The theory of modern alcoholism states that drinking problems are sometimes caused by brain disease, characterized by changes in brain structure and function.
The American Medical Association (AMA) stated that alcoholism was a disease in 1956. In 1991, the AMA further supported the double classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.
Video Disease theory of alcoholism
Theory
Alcoholism is a chronic problem. However, if managed correctly, brain damage can be stopped and to some extent reversed. In addition to drinking problems, the disease is characterized by symptoms including impaired control over alcohol, compulsive thoughts about alcohol, and distorted thinking. Alcoholism can also cause indirectly, through excessive consumption, physical dependence on alcohol, and diseases such as cirrhosis of the liver.
The risk of developing alcoholism depends on many factors, such as the environment. Those with a family history of alcoholism are more likely to develop themselves (Enoch & Goldman, 2001); However, many individuals have developed alcoholism without a family history of the disease. Because alcohol consumption is needed to develop alcoholism, the availability and attitudes toward alcohol in individual environments affects their likelihood of developing disease. Current evidence shows that in men and women, alcoholism is 50-60% genetically determined, leaving 40-50% for environmental influences.
In a 2001 review, McLellan et al. compare the diagnosis, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatment (adherence and relapse) drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. They found that genetic heritability, personal choice, and environmental factors are comparatively involved in the etiology and course of all these disorders, providing evidence that drug dependence (including alcohol) is a chronic medical illness.
Maps Disease theory of alcoholism
Genetics and the environment
According to theory, genes play a strong role in the development of alcoholism.
Twin studies, adoption studies, and artificial selection studies show that one's genes can influence them to develop alcoholism. Evidence from twin studies suggests that the concordance rate for alcoholism is higher for monozygotic twins than dizygotic twins - 76% for monozygotic twins and 61% for dizygotic twins. However, studies of female twins show that women have a lower concordancy rate than men. The reasons for gender differences may be due to environmental factors, such as negative public attitudes toward female drinkers. Twin studies show that men are more likely to have a genetic predisposition for alcoholism. However, this does not indicate that men who do have genetic predisposition will become alcoholics. Sometimes individuals never face environmental triggers that lead to alcoholism.
Adoption studies also show a strong genetic predisposition to alcoholism. Studies in children separated from their biological parents indicate that alcoholic biological father children are more likely to become alcoholics, even though they have been separated and raised by non-alcoholic parents. Women show similar results, but to a lesser extent.
In the study of artificial selection, certain types of rats were bred to prefer alcohol. These mice prefer to drink alcohol over other liquids, produce tolerance for alcohol and show physical dependence on alcohol. Mice that are not raised for this preference do not have these properties. After analyzing the brains of these two strains of mice, it was found that there was a difference in the chemical composition of certain areas of the brain. This study shows that certain brain mechanisms are more genetically predisposed to alcoholism.
Convergent evidence of this study presents a strong case for the genetic basis of alcoholism.
History
Historians argue that it has a virtue in arguing that drinking habits carry disease characteristics. Some have noted that the Scottish physician, Thomas Trotter, was the first person to characterize excessive drinking as a disease, or medical condition.
Others point to the American doctor Benjamin Rush (1745-1813), the signatory to the United States Declaration of Independence - who understands drunkenness into what we now call "loss of control" - as perhaps the first to use the term "addiction" in this sense.
My observations give me the authority to say that those who have been addicted to them must abstain from them all of a sudden and completely. 'No feeling, no grip, no touch' should be inscribed on every ship containing the spirits in a man's house, who wants to be healed of the habit of disorder.
Rush argues that "drunken habits should be regarded not as bad habits but as illness", describing it as "palsy of the will". Rush outlines his views in a book published in 1808. His views are explained by Valverde and by Levine:
Swedish physician Magnus Huss coined the term "alcoholism" in his book Alcoholismus chronicus (1849). Some argue that he is the first person to systematically describe the physical characteristics of drinking habits and claim that it is a disease. However, this came several decades after Rush and Trotter wrote their work, and some historians argue that the idea that drinking habits is a sick state arises early.
Given this controversy, the best thing to say is that the idea that drinking alcohol is a disease has become more acceptable in the mid-nineteenth century, although many writers still argue it is a crime, a sin, and not a scope of medicine but of a religion.
Between 1980 and 1991, medical organizations, including the AMA, worked together to establish policies regarding their position on disease theory. These policies were developed in 1987 in part because third-party replacements for treatment were difficult or impossible unless alcoholism was categorized as illness. The AMA policy, established through consensus federations of state and specialized medical communities in their House of Delegates, states, in the section:
"The AMA supports the proposition that drug dependence, including alcoholism, is a disease and that their care is a legitimate part of medical practice."
