Alcohol abuse is one of the greatest problems facing our modern-day society. An estimated 9 million people in the United States alone are alcoholics or problem drinkers. Each year alcohol abuse costs the United States economy an estimated 25 billion dollars and the human suffering exacted by alcohol cannot be translated into monetary terms. As the use of alcohol increases, as more young people take up drinking, the incidence of alcohol-related problems also increases. Clearly there is an urgent need to intensify current efforts of treating and preventing alcohol abuse. To maximize the effectiveness of these efforts, a base of reliable, objective, and scientific facts needs to be established.

The subject of alcohol abuse is exceedingly complex. Alcoholism affects all segments of our society and its amelioration poses a real challenge to people concerned with improving the quality of life. Significant strides have been made to help alcoholic people, but the area of alcoholism is fraught with too much heat and too little light. Too much reliance has sometimes been placed on conventional wisdom and dogma. I point this out not to belittle in any way the significant advances that have been made in the past. Rather, I believe that realistic appraisal of the current state of our knowledge lends a hopeful note to the opportunities that lie ahead.

The way to address problems of alcoholism is to ask the difficult questions and probe deeply for answers. We do not know so many essential facts about alcoholism. What is the nature of addiction? What are the precise effects of alcohol on the brain, the liver, the pancreas, and the heart? We need a much greater emphasis on the effects of alcohol on the central nervous system. We do not yet know the neurochemical bases of the behavioral changes produced by alcohol. What are the mechanisms underlying tolerance, adaptation, and dependence? What is the withdrawal reaction and are there drugs that can mitigate it?

The social and psychological aspects of drinking and alcohol abuse urgently need exploration. What stresses of modern-day life impel certain people toward excessive drinking? What role does drinking play for the poor, for minorities such as Indians, Hispanics, and Blacks, for youth and the elderly? Why are more and more women using alcohol? What will be the results of increased drinking in women for their likelihood of becoming alcoholics and what is the effect of increased drinking among women on their offspring? One of the facts that adds to the complexity of the problem is that alcohol use has been a part of our society for so long. Use of the beverage alcohol is part of our sociocultural heritage and this makes for difficult research.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is addressing some of these questions. When I was appointed Director of the NIAAA, I brought with me the clear realization of the high priority that must be given to research. To facilitate the basic and applied research activities of NIAAA, we have had to undergo some reorganization. We have elevated Intramural Research to division status with three proposed branches: Biochemistry, Psychobiology, and Clinical Studies. We have also created a separate Division of Extramural Research with two branches: Epidemiology and Special Studies, and Extramural Studies. This reorganization is fortuitous for a healthy exchange of inforMation and will facilitate the development of a knowledge base for maximally effective treatment and prevention.

Through research it is possible to answer some of the crucial and fundamental questions about alcohol. Many scientists, such as the contributors to this book, have already begun to address the challenging area of alcohol abuse. This volume illustrates the kinds of issues that basic research is concerned with. From reading these chapters, one can clearly see that significant advances are being made in understanding the addictive processes, the nature of dependence and withdrawal, and the mechanisms of tolerance. The similarities and differences between alcohol and other drugs such as the opiates need to be determined. Their delineation will have beneficial spinoffs both for the areas of alcohol abuse and drug dependence.

This volume also illustrates the concern of scientists with establishing viable models for assessing the effects of alcohol. Some of the most basic and fundamental questions about drug actions depend upon refined model systems for answers. The nature of tolerance, for example, needs to be explored at the level of the single cell as well as in the intact animal. With sophisticated model systems, scientists can examine one question at a time with a high degree of control not possible in studies of man. The knowledge derived from basic studies will lead to progress in the applied sciences.

Readers of this book will discover some of the exciting advances that are being made in basic research on alcohol and drug dependence. In the coming years, we will see continuing advances in these areas. This is a challenging area for investigation, and we must proceed in the spirit of excellence. Endeavors to improve the quality of life for the millions of victims of alcoholism is a task worthy of our most compassionate attention.

ERNEST P. NOBLE
National Institute on Alcohol Abuse and Drug Addiction
Rockville, Maryland 20852

* This foreword was prepared by Ernest P. Noble, Ph.D., M.D. in his private capacity. No official support or endorsement by the ADAMHA or NIAAA is intended or should be inferred.