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CORK Bibliography: Disease Concept

54 citations. January 2010 to present

Prepared: March 2012

Anton R. Substance abuse Is a disease of the human brain: Focus on alcohol. Journal of Law, Medicine & Ethics 38(4): 735-744, 2010. (56 refs.)

Alcohol and substance abuse are prevalent in our society. Advances in neuroscience have led to a clearer understanding of the effects of abused substances on the brain. Clues are now available regarding how a person goes from a "user" to being addicted based on brain chemistry, anatomy, and genetic risk. During this process the person loses at least partial, if not complete, control, over their compulsive substance use. This article attempts to put modern notions of alcohol and substance abuse and dependency into a societal and cultural context with the hope of reducing the stigma of this illness while shifting the focus a bit more away from criminal solutions to those offered by health care and treatment options.

Badiani A; Belin D; Epstein D; Calu D; Shaham Y. Opiate versus psychostimulant addiction: The differences do matter. Nature Reviews. Neuroscience 12(11): 685-700, 2011

The publication of the psychomotor stimulant theory of addiction in 1987 and the finding that addictive drugs increase dopamine concentrations in the rat mesolimbic system in 1988 have led to a predominance of psychobiological theories that consider addiction to opiates and addiction to psychostimulants as essentially identical phenomena. Indeed, current theories of addiction - hedonic allostasis, incentive sensitization, aberrant learning and frontostriatal dysfunction - all argue for a unitary account of drug addiction. This view is challenged by behavioural, cognitive and neurobiological findings in laboratory animals and humans. Here, we argue that opiate addiction and psychostimulant addiction are behaviourally and neurobiologically distinct and that the differences have important implications for addiction treatment, addiction theories and future research.

Baler RD; Volkow ND. Addiction as a systems failure: Focus on adolescence and smoking. (review). Journal of the American Academy of Child and Adolescent Psychiatry 50(4): 329-339, 2011. (115 refs.)

Objective: Scientific advances in the field of addiction have forever debunked the notion that addiction reflects a character flaw under voluntary control, demonstrating instead that it is a bona fide disease of the brain. The aim of this review is to go beyond this consensus understanding and explore the most current evidence regarding the vast number of genetic, developmental, and environmental factors whose complex interactions modulate addiction risk and trajectory. Method: Focusing on childhood and adolescent smoking as a paradigm, we review the important risk factors for the development of addictions, starting at the level of genetics and closing with a focus on sociocultural and policy factors. Results: A critical review of the pertinent literature provides a detailed view of the cumulative power of risk and protection factors across different phenomenological levels to modulate the risk of undesirable outcomes, particularly for young people. The result represents a compelling argument for the need to engage in comprehensive, multilevel approaches to promoting health. Conclusions: Today, the field of medicine understands more about disease than about health; however it need not be that way. The view of drug addiction as a systems failure should help refocus our general approach to developing dynamic models and early comprehensive interventions that optimize the ways in which we prevent and treat a complex, developmental disorder such as drug addiction.

Bienvenu OJ; Davydow DS; Kendler KS. Psychiatric 'diseases' versus behavioral disorders and degree of genetic influence. (review). Psychological Medicine 41(1): 33-40, 2011. (56 refs.)

Background. Psychiatric conditions in which symptoms arise involuntarily ('diseases') might be assumed to be more heritable than those in which choices are essential (behavioral disorders). We sought to determine whether psychiatric 'diseases' (Alzheimer's disease, schizophrenia, and mood and anxiety disorders) are more heritable than behavioral disorders (substance use disorders and anorexia nervosa). Method. We reviewed the literature for recent quantitative summaries of heritabilities. When these were unavailable, we calculated weighted mean heritabilities from twin studies meeting modern methological standards. Results. Heritability summary estimates were as follows : bipolar disorder (85 %), schizophrenia (81 %), Alzheimer's disease (75 %), cocaine use disorder (72 %), anorexia nervosa (60 %), alcohol dependence (56 %), sedative use disorder (51 %), cannabis use disorder (48 %), panic disorder (43 %), stimulant use disorder (40 %), major depressive disorder (37 %), and generalized anxiety disorder (28 %). Conclusions. No systematic relationship exists between the disease-like character of a psychiatric disorder and its heritability; many behavioral disorders seem to be more heritable than conditions commonly construed as diseases. These results suggest an error in 'common-sense' assumptions about the etiology of psychiatric disorders. That is, among psychiatric disorders, there is no close relationship between the strength of genetic influences and the etiologic importance of volitional processes.