In 1991, the AMA further supported the double classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.
Controlled playback
The disease theory is often interpreted as implying that problem drinkers are unable to return to the problem of 'normal' free drinking, and therefore treatment should focus on total abstinence. Some critics have used the evidence of controlled drinking in previously dependent drinkers to disprove the theory of alcoholism.
The first major empirical challenge for the theory's interpretation of this disease follows the 1962 study by Dr. D. L. Davies. Davies' follow up 93 troubled drinkers found that 7 of them were able to return to "controlled drinking" (less than 7 drinks per day for at least 7 years). Davies concludes that "the accepted view that no normal alcoholic drinker should be modified, although all patients should be advised not to have total abstinence"; After Davies study, several other researchers reported cases of problem drinkers back into controlled drinking.
In 1976, a major study commonly referred to as the RAND report, published evidence of problem drinkers who studied moderate alcohol consumption. The publication of this study renewed the controversy about how people who suffer from ailments that are said to cause unbridled drinking can manage to drink in a controlled manner. Subsequent studies also reported evidence of a return to controlled drinking habits. Similarly, according to the National Institute of 2002 on Alcohol Abuse and Alcoholism (NIAAA) study, about one in every six (18%) alcohol-dependent adults in the US whose dependence began more than a year earlier has been "low-risk drinkers" from 14 drinks per week and 5 drinks per day for men, or less than 7 per week and 4 per day for women). This modern longitudinal study examined more than 43,000 people representing the US adult population, rather than focusing only on those seeking or receiving treatment for alcohol dependence. "Twenty years after the onset of alcohol dependence, about three-quarters of individuals are in full recovery, more than half of those who have fully recovered from drink at low risk level without symptoms of alcohol dependence."
However, many researchers debate smaller study results. The 1994 follow-up of the original 7 cases studied by Davies suggests that he "has substantially been misled, and the paradox exists that an influential paper that stimulates a lot of new thinking is based on false data." A recent study, long-term follow-up (60 years) of two groups of alcoholic men by George Vaillant at Harvard Medical School concluded that "return to drinking habits often lasts for more than a decade without recurrence or evolution into abstinence." Vaillant also noted that "drinking controlled liquor, as reported in short-term studies, is often a mirage."
The second RAND study, in 1980, found that alcohol dependence was a very important factor in the relapse process. Among people with low dependence on admission, the risk of relapse appears relatively low for those who then drink without problems. But the greater the initial level of dependence, the higher the chances of relapse for nonproblem drinkers. The second RAND research findings have been reinforced by subsequent research by Dawson et al. in 2005 found that severity was positively associated with the possibility of abstinent recovery and was negatively associated with the possibility of non-abstinent or controlled recovery. Other factors such as significant abstinence periods or changes in life circumstances were also identified as a powerful influence for success in a book about Controlled Drinking published in 1981.
Managed drinking
As part of a harm reduction strategy, the provision of small quantities of alcoholic beverages to homeless alcoholics at homeless shelters in Toronto and Ottawa reduces government costs and improves health outcomes.
Legal considerations
In 1988, the US Supreme Court upheld a rule in which the Veterans Administration was able to avoid paying benefits by assuming that primary alcoholism was always the result of a veteran's "deliberate self-inflicted" veteran. The majority opinion by Justice Byron R. White echoes the findings of the District of Columbia Circuit that there is "a substantial body of medical literature that even opposes the proposition that alcoholism is a disease, let alone that it is a disease borne by the victim. He also writes: "Indeed, even among many who consider alcoholism a" disease "whose victims are genetically vulnerable, alcohol consumption is not considered to be entirely voluntary." However, the majority opinion stated in the conclusion that "this litigation does not require the Court to decide whether alcoholism is a disease whose victims can not control it, it is not our role to resolve this medical issue in which the authorities remain sharply divided." Different opinion states that "despite many comments in the mass media, these cases are not related to whether alcoholism, simplistically, is or not" disease. ""
The American Bar Association "confirms the principle that dependence on alcohol or other drugs is a disease."
Current acceptance
Alcoholism is a disease with known pathology and an established pathway of transduction of biomolecular signals that culminates in? Fosb overexpression in D1-type medium spiny neurons from nucleus accumbens; when this overexpression occurs ,? FosB induces an addictive state.
