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Book Forum: Disorders of Appetite and Reward Systems   |    
Beyond the Influence: Understanding and Defeating Alcoholism
WILLIAM R. FLYNN, M.D.
Am J Psychiatry 2001;158:1754-a-1755. doi:10.1176/appi.ajp.158.10.1754-a
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By Katherine Ketcham and William F. Asbury, with Mel Schulstad and Arthur P. Ciaramicoli, Ed.D., Ph.D. New York, Bantam Books, 2000, 355 pp., $13.95 (paper).

The authors of this book are a professional writer of nonfiction, a journalist, an alcoholism activist, and a clinical psychologist, respectively. They wrote this book for the general public as a sequel to Under the Influence, co-authored by Ms. Ketcham and James R. Milam, Ph.D., and first published in 1981.

The authors of Beyond the Influence vigorously argue that alcoholism is a disease, not a behavior problem. They contend that theories explaining alcohol addiction as a consequence of personality flaws or stress have impeded effective prevention and treatment. They freely discuss their personal experiences or those of loved ones. Former Senator George McGovern, who lost an adult daughter to the disease, wrote the foreword. The authors also try to put to rest the notion that an alcoholic can drink at all. I thought that their discussion of the distinction among social drinking, problem drinking, and alcoholism was particularly well done.

This is not a volume for the psychiatrist’s library. We should already know what is in it. We should, however, recommend this book for reading by anyone who drinks or who will drink alcoholic beverages. It is easy to read. It is not a scientific work but one of investigative journalism, filled with vignettes, brief case histories, and quotations from wise men and women through the ages. The work of prominent psychiatric experts such as George Vaillant and Marc Schuckit is freely cited. The text is made easier to read by the fact that references are given at the end of the book and cited by chapter and page.

The authors take on the "booze merchants" and the advertising industry for encouraging everyone to enjoy alcohol even though they know very well that there are people who should never do so. Individuals who are destined to become alcoholics are physiologically different from the rest of the population. Business interests perpetuate the idea that alcohol addiction is the result of foolishness and abuse of drinking. The fact is that there are legions of people who are powerless over their alcohol use.

The book is divided into three sections: The Problem, The Solution, and The Future. The authors contend that physicians who rely strictly on DSM-IV criteria woefully underdiagnose the disease. One of the co-authors presents his drinking history to illustrate that point. The chapter on the solution, i.e., prevention and treatment, reminded me of a 1997 book by a psychiatrist, Robert L. Dupont, titled The Selfish Brain(1, 2). Dupont advocated reliance on 12-step, abstinence-based programs as the sine qua non for the solution to any addiction.

The authors are not optimistic about the future in view of the profits to be made in the sale of beer, wine, and spirits. This book is about the early education of those at risk for addiction and out-of-control drinking.

Flynn WR: book rev, RL DuPont: The Selfish Brain: Learning From Addiction. Am J Psychiatry  1998; 155:304
 
DuPont RL: The Selfish Brain: Learning From Addiction. Washington, DC, American Psychiatric Press, 1997
 
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References

Flynn WR: book rev, RL DuPont: The Selfish Brain: Learning From Addiction. Am J Psychiatry  1998; 155:304
 
DuPont RL: The Selfish Brain: Learning From Addiction. Washington, DC, American Psychiatric Press, 1997
 
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