Etiology of alcoholism reconsidered. The case for a biopsychosocial process.
Etiology of alcoholism reconsidered. The case for a biopsychosocial process.
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重新考虑酗酒的病因。
DOI：
10.1037/0003-066x.41.7.783
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
Edith S. Lisansky Gomberg
中科院分区：
文献类型：
--
作者：
R. A. Zucker;Edith S. Lisansky Gomberg
在包括生理、行为和社会文化变量的纵向发展框架的背景下，最好地理解酒精中毒的病因学。最近报道的Vaillant后续研究，尽管表面上是在这样的框架内进行的，但实际上低估了人格影响的作用，并对童年的影响不屑一顾。我们回顾了这些数据，并就儿童影响、个性和文化因素在病因过程中的作用提出了一套不同的结论。一个现有的纵向文献的替代综合审查被提出，将这些发现置于生物心理社会过程的背景下。酗酒是一种极具破坏性的疾病，其影响范围远远超出了患者本身。理解其原因的问题也是一个特别有趣的问题。最近的证据表明，导致一个人开始饮酒的特征可能只与对后期饮酒和问题饮酒现象的影响有松散的联系。与开始有问题的使用模式相关的因素与有助于维持酒精使用模式或后来形成涉及酗酒或依赖的习惯性问题的那些药理学和行为特征不一定相同。鉴于这种情况，也可能需要对病因的重要性进行不同的排序，以充分描述过程中不同阶段的因果关系。因此，Korsakoff综合征是慢性酒精滥用的一种终态现象，是一种最好用神经病理学术语描述的病理；其影响的方向最好被理解为从大脑功能障碍到行为(Wilkinson&Carlen，1981)。相比之下，酒精使用的开始被最好地理解为一种由个体差异变量和社会影响预测的现象(Jessor&Jessor，1975；Marulies，Kessler，&Kandel，1977)。用于描述这些发病、维持和依赖的多种现象的理论模型和数据语言涉及在生命周期的不同时间点对生理、行为和社会环境变量的根本不同的解释水平和不同的顺序。因此，在早期，如此复杂的多学科问题为了描述其过程而产生简单化和简单化的解释也就不足为奇了。在过去的十年中，一些病因学的纵向研究已经在足够广泛的数据集和开始允许对方差分布进行分割的多变量分析策略下进行。然而，所有这些已经深入到值得发表的研究中，都是关于饮酒的早期阶段和饮酒问题的研究(Huba&Bentler，1984；Jessor&Jessor，1977；Kandel&Logan，1984)，或者讨论过一组基本上正常或最糟糕的表观障碍饮酒模式的受试者(Fillmore，1975；Fill-More，Bacon，&Hyman，1979)。没有人坦率地与酗酒的受访者打交道，也没有人足够全面地考虑到生物(包括遗传)、心理、社会和文化因素对影响的程度进行评估。因此，当一个数据集被提出时，这对该领域来说是一个重大事件，该数据集承诺解决酒精中毒如何演变的病因学问题，并具有前瞻性的方法和足够广泛的变量阵列，以便可以检查这种疾病的潜在生物心理社会性质。这就是Vaillant和Milofsky(1982)最近一份报告的重要性。自发表以来，这项研究在文献中受到了潜移默化的关注。鉴于我们对作者对他们自己的数据的解释以及他们对该地区早期纵向工作的解释存在重大分歧，我们认为对他们的发现和早期研究的另一种解释是必要的。在本文中，我们非常仔细地考察了Vaillant和Milofsky的研究细节，特别关注了个性和童年影响对酒精行为的作用，得出了一组不同的结论，并基于我们自己对未来酒精病因学文献的综合重新审视，找到了与Vaillant和Milofsky的账户有很大不同的另一种观点的重要支持。Vaillant的随访研究
The etiology of alcoholism is best understood within the context of a longitudinal-developmental framework that includes physiological behavioral and sociocultural variables. The recently reported Vaillant fol- low-up study, although ostensibly set within such a frame- work, in fact understates the role of personality influences and dismisses childhood effects out of hand. We review these data and offer a different set of conclusions about the roles of childhood influences, personality, and cultural factors in the etiologic process. An alternative integrative review of the existing longitudinal literature is presented that sets these findings in the context of a biopsychosocial process. Alcoholism is a profoundly damaging disorder whose im- pact spreads far beyond the one who suffers from it. The problem of understanding its causes is also an especially interesting one. Recent evidence suggests that the char- acteristics that lead an individual to begin drinking may only be tied loosely to influences on later stage drinking and problem drinking phenomena. The factors connected with beginning a pattern of problem use are not neces- sarily the same as those pharmacological and behavioral characteristics that contribute to the maintenance of the alcohol use pattern or to the later build-up of a habitual problem involving alcohol abuse or dependency. Given this state of affairs, it is also likely that different orderings of the importance of etiologic factors will be needed to adequately describe cause and effect at different stages in the process. Thus, Korsakoff's syndrome, one end-state phenomenon of chronic alcohol abuse, is a pathology best described in neuropathological terms; the direction of ef- fect