Alcohol and Alcoholism Vol. 35, No. 2, pp. 216, 2000
© 2000 Medical Council on Alcoholism
Book Reviews
Alcohol and Alcoholism — Effects of Brain and Development.
As a psychiatrist involved in both the treatment of alcohol dependence and research into its effects on the brain I was interested to read this new volume. My initial impression was one of disappointment with the basic nature of the figures and graphs, it is not an attractive book.
The book comprises 12 chapters written by a variety of authors. The majority of these deal with preclinical research into the effects of alcohol on the fetus and factors affecting response to alcohol. This preclinical and developmental bias is partly explained by the editor's note in the introduction that the book is the product of a symposium at Binghampton University in 1996 and that it represents 20 years of work by groups associated with that institution. Thus, it is an amalgam of research interests gathered together in post-hoc fashion. Since it has such varied themes, I will endeavour to encapsulate its contents.
Chapters 1, 9, and 11 are specifically clinical in orientation. Chapter 1 is a review of the work by Mattson et al. concerning magnetic resonance imaging and cognitive function of children who experienced prenatal alcohol exposure and those who actually suffered fetal alcohol syndrome. Chapter 9 describes the interesting work undertaken by Mennella on the effects of alcohol ingestion prior to lactation. In a series of simple experiments it is shown that adults could differentiate between milk produced after an alcoholic drink as opposed to non-alcoholic one and that there was a reduction in milk consumption by babies after the nursing mother had drunk alcohol. Chapter 11 provides a readable account of the evidence available from several meta-analyses of the cost-effectiveness of alcohol-treatment strategies. The authors then choose to detail two with the highest efficacy: Motivational Enhancement Therapy and The Community Reinforcement Approach, and to contrast these with a novel programme (Community Reinforcement and Family Training) which concentrates on teaching a concerned family member ways in which to encourage an alcohol-dependent patient to seek help from professionals. The descriptions of each are brief and clear.
The preclinical topics start with a discussion of the factors which determine whether alcohol causes prenatal damage. Chapter 3 is a discussion of the effect of prenatal alcohol on neuronal activity. The authors hypothesize that alcohol's effect on the developing brain is mediated via disruption of neural plasticity. There is an account of evidence that environmental enrichment resulted in improving the poor performance and reduced neocortical thinning associated with prenatal alcohol. In vitro work studying the effect of alcohol on neurite outgrowth is discussed and the possible involvement of GAP43/B50 protein levels speculated upon. The authors further hypothesize that disruption of certain proteins causing abnormal neurite outgrowth, and in turn reduced neuronal plasticity, ultimately may be responsible for the behavioural and anatomical sequelae associated with prenatal alcohol exposure. The authors admit that they have no evidence as yet of prenatal alcohol altering in vivo GAP43/B50. Thus their attractive hypothesis is unproven.
Two later chapters explore the genetic differences and their effect on psychomotor stimulation by alcohol in mice (chapter 6) and the preference for alcohol among certain rat lines (chapter 7). Further chapters include a description of an animal model of the alcohol-deprivation effect, that is the reinstatement to previously high consumption after a period of abstinence upon re-exposure to alcohol (chapter 8) and evidence that when exposed to alcohol early in life, rats may learn a preference for alcohol (chapter 10).
Thus this book provides a series of stand-alone chapters which are, in the main, descriptions of preclinical insights into the effects of alcohol on the fetus and developing brain. As such it is a useful reference volume for clinicians in the field and will be of most interest to those directly involved in such research.
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