Primary and secondary prevention of alcoholism: emerging trends and research strategy

1. The theoretical and empirical value of a "level conceptualization in prevention" as proposed by the classical 'public health' model is challenged. 2. Although prevention should be related only to reduction of incidence of the disease (new cases), for various reasons the authors also include secondary prevention in the prevention of alcoholism. 3. Two main strategies are proposed in the prevention of alcoholism: (a) the global prevention directed to the population at large, and (b) the oriented or selective prevention directed to specific target groups (high risk groups). 4. In primary prevention a theoretical model, based on system theory "the ecogenetic wheel model" is proposed which tries to integrate the multidimensional (dependent variables), multifactorial and family approaches (independent variables) involved in alcoholic-related problems. 5. The biological predictors (chromosomal and biochemical markers) and psychological predictors to be used in the early detection of alcoholism are discussed. 6. Two theories are suggested for detection of biochemical markers: direct detection in naive subjects and indirect detection (activating theory) in subjects exposed to ethanol. 7. Secondary prevention could presently benefit from a "constellation" of clearly identified biological markers which would allow for the early detection of initial alcoholics. Screening programs could be implemented for selected target groups such as (a) occupational alcoholism programs, (b) programs for alcoholics' families, (c) programs for specific hospitalized patients and (d) alcohol programs related to traffic accidents.