In 2004, the World Health Organization published a detailed report on alcohol and other psychoactive substances entitled "Neuroscience from the use and dependence of psychoactive substances". It states that this is "the first attempt by WHO to provide a comprehensive review of the biological factors associated with the use and dependence of substances by summarizing the vast amount of knowledge gained in the last 20-30 years." This report highlights the current state of knowledge of the working mechanisms of various a type of psychoactive substance, and explains how the use of this substance can lead to the development of dependency syndrome. "The report states that" previous dependence is not recognized as a brain disorder, in the same way as psychiatric and mental illnesses not previously seen as a result of brain disorders. , with recent advances in neuroscience, it is clear that dependence is a brain disorder such as neurological or other psychiatric diseases. "
The American Society of Addiction Medicine and the American Medical Association both maintain a broad policy on alcoholism. The American Psychiatric Association recognizes the existence of "alcoholism" as an equivalence of alcohol dependence. The American Hospital Association, the American Public Health Association, the National Association of Social Workers, and the American College of Physicians classify "alcoholism" as a disease.
In the US, the National Institutes of Health has a special institute, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), concerned with the support and behavior of biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol related issues. It funds about 90 percent of all such research in the United States. The official position of the NIAAA is that "alcoholism is a disease." Alcoholism is a disease, alcoholism can be as strong as food or water, an alcoholic will continue to drink despite serious family, health, or legal problems, like many other diseases, chronic alcoholism, which means that it lasts a person's lifetime, usually follows a predictable course, and has symptoms.Risk for developing alcohol is influenced both by one's genes and by his lifestyle. "
Criticism
Some doctors, scientists, and others have rejected the theory of alcoholism with logical, empirical, and other reasons. Indeed, some addictive experts like Stanton Peele are blatant in their rejection of the disease model, and other prominent alcohol researchers such as Nick Heather have written a book that intends to deny the disease model.
Some critics of the disease model argue that alcoholism still involves choice, not loss of total control, and their selected alcoholic peeler, applying the concept of disease, poses a threat to individual health; the concept of illness provides the substance of the offender of reason. A disease can not be cured by the power of desire; Therefore, adding a medical label transfers the responsibility of the offender to the caregiver. Inevitably the perpetrators become unwanted victims, and just as they take on the role. They argue that the theory of alcoholism diseases exists only to benefit professionals and government agencies responsible for providing recovery services, and disease models have not offered a solution for those who are trying to stop alcohol abuse and drug use.
These critics argue that by removing some of the stigma and personal responsibility the concept of disease actually increases alcoholism and drug abuse and thus the need for treatment. This is somewhat supported by research that found that greater belief in the theory of alcoholism disease and a higher commitment to total abstinence became a factor correlated with the increased likelihood that an alcoholic would experience a full (substantial continuous use) relapse after the initials. hose (disposable). However, the authors note that "the direction of causality can not be determined from this data.It is possible that belief in alcoholism as a disease that loses control controls the client to relapse, or that recurrence reinforces the client's confidence in the disease model."
One study found that only 25 percent of doctors believe that alcoholism is a disease. The majority believe alcoholism to be a social or psychological issue is not a disease.
A survey of doctors at the annual International Physicians conference in Alcoholics Anonymous reported that 80 percent believe that alcoholism is just a bad behavior rather than a disease.
Thomas R. Hobbs said that "Based on my experience of working in addiction for the past 10 years, I'm sure many, if not most, health care professionals still see alcoholism as a determination or behavioral problem and resistant to seeing it as a disease."
Alcoholics Anonymous says that "Some professionals will tell you that alcoholism is a disease while others argue that it is a choice" and "some doctors will tell you that it is actually a disease."
Lynn Appleton says that "Despite all public statements about alcoholism as a disease, medical practice refuses to treat it that way, not just alcoholism does not follow the 'disease' model, can not receive standard medical care. He said that "medical doctor's rejection of the theory of alcoholism has a strong foundation in biomedical models that support most of their training" and that "medical research on alcoholism does not support disease models."
"Many doctors are reluctant to prescribe drugs to treat alcoholism, sometimes because of the belief that alcoholism is a moral disorder rather than a disease," according to Dr. Bankole Johnson, Chair of the Department of Psychiatry at the University of Virginia. Dr Johnson's own pioneering work has made an important contribution to the understanding of alcoholism as a disease.
Certain drugs including opioid antagonists such as naltrexone have been shown to be effective in the treatment of alcoholism, although studies have not shown long-term efficacy.
The frequency and quantity of alcohol use is not related to the condition; that is, people can drink a lot without having to be alcoholic, and alcoholics can drink least or rarely.
See also
- Model addiction disease
References
Source of the article : Wikipedia
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