The National Institute of Alcohol Abuse and Alcoholism (NIAAA) this fall will open the first alcoholism treatment and research program at a major federal research facility, the Bethesda campus of the National Institutes of Health.
The opening also marks the beginning of a comprehensive, long-lasting NIAAA study of alcoholism and its ravaging effects--mental and physical--on both the alcoholic and his or her family.
Eventually, the researchers hope to have as many as 200 alcoholic patients and their families, who will be followed indefinitely.
"Alcoholism tends to occur in families," says psychiatrist and clinical pharmacologist Dr. Peter R. Martin, "but to date, the genetic mechanisms involved and the specific contributions of environmental and psychological factors remain unresolved."
"Very many people with psychiatric illnesses and psychiatric problems abuse alcohol," says Martin, who will be out-patient director and acting ward chief, "but a lot of people abuse alcohol and as a consequence develop psychiatric and medical problems.
"In places like France or Russia 50 to 60 percent of hospital admissions are alcohol-related." In this country, he says, it is probably about 20 to 40 percent.
Problems range from stomach ulcers to esophageal cancer to a gamut of ailments affecting liver, heart and lung functions and brain disease. (Alcohol-induced brain disease is second only to Alzheimer's as the most common cause of dementing illness.)
NIAAA researchers are hot on the trail of a psychobiological link to alcoholism--either as a cause, a pre-disposing genetic factor or as a possible predictor of those at risk.
Work at NIAAA and at its sister agency, the National Institute of Mental Health, has implicated a deficiency of the neurotransmitter serotonin. Research has shown that in alcoholism as well as in depressed--but nondrinking--relatives of alcoholics, there were lower than normal concentrations of a chemical that appears when serotonin is metabolized.
Serotonin, one of the chemical brain messengers affecting mood and behavior, appears to carry a message of cheer and good feeling, and also may be related to memory and learning functions.
Deficiencies have been linked to depression and violent and impulsive behavior and now, perhaps, alcoholism.
Dr. Markku Linnoila, a psychiatrist and clinical pharmacologist, will be the overall director of the new study. He was co-author of a recent report in the journal Science on work showing how a drug (zimelidine), known to enhance serotonin, could reverse the adverse effects of alcohol on memory.
"Alcohol tends to release serotonin so, initially, there may be more around," says Linnoila. "We could hypothesize that alcoholics might have a deficit in serotonin and might use alcohol as a self-medication.
"But in the long run, it depletes the stores and its use then becomes self-defeating because there isn't any more serotonin to be released, and the effect reverses itself.
"We know that as one observes alcoholics during drinking binges they become quite anxious, no longer getting any pleasure from alcohol. Now whether that is related to serotonin, we don't yet know."
"A point to make in the study of alcohol," says Martin, "is that you will never know for sure whether a trait identified in alcoholism is due to alcohol consumption or is a predisposing factor.
"The only way to get around that is to study at-risk individuals--those with family histories of alcoholism-- prior to the beginning of their interaction, and then follow them up when some of them become alcoholic."
Study participants will be recruited by Yolande B. Davenport, chief of the Family Studies Unit and a social worker experienced in family therapy.
Because "alcoholics tend to have unstable relationships and job histories," notes Linnoila, the recruiting process is expected to be a difficult task, making the family's help particularly vital.
Being sought for the program are:
* Individuals at risk--those with alcoholism in their families.
* Individuals and/or their families for whom alcohol is a distinct problem: It interferes with their lives in any sphere--psychosocial, medical, legal.
* Individuals who have used alcohol for such a long time that it has caused definite damage to a number of organ systems, including the brain.
Researchers expect that most initial alcoholic participants will be referred by health-care professionals, partly because the 10-bed in-patient unit to open in mid-September will not, at first, be used for detoxification.
All alcoholics accepted for the study will spend about six weeks as in-patients, undergoing a battery of physical, psychiatric, psychobiologic and neurologic tests. Various treatment techniques--medical, psychiatric or both--will be individually tailored and continued on an out-patient basis. Families will be studied as out-patients wherever possible, to serve as support systems and to reinforce therapies.
"It has been relatively well demonstrated that many psychotherapeutic approaches have not worked well," says Linnoila. "The traditional treatment is a short detoxification stay and then follow-up treatment for weeks or months. But we know that many alcoholics have severely impaired memory functions during that time and psychotherapy is a relearning experience.
"It seems quite logical to me that a relearning experience cannot be very effective if the person who is trying to relearn something doesn't remember very well what is going on."
Participants will be treated during relapses and immediately after they stop drinking "to help them get back into life," says Linnoila. "So that in that sense we will be serving them as totally as possible."
To receive the initial screening questionnaire for participation in the study--either as an alcoholic or relative of an alcoholic--write Laboratory of Clinical Studies, National Institute of Alcohol Abuse and Alcoholism, Building 10, 3C218. Bethesda, Md. 20205. Phone: 496-7026.