Bignamini E. Psychotherapeutic management of heroin-addicted patients. Psychopathological, relational and organizing aspects. Heroin Addiction and Related Clinical Problems 12(4): 33-39, 2010. (17 refs.)

Addiction is a pathological condition which is still only partly understood, the complexity of reality exceeds our capacity to elaborate and synthesize the information that is currently available, so compelling us to operations of simplification, in order to become operative. In this exposition I will discuss how, starting from a view of addiction as a pathology of relationships, and from a pragmatic vision of the available therapeutic techniques as tools of intervention rather than interpretive theories of realty, is it possible and necessary to evaluate the psychotherapeutic approach.

Bliss DL. Beyond the disease model: Reframing the etiology of alcoholism from a spiritual perspective. Journal of Teaching in the Addictions 8(1/2): 10-26, 2009. (59 refs.)

The disease model of alcoholism, which has gained prominence since the mid-20th century as the major etiological model of alcoholism, suffers from several limitations including its overemphasis on biological factors at the expense of other psychosocial factors, in addition to its lack of consistency with a holistic, social work person-in-environment perspective. The increased interest in spirituality among social work and other helping professionals calls on educators and practitioners to be at the forefront of efforts to develop new holistic conceptualizations of alcoholism that can incorporate spirituality. Using transpersonal theory as a conceptual framework, a spiritual etiological model of alcoholism is presented that complements the strengths of the disease model by allowing for the inclusion of biological determinants of alcoholism, providing a complementary way to understand alcoholism that can be taught to students and utilized by practitioners.

Branch MN. Drug addiction. Is it a disease or is it based on choice? A review of Gene Heyman's "Addiction: A disorder of choice.". Journal of the Experimental Analysis of Behavior 95(2): 263- 267, 2011. (15 refs.)

A disorder of choice, Gene Heyman surveys a broad array of evidence historical, anthropological, survey, clinical, and laboratory-based to build an argument about the role of basic choice processes in the phenomena that comprise drug addiction. He makes a compelling, multifaceted argument that conceptualizing drug addiction as a chronic disease (like schizophrenia or diabetes) is both misleading and erroneous. in developing his argument, he points out that the best survey data available indicate that most drug addicts quit their addiction, a fact inconsistent with a chronic-disease model. He illustrates how basic, normal choice processes can lead to addiction, arguing that people do not choose to be addicts, but that normal choice dynamics can lead them to that condition. He points to a variety, of factors that keep most from becoming addicted, with a focus on the role of choice governed by choice-by-choice contingencies versus choice governed by the outcome of sequences of choices, a difference in an under-described activity called framing. His view is consistent with the most effective treatments currently available, and provides a basis for continued basic research on choice as well as research on treatment and prevention.

Brizer D; Castandea R, eds. Clinical Addiction Psychiatry. New York: Cambridge University Press, 2011. (Chapter refs.)

This book is described as an anthology of essays setting forth the most current and authoritative information on addiction theory, practice and research. Each chapter is authored by a recognized authority in the field. The volume covers diverse material, from the environment, to genetics, culture and spirituality, treatment and pharmacology. The book, with 24 essays, is organized in three parts. Part I sets forth basic constructs of addiction medicine. This includes discusssion of the disease concept, abstinence as a treatment goal, medical sequelae of addiction, the relationship of substance use and suicide. psychotherapic paradigms, and drug therapies. Part II focuses upon "the real world." It includes twelve step approaches; nicotine addiction and smokng cessation; managing alcoholism in primary care; methadone treatment; prescription drug abuse. Part III considers special topics, such as pain management and addiction treatment; neurofeedback; drug therapies for alcohol dependence; emergency medical presentation; acupuncture; and and EEG neurofeedback therapy.

Brizer D. Death, drugs, and rock and roll. (Chapter 1). IN: Brizer D; Castandea R, eds. Clinical Addiction Psychiatry. New York: Cambridge University Press, 2011

Broadus AD; Hartje JA; Roget NA; Cahoon KL; Clinkinbeard SS. Attitudes about addiction: A national study of addiction educators. Journal of Drug Education 40(3): 281-298, 2010. (28 refs.)

