What You Can Change _. And What You Can't - Martin E. Seligman [161]
6. All major studies of the natural history of alcoholism are about men. There is not a single one about women. While considerably fewer women are alcoholic, given the large absolute numbers of female alcoholics, there is a serious need for knowledge about the course of recovery among women.
7. See Vaillant, The Natural History of Alcoholism, 74–90; W. Beardslee, L. Son, and G. Vaillant, “Exposure to Parental Alcoholism During Childhood and Outcome in Adulthood: A Prospective Longitudinal Study,” British Journal of Psychiatry 149 (1986): 584–91; and R. Drake and G. Vaillant, “Predicting Alcoholism and Personality Disorder in a 33-Year Longitudinal Study of the Children of Alcoholics,” British Journal of Addiction 83 (1988): 799–807.
8. The quote comes from M. Tyndel, “Psychiatric Study of One Thousand Alcoholic Patients,” Canadian Psychiatric Association Journal 19 (1974): 21–24. See also C. Vaillant, E. Milofsky, R. Richards, and G. Vaillant, “A Social Casework Contribution to Understanding Alcoholism,” Health and Social Work 12 (1987): 169–76.
9. Someday the notion of “physical addiction” may come to have a specific physical, rather than just a behavioral, meaning. There is evidence that the brain may lose plasticity—the ability to make choices—as alcoholism gets worse. There is also evidence that when brain cells live in alcohol for a time, they change: They acclimate to an alcoholic medium and function better with alcohol than without it. See A. Urrutia and D. Gruol, “Acute Alcohol Alters the Excitability of Cerebellar Purkinje Neurons and Hippocampal Neurons in Culture,” Brain Research 569 (1992): 26–37; D. Gruol, “Chronic Exposure to Alcohol During Development Alters the Membrane Properties of Cerebellar Purkinje Neurons in Culture,” Brain Research 558 (1991): 1–12. Repeated doses of alcohol might even produce brain-cell “kindling” of the sort that Robert Post has hypothesized for cocaine, for stress, and for depression. See R. Post, “Transduction of Psychosocial Stress into the Neurobiology of Recurrent Affective Disorder,” American Journal of Psychiatry 149 (1992): 999–1010. But at present, the “physical” part of addiction is mostly hypothetical.
10. A. Pokorny, T. Kanas, and J. Overall, “Order of Appearance of Alcoholic Symptoms,” Alcoholism: Clinical and Experimental Research 5 (1981): 216–20, lay out the steps of the progression, based on retrospective data.
11. This latest data and theory are contained in a personal communication from George Vaillant, July 1992.
12. See Vaillant, The Natural History of Alcoholism, 170–71, for a lucid discussion of the who and why of relapse.
13. F. Baekland, L. Lundwall, and B. Kissim, “Methods for the Treatment of Chronic Alcoholism: A Critical Approach,” in R. Gibbons, Y. Israel, H. Kalant, et al., eds., Research Advances in Alcohol and Drug Problems, vol. 2 (New York: Wiley, 1975), 247–327; D. Armor, J. Polich, J. Michael, and H. Stanbul, Alcoholism and Treatment (Santa Monica, Calif.: The Rand Corporation, 1976); R. Rychtarik, D. Foy, W. Scott, et al., “Five to Six Year Follow-up of Broad Spectrum Behavioral Treatment for Alcoholism: Effects of Controlled Drinking Skills,” Journal of Consulting and Clinical Psychology 55 (1987): 106–8.
14. George Vaillant, personal communication, July 1992.
15. G. Vaillant, “What Can Long-term Follow-up Teach Us About Relapse and Prevention of Relapse in Addiction?” British Journal of Addiction 83 (1988): 1147–57. G. Edwards, “As the Years Go Rolling By: Drinking Problems in the Time Dimension,” British Journal of Psychiatry 154 (1989): 18–26, found that out of the ex-patients followed for a decade, 18 died (250 percent above expectation), 33 had good outcomes, 11 were equivocal, and 56 had bad outcomes.
16. The single best study I can find of elaborate