The first three volumes of this series have dealt with materials which generally justify the title, The Biology of Alcoholism. This is only remotely true of the present volume, Social Aspects of Alcoholism, or of the final volume to come, Treatment and Rehabilitation. Except for small portions of the treatment section which involve pharmacotherapy, much of these last two volumes deals with the psychological aspects of alcoholism and still more with the social. It is interesting to review the evolution of this new pattern over the past seven years, a pattern which, had it existed initially, would have resulted, if not in a dif ferent format, at least in a different title. Our initial selection of areas to be covered was influenced by our desire to present as "hard" data as possible, in an attempt to lend a greater aura of scientific rigor to a field which was generally considered as "soft. " When we completed our review of this material in volumes 1-3, we recognized that what we might have gained in rigor, we had more than lost in completeness. These volumes presented a picture of a biological disease syndrome for which the remedies and preventive measures were presumably also biological. And yet, most workers in the field readily accept the significant contributions of psychological and social factors to the pathogenesis and treatment of alcoholism.
In this volume, the third of our series, the emphasis has shifted from the theoretical and experimental to the more clinical and practical aspects of alcoholism. Where, in the earlier volumes, more attention was directed to animal than human studies, in this volume, almost all material deals with the human condition. The clinical manifestations of alcoholism may be divided into two major aspects, that of the disease itself and that of its complications. This separation is to some extent artificial since, in a sense, the natural history of the disease is a function of the development of certain complicating mechanisms. These mechanisms in turn either become part and parcel of the underlying condition -alcoholism-or give rise to a new set of clinical variables characterized as "medical complications. " At this point, the dichotomy becomes real. The disease alcoholism tends to be seen as a distinct psychosocial entity and to be treated with psychosocial techniques. The "medical complications" are more clearly envisioned as being within the legitimate domain of medical practice and are treated by physicians who often tend to ignore the underlying alcoholism. The "patient" is sometimes lost in between. The major thrust of this volume is an attempt to describe the mechanisms of alcoholism as they are now known, in such a way as to establish a continuum between the disease alcoholism and its "medical complications.
The first three volumes of this series have dealt with materials which generally justify the title, The Biology of Alcoholism. This is only remotely true of the present volume, Social Aspects of Alcoholism, or of the final volume to come, Treatment and Rehabilitation. Except for small portions of the treatment section which involve pharmacotherapy, much of these last two volumes deals with the psychological aspects of alcoholism and still more with the social. It is interesting to review the evolution of this new pattern over the past seven years, a pattern which, had it existed initially, would have resulted, if not in a dif ferent format, at least in a different title. Our initial selection of areas to be covered was influenced by our desire to present as "hard" data as possible, in an attempt to lend a greater aura of scientific rigor to a field which was generally considered as "soft. " When we completed our review of this material in volumes 1-3, we recognized that what we might have gained in rigor, we had more than lost in completeness. These volumes presented a picture of a biological disease syndrome for which the remedies and preventive measures were presumably also biological. And yet, most workers in the field readily accept the significant contributions of psychological and social factors to the pathogenesis and treatment of alcoholism.
Alcoholism is a uniquely human condition. Although some forms of alcohol dependence can be induced experimentally in a variety of laboratory animals, the complete spectrum of alcoholism with all of its physical, psychological, and social implications occurs only in man. The special quality of this relationship becomes more significant when one considers that the manifestations of most physical disease syndromes in animals and man are more similar than they are different. The uniqueness of alcoholism lies in the fact that it is one of the few physical diseases which reflects at all levels the problems of individuals coping with the complexities of human society. In order to present a more coherent picture of these complex relationships, we have attempted to impose a logical sequence upon the material. This sequence lies along a dual parameter-from the physical to the social and from the theor etical to the empirical. Consequently, it was natural for the first volume in this series to deal with biochemistry, the most basic and physical aspect of the inter action of alcohol and man. It is equally natural for this, the second volume, to deal with physiology and behavior, for these levels of phenomenology-partic ularly the latter-are already more empirical and psychological in their mani festations. Finally, the third volume, clinical pathology, describes the disease itself, with all of the medical and social implications carried in the word "alcoholism.
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