The following study, funded by the National Institute of Drug Abuse (NIDA), utilized the Addiction Belief Inventory (ABI; Luke, Ribisl, Walton, & Davidson, 2002) to examine addiction attitudes in a national sample of U. S. college/university faculty teaching addiction-specific courses (n - 215). Results suggest that addiction educators view substance abuse as a coping mechanism rather than a moral failure, and are ambivalent about calling substance abuse or addiction a disease. Most do not support individual efficacy toward recovery, the ability to control use, or social use after treatment. Modifiers of addiction educator attitudes include level of college education; teaching experience; licensure/certification, and whether the educator is an addiction researcher. Study implications, limitations, and directions for future research are discussed.

Courtwright DT. The NIDA brain disease paradigm: History, resistance and spinoffs. BioSocieties 5(1, special issue): 137-147, 2010. (31 refs.)

This article examines 'the NIDA paradigm', the theory that addiction is a chronic, relapsing brain disease characterized by loss of control over drug taking. I critically review the official history of the National Institute on Drug Abuse ( NIDA) paradigm and analyze the sources of resistance to it. I argue that, even though the theory remains contested, it has yielded important insights in other fields, including my own discipline of history.

Cowan D. Methodological issues in evaluating auricular acupuncture therapy for problems arising from the use of drugs and alcohol. Acupuncture in Medicine 29(3): 227-229, 2011. (27 refs.)

Auricular acupuncture is an accessible, non-confrontational therapy that appears to be effective when used in drug and alcohol treatment facilities, hospitals and prisons in the UK, Europe and the. Despite being popular, research evidence on its effectiveness is lacking, and as a result services are underfunded and risk being withdrawn. There are methodological problems in researching auricular acupuncture. In these days of evidence-based medicine, most studies in this area are explanatory randomised controlled trials, which is limited in capturing the complete benefits of the intervention. Furthermore, there is lack of consensus over definitions of the concept of 'addiction' and whether or not this should be perceived as a 'disease' that can be 'cured' by an intervention such as auricular acupuncture. Basic concepts such as these need to inform development of outcome measures, which should include retention of clients in treatment as an indicator of success. It is argued here that the best approach will integrate research on physical effects with research on subjective experience of those with drug and alcohol problems. The challenge is to design large scale, high quality, pragmatic randomised controlled trials to assess the effectiveness of auricular acupuncture over the longer term in settings that mimic the delivery of treatment in practice and are informed by acupuncture's own diagnostic traditions, using a combination of objective, quantitative methods and subjective, qualitative methods.

Cullen B. Treating alcohol-related problems within the Irish healthcare system, 1986-2007: An embedded disease model of treatment? Drugs: Education, Prevention and Policy 18(4): 251-260, 2011. (30 refs.)

This article assesses the implementation of the policy on the treatment of alcohol problems in Ireland during the period 1986-2007. At the commencement of this period, a major policy statement in relation to the treatment of alcohol within the mental health care system presaged radical change - in effect it proposed a shift from the then dominant disease model of alcoholism to one that was focused on public health principles. Towards the end of the period, a further statement made the rather sanguine claim that many of the intended changes had taken place. This article adopts a more critical approach. Using epidemiological data from annual reports on the activities of mental health centres and also drawing from a recently conducted action-research project that focused on addiction treatment within a regional health authority, the article highlights that change has been slow and that some of the main tenets of the disease model remain in place.

Detar DT. Understanding the disease of addiction. Primary Care 38(1): 1+, 2011. (41 refs.)

Addiction is a chronic brain disease. Drug addiction manifests as a compulsive obsession to use a substance despite serious detrimental and sometimes irreversible consequences. Drug addiction is not the same as drug dependency because dependency may not manifest as an addictive behavior. This problem is fundamental to understanding the disease of addiction. This article discusses the neurobiology and genetics of drug addiction.

Dingel MJ; Karkazis K; Koenig BA. Framing nicotine addiction as a "disease of the brain": Social and ethical consequences. Social Science Quarterly 92(5): 1363-1388, 2011. (122 refs.)

