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Even for employed problem drinkers who are not abusing drugs and who have no serious medical problems, an initial referral to AA alone or a choice of programs, although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse.

During neurotransmission, synaptic vesicles undergo multiple rounds of exo-endocytosis, involving recycling and/or degradation of synaptic proteins. While ubiquitin signaling at synapses is essential for neural function, it has been assumed that synaptic proteostasis requires the ubiquitin-proteasome system (UPS). We demonstrate here that turnover of synaptic membrane proteins via the endolysosomal pathway is essential for synaptic function. In both human and mouse, hypomorphic mutations in the ubiquitin adaptor protein PLAA cause an infantile-lethal neurodysfunction syndrome with seizures. Resulting from perturbed endolysosomal degradation, Plaa mutant neurons accumulate K63-polyubiquitylated proteins and synaptic membrane proteins, disrupting synaptic vesicle recycling and neurotransmission. Through characterization of this neurological intracellular trafficking disorder, we establish the importance of ubiquitin-mediated endolysosomal trafficking at the synapse.

The "second public health revolution" targets factors in the environment, together with lifestyle, to prevent illness and untimely death. Yet the growth of the "wellness movement" has driven a wedge between public health advocates who argue for environmental solutions and those whose major focus is individual behavior. This tension is nowhere more evident than in the workplace, where the new wellness professionals are at odds with specialists in occupational health and industrial hygiene. This paper reports findings from a cross-sectional survey of a sizeable sample of workers at six New England facilities of a very large American manufacturing firm, assessing their perceptions of risk in the two domains: environmental exposures and lifestyle risks. Multiple regression analyses reveal that both job risks and life risks are associated with a variety of potentially costly and disruptive health problems, even after controlling for demographic and occupational factors. This analysis suggests that wellness programs in the workplace will be more effective if they integrate environmental protection with efforts to reduce lifestyle risk.

In this chapter, we discuss research that assessed whether gender differences exist in the relationship between work and personal factors associated with mental distress in a sample of male and female workers in New England. Furthermore, we sought to determine whether the Karasek job strain model, which measures the impact of job content on worker health, could be improved to better explain mental distress in men and women.We began this study intending to do a comparative analysis of job stress and mental distress for men and women inasmuch as most studies have concentrated on male workers, and we had available to us a sample with sufficiently large numbers of women to provide a sound sample. In this chapter, we also describe previous job stress research and assess some of the key sources and moderators of mental distress. Models of Job Stress and WorkOccupational health research has been expanding in recent years beyond a n exclusive focus on physical hazards in the workplace to broader conceptions of health that embrace psychosocial dimensions of work: the "social environment at work, organizational aspects of the job and certain operational aspects of the tasks performed" (Sauter, Murphy, & Hurrell, 1990, p. 1150. Occupa-The material for this chapter was adapted from a presentation by Cynthia A. Piltch and from her doctoral dissertation conducted at Boston University as a Pew Scholar with a grant from the Pew Memorial Trust. Lois Biener, Jonathan Howland, and Timothy Heeren made helpful contributions to that effort. The New England Worker's Health Study was funded in part by grants to D. C. Walsh from the Commonwealth Fund, the General Electric Foundation, the National Institutes of Health, and the Kellogg National Fellowship Program. Daniel M. Merrigan, Richard Youngstrom, and Susan K. Hamilton made important contributions to the study during its early conceptualization and data collection phases.

a n d H ealth Care S tatistics from several sources convey the strong impression that corporate-sponsored counseling for trou bled employees, or " employee assistance," is coming o f age. The majority of the nation's largest and most prominent corporations now sponsor some form o f organized employee counseling, and the alco holism programs from which these larger efforts have developed are themselves proliferating. Occupational alcoholism programs expanded at a measured rate for over 30 years, but the pace began to accelerate sharply during the 1970s. In its 1981 report to Congress, the National Institute on Alcohol Abuse and Alcoholism (N IAAA) charted this growth: from 4 to 6 programs

A corporate health ethic, forged in U.S. industry in the 20th century, clearly demarcated boundaries between private and workplace health concerns. This article advances evidence that the boundary is blurring, and argues that trends in workplace initiatives, including employee assistance, wellness programs, and drug screening, are giving shape to a new corporate health ethic. The new ethic emphasizes workers' lifestyles on and off the job, engendering a shift in corporate jurisdiction over employee health and behavior. Economic arguments such as "health care cost containment" are commonly offered as explanations for these new health initiatives. But the authors see the new ethic as a deeper response to a changing corporate environment and, more fundamentally, as emblematic of changes in the social control of work and productivity. They argue that the new health ethic may be a harbinger of new forms of social control in the workplace.

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