Alcoholism, politics, and bureaucracy: the consensus against controlled-drinking therapy in America

Making animals alcoholic: shifting laboratory models of addiction

The use of animals as experimental organisms has been critical to the development of addiction research from the nineteenth century. They have been used as a means of generating reliable data regarding the processes of addiction that was not available from the study of human subjects. Their use, however, has been far from straightforward. Through focusing on the study of alcoholism, where the nonhuman animal proved a most reluctant collaborator, this paper will analyze the ways in which scientists attempted to deal with its determined sobriety and account for their consistent failure to replicate the volitional consumption of ethanol to the point of physical dependency. In doing so, we will see how the animal model not only served as a means of interrogating a complex pathology, but also came to embody competing definitions of alcoholism as a disease process, and alternative visions for the very structure and purpose of a research field.

The effect of psychotherapy on self-awareness in incarcerated and nonincarcerated alcoholics: a pilot study

Changes in self-awareness in incarcerated and nonincarcerated male alcoholics are measured before and after disaccustoming therapy based on Alcoholics Anonymous principles. The four-mode conception of self-awareness of Zaborowski is employed. The results show significant and expected changes in incarcerated participants (in defensive, individual, and reflective modes of self-awareness) and almost no changes in nonincarcerated individuals. An effect of motivation on therapy is also identified. Incarceration appears to be more conducive to recovery than to conditions outside the prison.

Reduced-risk drinking as a treatment goal: what clinicians need to know

Reduced-risk drinking as a treatment goal for clients with alcohol problems has received limited acceptance in the United States. The majority of literature addressing reduced-risk drinking has focused on debates between proponents of traditional abstinence treatment and those supporting nonabstinence treatment. Proportionately little attention has been given to objective consideration of the potential advantages of integrating both abstinence and nonabstinence goals as part of a comprehensive continuum of treatment for clients with alcohol problems. Further, there is a lack of guidelines available to assist clinicians in treating and supporting clients with nonabstinence goals. The purpose of this article is to review the potential advantages of reduced-risk drinking for clients with alcohol problems and to forward strategies designed to assist clinicians in safely treating clients who wish to reduce rather than abstain from drinking alcohol. Current gaps in the literature and implications for future research are identified.

Nicotine as an Addictive Substance: A Critical Examination of the Basic Concepts and Empirical Evidence

The present review is a critical analysis of the concepts behind and the empirical data supporting the view that tobacco use represents an addiction to nicotine. It deals with general aspects of the notion of addiction, while concentrating on specific problems associated with incorporating nicotine into current frameworks. The notion of addiction suffers from unprecedented definitional difficulties. The definitions offered by various authorities are very different, even contradictory. Definitions that reasonably include nicotine are so broad and vague that they allow many trivial things, such as salt, sugar, and watching television, to be considered addictive. Definitions that exclude the trivia also exclude nicotine. The addiction hypothesis, in general, is strongly shaped by views that certain drugs bring about a molecular level subversion of rationality. The main human evidence for this is verbal reports of smokers who say that they can't quit. On the other hand, the existence of many millions of successful quitters suggests that most people can quit. Some smokers don't quit, but whether they can't is another matter. The addiction hypothesis would be greatly strengthened by the demonstration that any drug of abuse produces special changes in the brain. It has yet to be shown that any drug produces changes in the brain different from those produced by many innocuous substances and events. The effects of nicotine on the brain are similar to those of sugar, salt, exercise, and other harmless substances and events. Apart from numerous conceptual and definitional inadequacies with the addiction concept in general, the notion that nicotine is addictive lacks reasonable empirical support. Nicotine does not have the properties of reference drugs of abuse. There are so many findings that conflict so starkly with the view that nicotine is addictive that it increasingly appears that adhering to the nicotine addiction thesis is only defensible on extra-scientific grounds.

Reward deficiency syndrome: a biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors

The dopaminergic system, and in particular the dopamine D2 receptor, has been implicated in reward mechanisms. The net effect of neurotransmitter interaction at the mesolimbic brain region induces "reward" when dopamine (DA) is released from the neuron at the nucleus accumbens and interacts with a dopamine D2 receptor. "The reward cascade" involves the release of serotonin, which in turn at the hypothalmus stimulates enkephalin, which in turn inhibits GABA at the substania nigra, which in turn fine tunes the amount of DA released at the nucleus accumbens or "reward site." It is well known that under normal conditions in the reward site DA works to maintain our normal drives. In fact, DA has become to be known as the "pleasure molecule" and/or the "antistress molecule." When DA is released into the synapse, it stimulates a number a DA receptors (D1-D5) which results in increased feelings of well-being and stress reduction. A consensus of the literature suggests that when there is a dysfunction in the brain reward cascade, which could be caused by certain genetic variants (polygenic), especially in the DA system causing a hypodopaminergic trait, the brain of that person requires a DA fix to feel good. This trait leads to multiple drug-seeking behavior. This is so because alcohol, cocaine, heroin, marijuana, nicotine, and glucose all cause activation and neuronal release of brain DA, which could heal the abnormal cravings. Certainly after ten years of study we could say with confidence that carriers of the DAD2 receptor A1 allele have compromised D2 receptors. Therefore lack of D2 receptors causes individuals to have a high risk for multiple addictive, impulsive and compulsive behavioral propensities, such as severe alcoholism, cocaine, heroin, marijuana and nicotine use, glucose bingeing, pathological gambling, sex addiction, ADHD, Tourette's Syndrome, autism, chronic violence, posttraumatic stress disorder, schizoid/avoidant cluster, conduct disorder and antisocial behavior. In order to explain the breakdown of the reward cascade due to both multiple genes and environmental stimuli (pleiotropism) and resultant aberrant behaviors, Blum united this hypodopaminergic trait under the rubric of a reward deficiency syndrome.