Objectives. In this article, we seek to better understand how a genomic vision of addiction may influence drug prevention and treatment. Though social influences on substance use and abuse (e. g., peer and family influence, socioeconomic status) are well documented, biomedical intervention is becoming increasingly technoscientific in nature. We wish to elucidate how emphasizing biological influences on substance use may lead to a vision of addiction as a phenomenon isolated within our bodies and neurochemistry, not lived daily within a complex social web of relationships and a particular political economy, including the tobacco industry, which aggressively markets products known to cause harm. Methods. We explore the emerging view of addiction as a "disease of the brain" in open-ended interviews with 86 stakeholders from the fields of nicotine research and tobacco control. Interview data were analyzed using standard qualitative techniques. Results. Most stakeholders hold a medicalized view of addiction. Though environmental variables are understood to be a primary cause of smoking initiation, the speed and strength with which addiction occurs is understood to be a largely biological process. Though stakeholders believe that an increased focus on addiction as a disease of the brain is not likely to lead to widespread unrealistic expectations for cessation therapies, they remain concerned that it may reinforce teenagers' expectations that quitting is not difficult. Finally, stakeholder responses indicate that genetic and neuroscientific research is unlikely to increase or decrease stigmatization, but will be used by interest groups to buttress their existing views of the stigma associated with smoking. Conclusion. We argue that the main potential harms of focusing on biological etiology stem from a concept of addiction that is disassociated from social context. Focusing on genetic testing and brain scans may lead one to overemphasize pharmaceutical "magic bullet cures" and underemphasize, and underfund, more traditional therapies and public health prevention strategies that have proven to be effective. Genetic research on addiction may fundamentally change our conception of deviance and our identities, and may thus transform our susceptibility to substance use into something isolated in our biology, not embedded in a biosocial context.

Dorrian J. Alcoholism: disease or symptom? The challenges of managing advanced alcoholism and chronic illness. (editorial). Medical Journal of Australia 192(11): 661-662, 2010. (9 refs.)

Edwards G. The trouble with drink: Why ideas matter. Addiction 105(5): 797-804, 2010. (60 refs.)

This paper builds upon the work of previous authors who have explored the evolution of ideas in the alcohol arena. With revisions in the relevant sections of ICD and DSM forthcoming, such matters are of considerable contemporary importance. The focus here will be upon the history of the last 200 years. The main themes to be explored include the flux of ideas on what, over time, has counted as the trouble with drink, ideas on the cause of the problem and the impact of this thinking on public action. Medical authorities of the late Enlightenment period made the revolutionary suggestion that habitual drunkenness constituted a disease, rather than a vice. The thread of that idea can be traced to the present day, but with an alternative perception of drink itself or alcohol-related problems generally, as cause for concern, also having a lineage. There are several inferences to be drawn from this history: the need for vigilance lest disease formulations become stalking-horses for moralism and social control, the need to integrate awareness of alcohol dependence as a dimensional individual-level problem, with a public health understanding of the vastly amorphous and at least equally important universe of alcohol-related problems; the dangers lurking in scientific reductionism when the problems at issue truly require a multi-disciplinary analysis; and the need for global consensus rather than cultural imposition of ideas on what counts as the problem with drink.

Eversman MH. High and low threshold service provision in drug-free settings: Practitioner views. International Journal of Drug Policy 21(6): 501-506, 2010. (43 refs.)

Background: In the United States, drug-free (non-drug substitution) treatment programmes are informed by an abstinence-only, disease model. Some critics believe this model hinders treatment service utilization and retention. An alternative public health model of harm reduction suggests that drug services should have a "low-threshold" for entry and retention such that they are offered with few or no conditions, such as abstinence from drug use. Methods: Using semi-structured qualitative interviews with 15 practitioners from 9 outpatient drug-free agencies, this study examined beliefs about low threshold service provisions. Results: Respondents identified certain conditions for drug services as clinically and programmatically appropriate and necessary to ensure safety. Factors relevant to outpatient services, drug use and client dynamics were also cited. Respondents tended to support service conditions to inform treatment planning and practices. Conclusions: Practitioners in these settings accept and support some threshold of imposed service conditions as useful in treatment and service planning. When outpatient services are terminated clinically appropriate services are offered instead. Concerns for service accessibility should focus on the availability of medically intensive services.

Foddy B. Addiction and its sciences-philosophy. Addiction 106(1): 25-31, 2011. (48 refs.)

Philosophers have been writing about addiction continually since the 1990s, and a number of much older, broader philosophical theories are of direct relevance to the study of addiction. Yet the developments in the philosophical study of addiction have seldom been incorporated into the science of addiction. In this paper I focus upon two issues in the scientific literature: the disease classification of addiction and the claim that addictive behaviour is compulsive. While each of these views is open to debate on empirical grounds, there is a long history of philosophical work which must be engaged if these claims are to be justified in a philosophical sense. I begin by showing how the conceptual work of philosophers such as Boorse and Nordenfelt can be used to critique the claim that addiction is a disease. Following this, I demonstrate how deep philosophical concepts of freedom and willpower are embedded into scientists' claims about compulsion in drug addiction. These concepts are paradoxical and difficult, and they have consumed numerous contemporary philosophers of mind, such as Audi, Arpaly, Frankfurt, Mele, Wallace and Watson, among many others. I show how problems can arise when scientists sidestep the work of these philosophers, and I explain where scientists should seek to include, and sometimes exclude, philosophical concepts. Conclusions: Many philosophical concepts and theories can be of use to addiction science. The philosophical work must be understood and acknowledged if the science is to progress.

