Progrès récents dans l'étude de l'alcoolisme

Abstract

The phenomenon of denial of alcohol dependence prevails not only in a majority of alcoholics, but also in the diagnostic and therapeutic behavior of many physicians.

The reasons for this neglect of alcohol abuse are reviewed. In particular, value judgments rather than scientific data seem to lead a number of physicians to share the recent views of the U.S. Supreme Court on primary alcoholism: a “willful misconduct” rather than an illness. This dichotomy between primary and secondary alcoholism, simplistic in itself, is part of current attempts to describe a spectrum of alcoholic disorders, some more social, some more biological. The biological underpinnings of abnormal drinking behaviour include various abnormalities of cerebral neurotransmitters: dopaminergic, serotonergic, GABA and endogenous opiate systems among others. These abnormalities are partly genetically determined, pre-existing to alcohol abuse and explaining why “alcoholism runs in families”, and partly secondary to alcohol abuse. Their understanding may open the road to the use of specific pharmacological adjuvants in alcoholism treatment, in conjunction with psychotherapy, rehabilitation and self-help programs.