Dr. Saar Roelofs

ALCOHOLISM, WITHDRAWAL, ANXIETY
&
TREATMENT
Summary thesis (1990)

In Dutch with exception of two chapters in English
(the articles in scientifc American journals below).

Stylized image of nerve cells on cover thesis (Saar Roelofs)

There is a big gap between the scientific research on alcoholism and the

clinical practice. In this thesis it is endeavoured bridge this gap.

In the past decadæ much research is carried out on the biomedical

aspects of alcoholism, especially on the alterations which are the result

of long-term alcohol use. There is increasing evidence that after the

sudden withdrawal of alc6hol, those alterations may exist for a long time

and may even be permanent. Consistent with these findings, in this thesis
alcohol isn is defined iri biological terms.

In Chapter I the alcohol withdrawal syndrome (AWS) is discussed. After a
description of the clinical manifestations, the neurophysiological, psychological

and psychophysiological explanations with regard to the genesis of AWS are

presented. In this chapter, among other things, some recent developments

in neurotransmitter research are discussed. Moreover, the phenomena

cross tolerance and cross dependence between alcohol on the one hand and

benzodiazepines, barbiturates and opiates on the other are highlighted.

Clinical neurochemical, (electro)physiological and psychological research

shows that symptoms which appear during the acute phase of AWS may
exist for a long time - even for years - as milder subacute syndrome or as

a so-called addiction memory. The severity of this subacute AWS increases

with the duration of physical dependence on alcohol and decreases with

prolonged abstinence. Stressful and/or alcohol related stimuli may exacerbate

the subacute alcohol withdrawal symptoms. These latent manifestions

of a physical dependence on alcohol appear together with a craving for alcohol.

The symptoms disappear by moderate alcohol use. Resumption of alcohol use

reactivates a physical dependence on alcohol. Therefore, after an initial

norrnalizing effect, this reexposure to alcohol may lead to recidivism into

chronic alcohol use. As is true for residual symptomatology, premorbid

symptoms are exacerbated by alcohol use; in both case a vicious circle of

dependence may develop. It is discussed to what extent the symptoms

observed in abstinent alcoholics are to be considered as antecedents and

to what extent consequences of physically dependent alcohol use.

During the subacute AWS a variety of discomforting symptoms may appear.

Treatment methods which are directed towards the decrease of specific

alcohol related psychophysiological symptoms are recormended. Such methods

may induce a psychophysiological state which alcoholics may be striving to

achieve by ingesting alcoholic beverages.

After presenting review of the literature on hyperventilation and the

hyperventilation syndrome, in Chapter II the following hypotheses

are made plausible: a) hyperventilation is part of the subacute AWS and

appears together anxiety and craving for alcohol and b) a therapy directed

toward an improvement of the breathing pattern of abstinent

alcoholics 1) accelerates the recovery of withdrawai hyperventilation,

anxiety and craving for alcohol and 2) reduces the likelihood of relapse

into alcohol use. These hypotheses are tested the following rsearch.

In a random sample of male alcoholic inpatients and making use of a

cross sectional design significant positive correlations were found

between each of the following variables: a) the severity of physically

dependent alcohol use, b) the severity of hyperventilatory symptoms, c)

the severity of state and trait anxiety and 4) the severity of craving

alcohol, (Chapter III).

The hypothes that hyperventilation is part of a subacute alcohol

wthdrawal svndrome is corroborated further in second study, making

use of within-subjects research paradigm. In a random sample of male

abstinent alcoholics it was found that hyperventilatory and anxiety

symptoms decrease significantly after prolonged abstinence and

increase significantly subsequent to resumption of physically dependent

alcohol use (Chapter IV).

Finally, in a controlled study, the effedt of a breathing training and feedback

therapy was investigated within select sample of relatively young male

alcoholic inpatients, who had been abstinent for one month and who were

diagnosed afterwards as suffering from hyperventilation. It was found that

this therapy brings about long lasting improvements in (self reported and

physiological) symptoms of hyperventilation. This treatment is not effective,

however, in reducing psychological symptoms (anxiety and neuroticism),

craving for alcohol or the risk of relapse into alcohol use (Chapter V).

An ex-post-facto analysis shows that those subjects who resume moderate

or excessive alcohol use within 13,5 month after admission in hospital show

both higher neuroticism scores and higher respiratory rates in the first month

of their admission than subjects who stay abstinent during at least 13,5 month.

Therefore it is postulated that combining self control techniques such as

breathing therapy with individual psychotherapy create favorable conditions

in preventing recidivism into alcohol use. In a commentary on the etiology of

alcoholism this postulate is put into a broader context (Chapter VI).

Literature