Frank D. The trouble with morality: The effects of 12-step discourse on addicts' decision-making. Journal of Psychoactive Drugs 43(3): 245-256, 2011. (41 refs.)

Since its development in the 1960s, researchers have extensively scrutinized methadone maintenance treatment (MMT) as a medical response to heroin addiction. Studies consistently find that MMT is more successful than other treatment models in the reduction of opiate/opioid misuse, the transmission of diseases like HIV/AIDS and hepatitis C, and criminal arrest and conviction rates. Nonetheless, a significant portion of active and former heroin addicts view MMT negatively and-perhaps as a result-MMT is vastly underused. This study examines the effects of 12-Step discourses on the opinions and treatment decisions of active heroin addicts, addicts in MMT, and addicts in 12-Step treatment programs. The study finds the abstinence/morality based discourse of drug addiction and treatment is pervasive among addicts and their non-drug using relations and peers alike; moreover, addicts have internalized this narrative, oftentimes despite their own knowledge of MMT's success and positive personal experiences. The findings suggest that the dominance of abstinence/morality narratives contributes to MMT's poor reputation among, and low use rate by current and former heroin addicts and that the power of the dominant discourse is such that it produces a desire to buy into its values and tenets even when it is against the individual's interests to do so.

Fraser S. Hepatitis C and the limits of medicalisation and biological citizenship for people who inject drugs. Addiction Research & Theory 18(5): 544-556, 2010 , 2010. (23 refs.)

People who inject drugs access information about hepatitis C in a range of ways. For some, diagnosis is a key point at which information is encountered. This information is considered in public health circles to be important for initiating or enhancing safe injecting practice and self-care. Yet, not all of those diagnosed with hepatitis C continue to stay informed about the disease or about their health in general, preferring to postpone engagement with these issues. In this article, I draw on Nikolas Rose's idea of biological citizenship and interview material gathered from people who inject drugs, who have been diagnosed with hepatitis C to conduct an analysis of this deferral. Drawing on the empirical material, I note that in some cases, pursuing knowledge is sometimes overshadowed by more pressing material concerns such as homelessness. In other cases, the desire to acknowledge or confront the implications of the infection is absent to the point that 'keeping up' is not regarded as desirable. In other cases still, the information imparted at diagnosis is so incomplete that the merits of seeking further medical input are seen to be doubtful. Drawing on the theoretical material, the article asks, what kind of medical subjects, or biological citizens, are these interview participants, given their parallel status as hepatitis C patients and subjects of discourses of addiction? I conclude by considering the effectiveness of the medicalisation of addiction.

Grant JE; Potenza MN; Weinstein A; Gorelick DA. Introduction to behavioral addictions. American Journal of Drug and Alcohol Abuse 36(5): 233-241, 2010 , 2010. (102 refs.)

Background: Several behaviors, besides psychoactive substance ingestion, produce short-term reward that may engender persistent behavior, despite knowledge of adverse consequences, i.e., diminished control over the behavior. These disorders have historically been conceptualized in several ways. One view posits these disorders as lying along an impulsive-compulsive spectrum, with some classified as impulse control disorders. An alternate, but not mutually exclusive, conceptualization considers the disorders as non-substance or "behavioral" addictions. Objectives: Inform the discussion on the relationship between psychoactive substance and behavioral addictions. Methods: We review data illustrating similarities and differences between impulse control disorders or behavioral addictions and substance addictions. This topic is particularly relevant to the optimal classification of these disorders in the forthcoming fifth edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSMV). Results: Growing evidence suggests that behavioral addictions resemble substance addictions in many domains, including natural history, phenomenology, tolerance, comorbidity, overlapping genetic contribution, neurobiologicalmechanisms, and response to treatment, supporting the DSM-V Task Force proposed new category of Addiction and Related Disorders encompassing both substance use disorders and non-substance addictions. Current data suggest that this combined category may be appropriate for pathological gambling and a few other better studied behavioral addictions, e. g., Internet addiction. There is currently insufficient data to justify any classification of other proposed behavioral addictions. Conclusions and Scientific Significance: Proper categorization of behavioral addictions or impulse control disorders has substantial implications for the development of improved prevention and treatment strategies.

