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Book Forum: Substance Abuse   |    
Recent Developments in Alcoholism, vol. 14: The Consequences of Alcoholism: Medical, Neuropsychiatric, Economic, Cross-Cultural
Am J Psychiatry 2000;157:653-a-654. doi:10.1176/appi.ajp.157.4.653-a
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Detroit, Mich.

By Marc Galanter. New York, Plenum, 1998, 499 pp., $95.00.

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Alcoholism, to a degree, has been out of our society’s focus of attention lately, probably due to the legal status and relatively easy availability of alcohol and society’s preoccupation with other drugs of abuse. Yet, alcohol abuse remains a serious medical, economic, and societal problem. According to the book under review, the economic cost to society from alcohol abuse and alcoholism in the United States was an estimated $148 billion in 1992. Nevertheless, our knowledge of the most recent developments in this area has been mostly superficial.

A great deal of research on alcoholism and its consequences has been done. The results have been rather scattered through the literature. Therefore, years ago, the American Society of Addiction Medicine and the Research Society on Alcoholism undertook a heroic task to organize and summarize the available information on alcoholism—they started to publish Recent Developments in Alcoholism. The previous volumes covered numerous topics, from genetics to social and environmental issues. Volume 14 focuses on four consequences of alcoholism: medical, neuropsychiatric, economic, and cross-cultural. The book has 19 chapters written by 54 authors, most of whom are well-known experts in the field.

Section 1, Medical Consequences of Alcoholism, consists of five chapters focused on topics such as metabolism of ethanol and its adverse effects on the liver and stomach; alcohol and the pancreas; alcohol and cancer; alcohol and lipids; and the cardiovascular effects of alcoholism. This section is well edited and well written. It contains a wealth of interesting information; e.g., 75% of all medical deaths attributable to alcoholism are the result of cirrhosis of the liver. The discussion of the role of alcohol abuse in various forms of cancer is detailed and revealing. The chapter on the cardiovascular effects of alcohol points out that alcohol abuse is associated with a greater risk of coronary events and stroke and that, in contrast, moderate use of alcohol is favorably related to these disorders.

Section 2, Neuropsychiatric Consequences of Alcoholism, contains five chapters dealing with topics such as the mechanism of alcohol craving; effects of moderate alcohol intake on psychiatric and sleep disorders; executive cognitive functioning in alcohol use disorders; functional consequences of ethanol in the central nervous system as reflected in brain imaging studies; and complications of severe mental illness related to alcohol and drug use disorders. This is also a very informative section with a wealth of important information. The chapters addressing the effects of moderate drinking on psychiatric disorders and the complications of severe mental disorders related to alcohol use would probably be of the greatest value for the clinically oriented reader.

Section 3, Economic Consequences of Alcoholism, summarizes in four chapters topics such as economic costs of alcohol abuse and alcoholism; the effects of the price of alcohol on the consequences of alcohol use and abuse; problem drinking and productivity; and the cost offsets of alcoholism. This section is an excellent eye-opener about the economic costs of alcoholism, priced at $148 billion in 1992. Only $18.8 billion of this represented alcohol-related health care expenditures. Premature mortality accounted for $31.3 billion, impaired productivity for $67.7 billion, and crime for $19.8 billion.

The last section, An International Perspective of the Biobehavioral Consequences of Alcoholism, consists of five chapters reviewing such topics as cocaine metabolism in humans after alcohol abuse, hazardous and harmful alcohol consumption in Mexico, and an analysis of drinking habits of French existentialists during and after World War II (interesting, but clearly an out-of-place topic). The focus of this section is not clear.

This is an interesting, fairly well edited (except for possible overlaps with previous volumes), well-written, and excellently referenced volume. It skillfully summarizes the amazing amount of information in three areas. However, the fourth section seems to be out of place, unfocused, and not very useful. The book will be of interest for anyone seriously interested in alcoholism and its consequences. It is also a good reference book. However, a busy clinician may find it quite tedious and expensive reading.




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