Alcoholism: clinical implications of recent research

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.