In Reply.—
We would like to clarify some of the points raised by Dr Vaillant. In the first of our two articles we reviewed the various classification schemes proposed in the literature for the subdivision of alcoholics into relatively homogeneous subgroups. In particular, we reviewed the work of Cloninger, who, on the basis of adoption studies, provided evidence for the existence of two forms of inherited alcoholism in men.It will be remembered that one form, present in a subgroup of patients classified as type 2, was found to be highly heritable and independent of environmental influences. Type 2 patients were observed to exhibit alcohol-seeking behavior early in life, to be impulsive and risk taking, and to have a tendency to manifest antisocial behavior. The other form of inherited alcoholism, type 1, was found to necessitate a postnatal provocation in addition to the genetic predisposition if a susceptibility to alcoholism was