Hasin DS. Commentary on Shand, et al. (2011): Opioid use disorder as a condition of graded severity, similar to other substance use disorders. (commentary). Addiction 106(3): 599-600, 2011. (7 refs.)

Heyman GM. Addiction: A Disorder of Choice. Cambridge MA: Harvard University Press, 2009

This book draws upon behavioral economics in considering the nature of addiction. It repudiates biological determination that may be seen as arising from addiction as "brain disease." Rather addiction is seen as based on choices made on the basis of short-term goals/experiences, in the absence of a larger view of the rewards and penalties of a particular decision. Based on consideration of the nature of choice and motivation, the factors which lead to addiction are seen as operative in many domains in a consumer society.

Hudson NL; Mannino DM. Tobacco use: A chronic illness? Journal of Community Health 35(5): 549-553, 2010 , 2010. (21 refs.)

Tobacco use is a modifiable risk factor that has many characteristics of a chronic illness. We analyzed longitudinal data from participants in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS) and compared tobacco use to other chronic illnesses to evaluate effects on mortality. We limited our analysis to 20,293 participants aged 45 and older at baseline. We determined smoking status, diabetes status, hypertension, cardiovascular disease (ASCVD), and lung disease status at baseline. We developed Cox proportional hazard models, adjusting for age, sex and race and all comorbid diseases, to determine the effect of disease on mortality at up to 13 years of follow-up, 3,022 study participants died during the follow-up period. Adjusted proportional hazard models found that the risk of smoking for death had a hazard ratio (HR) of 2.0 (95% confidence interval [CI] 1.8, 2.2). This was similar to the mortality risk for ASCVD (HR 1.8, 95% CI 1.7, 2.0), diabetes (HR 1.9, 95% CI 1.7, 2.0), and chronic obstructive pulmonary disease (COPD) (HR 2.1, 95% CI 1.9, 2.4). The risk in former smokers were significantly less than that of current smokers (HR 1.1, 95% CI 1.01, 1.2). In the adjusted models, current cigarette smoking has a mortality risk that is in the same range of that seen in other "chronic diseases", whereas the risk in former smokers is greatly reduced. These data suggest that current smoking should be approached as aggressively as other chronic diseases that are amenable to interventions.

Joseph AM; Fu SS; Lindgren B; Rothman AJ; Kodl M; Lando H et al. Chronic disease management for tobacco dependence a randomized, controlled trial. Archives of Internal Medicine 171(21): 1894-1900, 2011. (31 refs.)

Background: Tobacco dependence disorder is a chronic relapsing condition, yet treatment is delivered in discrete episodes of care that yield disappointing long-term quit rates. Methods: We conducted a randomized controlled trial from June 1, 2004, through May 31, 2009, to compare telephone-based chronic disease management (1 year; longitudinal care [LC]) with evidence-based treatment (8 weeks; usual care [UC]) for tobacco dependence. A total of 443 smokers each received 5 telephone counseling calls and nicotine replacement therapy by mail for 4 weeks. They were then randomized to UC(2 additional calls) or LC(continued counseling and nicotine replacement therapy for an additional 48 weeks). Longitudinal care targeted repeat quit attempts and interim smoking reduction for relapsers. The primary outcome was 6 months of prolonged abstinence measured at 18 months of follow-up. Results: At 18 months, 30.2% of LC participants reported 6 months of abstinence from smoking, compared with 23.5% in UC (unadjusted, P=.13). Multivariate analysis showed that LC (adjusted odds ratio, 1.74; 95% CI, 1.08-2.80), quit attempts in past year (1.75; 1.06-2.89), baseline cigarettes per day (0.95; 0.92-0.99), and smoking in the 14-to 21-day interval post-quit (0.23; 0.14-0.38) predicted prolonged abstinence at 18 months. The LC participants who did not quit reduced smoking more than UC participants (significant only at 12 months). The LC participants received more counseling calls than UC participants (mean, 16.5 vs 5.8 calls; P < .001), longer total duration of counseling (283 vs 117 minutes; P < .001), and more nicotine replacement therapy (4.7 vs 2.4 boxes of patches; P < .001). Conclusion: A chronic disease management approach increases both short-and long-term abstinence from smoking.