is best understood as going from brain dysfunction to behavior (Wilkinson & Carlen, 1981). In contrast, the onset of alcohol use is best understood as a phenomenon predicted by individual difference variables and social in- fluences (Jessor & Jessor, 1975; Margulies, Kessler, & Kandel, 1977). The theoretical models and data language used to describe these multiple phenomena of onset, maintenance, and dependency involve radically different levels of explanation and different orderings of physio- logical, behavioral, and socioenvironmental variables at different points in the life cycle. It is not surprising, there- fore, that such a complex multidisciplinary problem has in earlier times generated simplistic and reductionistic explanations in an effort to describe its process. In the past decade, several etiologically focused lon- gitudinal studies have been carried out with a broad enough data set and a multivariate analytic strategy that begins to allow for the partitioning of variance contri- butions. However, all of those that have moved far enough along to warrant publication have been concerned with the early stages of drinking and problem drinking ac- quisition (Huba & Bentler, 1984; Jessor & Jessor, 1977; Kandel & Logan, 1984), or have dealt with a group of subjects who have had largely normal or at worst episod- ically disturbed drinking patterns (Fillmore, 1975; Fill- more, Bacon, & Hyman, 1979). None have dealt with frankly alcoholic respondents, and none have been suf- ficiently comprehensive to allow for the evaluation of the extent of effect contributed by biological (including ge- netic), psychological, social, and cultural factors. It is, therefore, a significant event for the field when a data set is presented that promises to address the etiological ques- tion of how alcoholism evolves, with a prospective method and a sufficiently broad array of variables such that the potential biopsychosocial nature of the disorder can be examined. This is the importance of a recent report by Vaillant and Milofsky (1982). Since its publication, this study has received sub- stantial attention in the literature. Given the significant disagreement we have with the authors' interpretation of their own data as well as their interpretation of earlier longitudinal work in the area, we felt that an alternative interpretation of their findings and of the earlier studies was in order. In the present article, we examine very closely the details of Vaillant and Milofsky's study with particular attention to the role of personality and of childhood influences on alcoholic behavior, reach a dif- ferent set of conclusions, and find significant support for an alternative position based on our own integrative re- view of the prospective literature on alcoholic etiology that substantially differs from Vaillant and Milofsky's ac- count. Vaillant's Follow-up Study
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影响因子：
--
作者：
Bohman,M;Sigvardsson,S;Cloninger,CR
通讯作者：
Cloninger,CR
DOI：
10.15288/jsa.1982.43.888
发表时间：
1982
期刊：
Journal of studies on alcohol
影响因子：
--
作者：
Moos,RH;Finney,JW;Gamble,W
通讯作者：
Gamble,W
酗酒者的青春期儿子：神经心理学和人格特征。
DOI：
10.1111/j.1530-0277.1984.tb05842.x
发表时间：
1984
期刊：
Alcoholism, clinical and experimental research
影响因子：
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作者：
Tarter,RE;Hegedus,AM;Goldstein,G;Shelly,C;Alterman,AI
通讯作者：
Alterman,AI
影响因子：
--
作者：
Cloninger,CR;Bohman,M;Sigvardsson,S
通讯作者：
Sigvardsson,S