[Jan 04, 97 - 09:39] Jane Kelley of 1:138/255 wrote to Jerry Schwartz:
JK> Convincing logic?  What more do you need?  ADHD IN CHILDREN OF FAMILIES
JK> WITH ALCOHOLISM IS A VARIATION OF THE SAME PROBLEM!
You have presented no scientific references to support that contention: none.
It is obvious from even a cursory scan of the medical literature that 
alcohol's mechanism is quite different from those of marijuana, amphetamines, 
cocaine, or opiates.  The latter (and most modern psychoactive 
pharmaceuticals) operate upon specific receptors, reuptake pathways, or the 
like; whereas alcohol interferes with a host of metabolic functions and is 
classified as a "dirty" drug for that reason (it "gums up the works" rather 
than manipulating specific functions).
Similarly, current research on AD(H)D indicates that it involves specific 
metabolic irregularities in specific parts of the brain.  No doubt at some 
point it will be possible (at least in theory) to diagnose AD(H)D by 
detecting those metabolic irregularities.  There is wide variability in both 
the symptoms of AD(H)D (hence the parentheses I use) and in the medications 
which are effective in various individuals.  This suggests that there is 
probably more than one specific cause of the external behaviors classified as 
AD(H)D, and nobody knows yet how many nor how closely related they are.  
However, in general they respond to one or another of a small handful of 
medications.
Turning that around, of course, you could say that only those cases which 
respond to those medications or which have those specific metabolic 
irregularities are "true" AD(H)D.  As a matter of diagnosis, that is a 
dangerous technique; but as a matter of definition, it may work.
If you are saying that there is a high percentage of the children of 
alcoholics who have a condition which resembles AD(H)D, but which is not 
treatable in the same way, then I am not in a position to argue with you, nor 
interested in doing so, since we are not talking about the same thing.  But 
if you are saying that if someone has AD(H)D, could be treated by the 
standard medications, but should not be because they have a relative with 
alcoholism, then I think you are wrong.
You said (and I'll concede, for the sake of argument) that 30% of all 
families have one or more individuals with alcoholism.  You also claim that 
33% of the children of such families have AD(H)D which should not be treated 
with the standard medications. Since I don't think there is a reliable number 
for the cases of AD(H)D in the population at large, will you grant me 10% for 
the sake of argument and easy math?
Now, if 30% of the families have a history of alcoholism, and 33% of their 
children have this putative alcohol-related form of AD(H)D, then the most 
simpleminded estimate is that .3*.33 or about 10% of the population would 
have this specific, alcoholism-related problem.  Subtract that from the 10% 
number I pulled out of the air in the paragraph above, and you have no room 
at all for non-alcohol-related AD(H)D.  You can fudge my 10% number upwards 
if you like, but in order to make room for the number of AD(H)D cases which 
appear to be unrelated to alcoholism you'd have to have an implausibly high 
total incidence of AD(H)D in the general population.
Of course, to do this properly you'd have to completely redo my calculations 
to compensate for sampling without replacement, but since you didn't specify 
how a "family" is counted in your 30% there's not much point in trying to do 
so.  (Most critically, how many generations and what degrees of consanguinity 
do you count as one family in that 30%?  If an alcoholic has two children who 
each marry and have children in turn, is that one family, two, or three?)
And as for your central argument, which I believe is that people with 
alcoholic relatives should not be treated with the standard medications for 
AD(H)D, that would rest not only upon your thesis that there is a form of 
AD(H)D which is unique to alcoholic families but on the corollary that no one 
with alcoholic relatives can have the "other" kind of AD(H)D.  I might be 
willing to concede the former, although I think it more likely that there are 
conditions related or consequent to alcoholism (FAS, FAE, or something not 
yet named) which are symptomatically similar to AD(H)D; for those people, the 
standard remedies for AD(H)D might well not work, and might be dangerous.
I would also concede that alcohol use (not alcoholism itself) might cause 
genetic changes which give rise to AD(H)D in subsequent generations, since 
heavy alcohol use does seem able to induce genetic damage in sperm (and 
therefore quite possibly in ova), let alone raise havoc with a fetus exposed 
to alcohol.  But I am unwilling to concede that those with alcoholic 
relatives should not be treated with the standard medications if those 
medications work, that all AD(H)D is coincident with a family history of 
alcoholism, nor (returning to your other theme) that if a medication is in 
the form of nuts, berries, twigs, or leaves that it is ipso facto better or 
safer than the product of a chemical laboratory. 
Jerry Schwartz
--- Msged/386 4.00
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