Meyer R E, Kranzler H R
Department of Psychiatry, University of Connecticut Health Center, School of Medicine, Farmington 06032.
J Clin Psychiatry. 1988 Sep;49 Suppl:8-12.
The alcoholism field has traditionally been marked by strong divisions between research and clinical practice. The most common modes of clinical practice, rooted in a strong self-help tradition, have not seemed to gain much from biological or behavioral research. Indeed, the most famous (and controversial) behavioral research study of the 1970s appeared to undermine the efforts of clinicians to encourage abstinence as the only reasonable treatment goal for alcoholics. Another study conducted in England in the 1970s appeared to show that simple one-time advice worked as well as more intensive, traditional treatment interventions in persuading alcoholic individuals to modify their behavior. In the 1980s, studies on DSM-III-defined co-morbid psychopathology have served to redefine the heterogeneity of alcoholic patients in treatment, while describing the impact of co-morbidity on clinical course and treatment response. Measures of severity of alcohol dependence in clinical populations led directly to the development of the DSM-III-R criteria for this disorder. Indeed, these measures of severity may have predictive validity relative to treatment response. Finally, newer pharmacological strategies have been suggested, based upon animal and preliminary human studies, which may reduce risk of relapse in some patients. Reviews of the current state of clinically significant research in the alcohol field, with implications for clinicians and clinical investigators are presented.
传统上，酒精中毒领域的研究与临床实践之间存在严重分歧。最常见的临床实践模式植根于强大的自助传统，似乎并未从生物学或行为学研究中获得太多收益。事实上，20世纪70年代最著名（且有争议）的行为学研究似乎削弱了临床医生将戒酒作为酗酒者唯一合理治疗目标的努力。20世纪70年代在英国进行的另一项研究似乎表明，简单的一次性建议在说服酗酒者改变行为方面与更密集、传统的治疗干预效果相同。20世纪80年代，关于《精神疾病诊断与统计手册》第三版（DSM-III）定义的共病精神病理学研究重新定义了接受治疗的酗酒患者的异质性，同时描述了共病对临床病程和治疗反应的影响。临床人群中酒精依赖严重程度的测量直接促成了DSM-III-R中该疾病标准的制定。事实上，这些严重程度测量对于治疗反应可能具有预测效度。最后，基于动物研究和初步人体研究，提出了新的药理学策略，这可能会降低一些患者的复发风险。本文介绍了酒精领域具有临床意义的研究现状，并探讨了其对临床医生和临床研究人员的启示。
