The Pharmacodynamics and Natural History of Alcoholism

  • Benjamin Kissin


Alcoholism may be defined as drug dependency upon ethanol in man and, as such, may be considered to follow Seevers’ (1968) paradigm of drug dependence with depressants (Fig. 1). Seevers postulates that the basic mechanism of compulsive abuse with alcohol, as with all drugs, is primary psychological dependence, a positive reinforcement conditioning paradigm in which the administration of alcohol is associated with a rewarding experience—usually either a euphoriant effect or the relief of discomfort—which, with each successive rewarding experience, reinforces the conditioned response, i.e., drinking. With alcohol, as with all depressant drugs, as increasing amounts are taken more frequently, the body adapts to the toxic effects of the drug and tolerance develops, both metabolic and tissue tolerance, as a result of which increasingly large doses may be ingested. As the tissues of the central nervous system remain bathed for prolonged periods of time in high concentrations of alcohol, the third significant mechanism of drug dependency develops, i.e., physical dependence, in which the central nervous system becomes physiologically dependent upon ethanol, resulting, as the concentration of alcohol in the body declines, in an acute withdrawal syndrome, marked by hyperexcitability of the CNS which, in its most severe form, manifests itself clinically as delirium tremens.


Heavy Drinking Withdrawal Syndrome Alcohol Intoxication Physical Dependence Chronic Alcoholism 
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© Plenum Press, New York 1974

Authors and Affiliations

  • Benjamin Kissin
    • 1
  1. 1.Downstate Medical CenterState University of New YorkBrooklynUSA

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