Researching harm reduction--care and contradictions

This paper sets out to identify why research is important in realizing the potential a harm-reduction framework has for informing policy and practice in relation to all psychoactive drugs. In doing so it includes examples of research about alcohol and tobacco, since legitimizing the harm-reduction approach requires strengthening the research foundation across both licit and illicit drugs. There are some practical as well as ethical and theoretical complexities in conducting research in this area, some of which are novel or exaggerated using harm-reduction principles. Potential impediments to research are identified. Articulation of these complexities might help to facilitate research which can help to determine the validity of harm reduction. The notion of the researchers "duty of care" might offer a way of deciding among competing accountabilities, but needs further articulation to be useful. [Translations are provided in the International Abstracts Section of this issue.]

Barriers to effective drug abuse prevention: the role of authoritarian ideology

The relationships between authoritarian ideology and attitudes and beliefs about illegal drugs, the War on Drugs, and prevention strategies were investigated among 353 university faculty, administrators, and students. A confidential mail survey assessed five variables: right-wing authoritarianism, attitude toward drug legalization, attitude toward drug decriminalization, belief regarding the controlled use of illegal drugs, and the tendency to endorse a "just say no" approach to substance abuse prevention. Multivariate analyses revealed that highly authoritarian participants were significantly more opposed to both drug legalization and drug decriminalization than less authoritarian participants. Only nonauthoritarian participants favored decriminalization, though they did not favor legalization. Compared to those scoring lower on authoritarianism, higher-scoring authoritarian participants held significantly more dichotomous beliefs about illegal drugs (i.e., that abstinence or compulsive drug abuse are the only possibilities related to involvement with illegal drugs). They were also less likely to recommend to potential drug users that they consider following guidelines for their use that may potentially function as protective factors against drug abuse, preferring instead to endorse the slogan "just say no to drugs." Comparisons between groups revealed that students scored significantly higher on authoritarianism and demonstrated significantly greater opposition to drug decriminalization than did faculty and administrators.

The Addiction Belief Scale

An eighteen-item Addiction Belief Scale (ABS) was developed to assess strength of belief in the disease versus free-will model of addiction (alpha = .91). Factor analysis of the ABS revealed three dimensions to the disease-model controversy of addiction. These include beliefs regarding personal power (subscale alpha = .91, n = 274), dichotomous thinking (subscale alpha = .83, n = 285), and addiction as a way of coping with life (subscale alpha = .47, n = 286). A discussion of scale analysis and suggestions for application of the ABS as a clinical and research instrument are presented.

For whom does Alcoholics Anonymous work?

A brief summary of the literature to evaluate for whom Alcoholics Anonymous (A.A.) is or is not likely to be effective is provided. A description of A.A. is presented. Next, support and criticisms of A.A., details of who A.A. seems to help and does not seem to help, and alternatives to A.A. are discussed. Finally, recommendations regarding matching clients to supportive treatments are made.

Why alcoholism is a disease

Arguments of proponents and critics of a disease concept of alcoholism are reviewed. It is concluded that the disease concept of alcoholism is in accord with modern usage of the concept of disease in the philosophy of science and the practice of biomedical science. Ascription of the term "disease" involves a value judgment by experts that observed lawfully recurring signs and symptoms are a significant deviation from a norm or standard of health. Value judgments of this and other kinds are inherent in biobehavioral science and its application. Criticisms of the traditional conception of the disease concept fail to distinguish empirical questions of etiology, treatment, and the characteristic features of alcoholism from the conventional and evaluative nature of the classification "disease." A critical review of the empirical research purporting to question the signs and symptoms of loss of control in alcoholics is also provided.

The conflict between public health goals and the temperance mentality

OBJECTIVES

The prevailing view today is that alcohol consumption is unambiguously a social and public health problem. This paper presents evidence to balance this view.

METHODS

Evidence of beneficial effects of alcohol against coronary artery disease is examined, together with cultural reasons for resistance in the United States to the implications of this evidence.

RESULTS

Alcohol use reduces the risk of coronary artery disease--the major cause of heart disease, America's leading killer--even for those at risk for such disease. Moreover, recent research indicates that alcohol continues to reduce risk at the higher levels of drinking measured in general populations. However, with consumption of more than two drinks daily, these gains are increasingly offset by greater mortality from other causes.

CONCLUSIONS

Educators, public health commentators, and medical investigators are uneasy about findings of healthful effects of drinking. A cultural preoccupation with alcoholism and the negative effects of drinking works against frank scientific discussions in the United States of the advantages for the cardiovascular system of alcohol consumption. This set has deep roots in American history but is inconsistent with public health goals.