Keane H; Hamill K. Variations in addiction: The molecular and the molar in neuroscience and pain medicine. BioSocieties 5(1, special issue): 52-69, 2010. (63 refs.)

This article critically examines two versions of addiction, the neuroscientific model of addiction as a brain disease and the behavioural model of addiction developed by pain medicine. By juxtaposing these different ways of seeing and acting on addiction, the article challenges the assumption that addiction is a constant and singular entity that can be identified outside a particular context. It also highlights the uses, limitations and tensions of each approach. The molecular gaze of the chronic relapsing brain disease model has the potential to undermine the stigmatization of addicts, while the therapeutic gaze of pain medicine recognizes that changes in the brain produced by long-term drug use are not in themselves pathological. The article suggests that the brain disease model is limited in its scope because it removes addiction from the social context in which it is experienced. On the other hand, the molecular knowledge produced by brain-based research is likely to challenge the ability of pain medicine to maintain clear-cut distinctions between dependence, the drug-seeking behaviour of pain patients and addiction.

Kosovski JR; Smith DC. Everybody hurts: Addiction, drama, and the family in the reality television show "Intervention". Substance Use & Misuse 46(7): 852-858, 2011. (25 refs.)

This article employs the literature on reality television as well as empirical studies on addiction to analyze Intervention's narrative. We look at the narrative structure of the Intervention's first six seasons (2005-2009), its repeated emphases on the causes of addiction, and the show's purported success rate. Highlighting disturbing discrepancies between the show's representations and assertions versus empirical research, Intervention's notions of what constitutes effective remedies are those treatments generally available only to the financially affluent, and the program's depictions of addiction and intervention practices reinforce a popular culture, rather than a science-based understanding, of the family and of addiction itself.

Kourosh AS; Harrington CR; Adinoff B. Tanning as a behavioral addiction. American Journal of Drug and Alcohol Abuse 36(5): 284-290, 2010 , 2010. (59 refs.)

Background: Persistent tanning despite potentially fatal consequences suggests a compulsive behavior similar to other addictive disorders. Objectives: To review the literature supporting tanning addiction from an epidemiological, behavioral, and neurobiological perspective. Methods: A comprehensive review of the medical literature was conducted to assess the health consequences of tanning, behaviors and other psychiatric disorders associated with tanning, and central rewarding effects of ultraviolet light. Results: Many frequent tanners endorse signs and symptoms adapted from Diagnostic and Statistical Manual-IV (DSM IV) substance abuse or dependence criteria. Recent studies suggest biochemical-mechanisms may reinforce ultraviolet light seeking behavior. Conclusions and Scientific Significance: Frequent and persistent tanning may reveal itself to be a dermatologic-psychiatric disorder with carcinogenic sequelae. Multidisciplinary studies are required to determine the validity of an addiction diagnosis and to explore pharmacologic and cognitive therapeutic options for affected persons.

Kuhar MJ. Contributions of basic science to understanding addiction. BioSocieties 5(1, special issue): 25-35, 2010. (35 refs.)

Discoveries in basic science have helped us understand the drug abuse/dependence/addiction brain disorder. One can view this brain disorder as a long-lasting, relapsing pattern of drug seeking and taking with adverse consequences. Drug self-administration studies in animals have revealed brain circuits and neurotransmitters that underlie drug-induced reward and reinforcement. Moreover, studies of effects of drugs on receptors have shown us how drugs can change gene expression and how drugs can change the biochemical makeup of the brain. Drug-induced changes in the brain are very long lasting, which presumably can explain why drug addiction is a chronic and relapsing disease. Also, drugs exert their actions at least partly through evolved brain circuits that serve functions critical for survival such as feeding and sex. Thus, drugs can harness our strongest instincts and the desire to use them can become very powerful. These findings should influence research, treatment and policy towards the disorder of drug addiction and abuse.

Laudet AB. The case for considering quality of life in addiction research and clinical practice. Addiction Science & Clinical Practice 6(1): unpaginated, 2011

Substance use disorders are increasingly viewed as chronic conditions, and addiction treatment services are beginning to adopt models that were developed to address other chronic conditions. These models address the impact of disease and services on the patient's overall well-being. From this perspective, treatment for addiction aims for the broad goal of recovery, which is defined as abstinence plus improved quality of life. However, the addiction field has come late to the chronic disease perspective, and the concept of quality of life in addiction is relatively undeveloped. This article reviews the evidence for the relevance of quality of life in substance use disorder treatment and recovery and discusses the importance of incorporating quality-of-life indices into research and services.

