Neuropsychology of alcoholism. Etiology, phenomenology, process, and outcome.

A number of empirical and conceptual issues are addressed in an effort to explain the diversity of neuropsychological deficits demonstrated by chronic alcoholics. In addition to consumption characteristics and the neurotoxic effects of ethanol, evidence is marshalled to implicate nutritional deficiency, hepatic disease, congeners in the beverage, and cognitive regression as also being contributory to the manifest impairments. Moreover, predrinking disturbances are considered that may be responsible in part for the neuropsychological deficits observed in chronic alcoholics. Our understanding of the neuropsychological concomitants of alcoholism can be increased by the adoption of a life-span approach to alcohol effects, localizing the system or region of maximal cerebral damage and relating these findings to treatment intervention. The extent to which adaptive capacity in alcoholics and social drinkers is predicted by neuropsychological test performance is of utmost importance, especially since nonalcoholic social drinkers also demonstrate a number of impairments.