An Introduction to the Literature.- 3 Drinking Behavior and Drinking Problems in the United States.- 4 Alcoholism in Women.- 5 Youthful Alcohol Use, Abuse, and Alcoholism.- 6 Family Structure and Behavior in Alcoholism: A Review of the Literature.- 7 The Alcoholic Personality.- 8 Alcoholism and Mortality.- 9 Alcohol and Unintentional Injury.- 10 Alcohol and Crimes of Violence.- 11 Alcohol Abuse and Work Organizations.- 12 Education and the Prevention of Alcoholism.- 13 The Effects of Legal Restraint on Drinking.

Interactions of Ethyl Alcohol and Other Drugs

Ethyl alcohol is a potent pharmacologic agent with a wide variety of biochemical and neurophysiological effects, most marked in the central nervous system but by no means restricted to it. The mechanisms of these pharmacological actions are not only poorly understood but are assumed to involve a wide spectrum of enzyme effects in addition to physiochemical effects on other parameters of drug activity such as membrane permeability, electrolyte activities, and so on. Consequently, it is not surprising that ethyl alcohol should both affect the action of other drugs and be affected by them. These interactions run the gamut from antagonistic effects with mutual neutralization to simple addition of similar effects to actual potentiating interactions where the total effect of the two drugs is greater than the sum of the effects of the two drugs alone. The mechanisms of these interactions are even less well understood than those for the individual drugs. The purpose of the chapter is to review those studies dealing with the empirical data describing the pharmacologic and behavorial effects of alcohol and drug combinations and also those studies which may illuminate the mechanisms of those interactions.

CORRELATES OF OUTCOME IN DISULFIRAM TREATMENT OF ALCOHOLISM

Three groups of outpatient alcoholics treated with disulfiram (group 1: high abstinence clinic attenders; group 2: low abstinence clinic attenders; group 3: clinic dropouts) were matched to control nondisulfiram patients with respect to variables thought to influence outcome in all kinds of alcoholism treatment. Only group 1 patients did better while on disulfiram than controls. Compared with group 2 and 3 patients, they were older, had a relatively long history of heavy drinking, were less likely to be depressed, and were more likely to have had delirium tremens (DTs) and Alcoholics Anonymous (AA) contact, to be abstinent on admission, and to rate high on motivation

Effects of ethanol on evoked potentials in the rat

Visual-evoked potentials were recorded from the visual cortex and reticular formation of chronically implanted rats. Recordings were obtained at fixed time intervals after an intraperitoneal injection of saline, 0.5, and 1.5 g/kg of ethyl alcohol. A significant depression in the evoked potentials was obtained with the high dose of alcohol, and was found to be even more striking at the visual cortex than at the reticular formation. However, no significant effect was observed with the low dosage of alcohol at either site.

Field dependence as a predictor of alcoholic therapy dropouts.

The present study was designed to investigate relationships between perceptual field dependence and selection criteria and dropout rates for alcoholic outpatients assigned to psychotherapy and drug therapy programs. Nineteen selectees for individual “insight” psychotherapy were compared with 19 nonselectees and with 18 drug therapy patients. On the basis of prior studies of field dependence it was hypothesized that alcoholics selected, by traditional clinical criteria, for insight psychotherapy would be significantly more field-independent than nonselectees. This hypothesis was supported by the results. It was further hypothesized that field dependence would be related to dropout status of alcoholic patients. Relatively field-dependent patients were expected to be early dropouts from psychotherapy, and relatively field-independent patients were expected to be early dropouts from drug therapy. The present results suggest that early dropouts from psychotherapy are significantly more field-dependent than remainers. However, no differences in field dependence were obtained between dropouts and remainers in drug therapy.

Evoked Potential Correlates of Expected Stimulus Intensity

The electrophysiological responses to a flash of medium intensity have different wave shapes in trials in which the occurrence of bright stimuli or dim stimuli is expected. When a bright or dim stimulus is signaled, the potentials evoked by the medium stimulus resemble the responses evoked by a real bright or dim flash.