Finding paradigms for the future of alcoholism research: an interdisciplinary perspective

This is a review article and critique of current research strategies in the alcohol field. Although the alcohol field is proud of its multidisciplinary tradition and scientific findings within specific disciplines, there are very few models of cross-disciplinary research and communication. Currently, the favored model of risk is genetic; the favored model of pathophysiology is molecular neuroscience; and the favored model of clinical investigation is narrowly categorical. If there is a hierarchy within science that is based on explanatory power, then models of alcoholism emerging from neuroscience, molecular biology, and genetics should be able to accommodate (if not account for) the findings on clinical aspects of alcohol dependence, as well as data on differential risk, course, and recovery that come from the behavioral and social sciences. The first section of this article reviews the most popular models of alcohol dependence over the past 40 years. I argue that the currently fashionable categorical approach to diagnosis in DSM-IV (and ICD-10) has failed to serve as a framework for interdisciplinary research and has failed to meet the needs of human geneticists, population-based researchers, psychosocial researchers, basic scientists working in animal models, and patient-oriented researchers. I argue for a return to the dimensional approach to diagnosis in the alcohol dependence syndrome construct. In the second section of the article, I lay out an agenda for revitalized patient-oriented research in the alcohol field, as a bridge between basic biological research and innovations in clinical practice, as well as the key to a valid diagnostic system that can inform research strategies in genetics and population-based research. In the third section of the article, I highlight the interface between genetic and psychosocial models of risk and propose a possible structure for future collaboration. I conclude with a plea to funding agencies and investigators to translate discipline-based scientific findings into a science relevant to alcoholism by addressing the challenges and opportunities of an interdisciplinary research agenda on the pathophysiology of alcohol dependence and the multidimensional sources of risk.