Public Domain

Lejoyeux M; Weinstein A. Compulsive buying. American Journal of Drug and Alcohol Abuse 36(5): 248-253, 2010 , 2010. (52 refs.)

Background: Compulsive buying is a chronic, repetitive purchasing that becomes a primary response to negative events and feelings, and may include symptoms equivalent to craving and withdrawal. Objectives: This article describes the addictive characteristics of compulsive buying, the psychiatric comorbidity, and the possibilities of treatment. Methods: Using PubMed and MedLine search engines, we performed a review of published literature over the period 1990-2010 using the keyword "compulsive buying". Results: A key feature distinguishing compulsive buyers from normal consumers, collectors, and hoarders is that the former focuses on the buying process itself, rather than the items bought. In this instance, the purchased items are usually never used, but tend to be hidden or thrown away. A recent screening study found that up to 5% of adult Americans appear to be afflicted with this compulsion. Compulsive buying results in adverse consequences, including financial and legal problems, psychological distress (depression, guilt), and interpersonal conflict. The most commonly associated comorbidities are depression and eating disorders. Nothing is known about the neurobiology and genetics of compulsive buying and relatively little about its treatment. Cognitive behavioral therapy has some efficacy, but no medication has been effective in controlled trials. Conclusions: Compulsive buying can be described as a behavioral dependence. A great deal of future research is needed to improve our understanding of compulsive buying.

Lukovitskaia EG. Causes of male deviance. Anthropology and Archeology of Eurasia 49(1): 17-20, 2010. (2 refs.)

Rapid transformation of women's roles in twentieth-century society, including feminism, is seen as a psychological threat to men. Using the work of English psychotherapist Roger Horrocks, the author discusses sociological data from urban Veliki Novgorod. Marginalized male drug addicts are studied in the context of a society that has criminalized drug addiction and forced men into dangerous positions of disillusionment, aggression, and deviance. Men are said to be the overwhelming majority of drug and alcohol abusers in the Novgorod region, where relatively low official statistics are balanced by more accurate perspective from penal colony officials.

Mack AH; Harrington AL; Frances RJ. Clinical Manual for Treatment of Alcoholism and Addictions. Washington DC: American Psychiatric Association, 2010

This manual provides a concise overview of addiction treatment issues relevant to physicians, nurses, psychologists, social workers, alcohol and drug counselors, and rehabilitation therapists and other health care professionals involved in the care of patients with substance use disorders. Following an introductory overview, Chapter 1 considers the magnitude of the problem. Chapter 2 addresses the neurobiology of addictive disorders and the disease concept. Chapter 3 and 4 focus upon evaluation, assessment, presentation and diagnosis. Chapter 5 reviews the natural history of substances of abuse, with the following chapter (Chapter 6) presenting issues which are frequently a part of substance abuse presentations: violence, suicide, injury, forensic issues and clinicial concerns in the correction settings. Chapter 7 examines the phenomenon of behavioral addictions. Chapter 10 focus upon substance use issues among children and adolescents. Chapter 11 addresses other special populations, i.e. seniors, mentally and physically handicapped persons, the chronically ill, and the homeless. Chapter 12 discusses behavioral addictions, including gambling, compulsive buying. Chapters 13 and 14 review treatment modalities and treatment approaches. The concluding chapter discusses the significant related public health issues.

McKay JR; Hiller-Sturmhofel S. Treating alcoholism as a chronic disease approaches to long-term continuing care. Alcohol Research & Health 33(4): 356-+, 2011. (79 refs.)

For many patients, alcohol and other drug (AOD) use disorders are chronic, recurring conditions involving multiple cycles of treatment, abstinence, and relapse. To disrupt this cycle, treatment can include continuing care to reduce the risk of relapse. The most commonly used treatment approach is initial intensive inpatient or outpatient care based on 12-step principles, followed by continuing care involving self-help groups, 12-step group counseling, or individual therapy. Although these programs can be effective, many patients drop out of initial treatment or do not complete continuing care. Thus, researchers and clinicians have begun to develop alternative approaches to enhance treatment retention in both initial and continuing care. One focus of these efforts has been the design of extended treatment models. These approaches increasingly blur the distinction between initial and continuing care and aim to prolong treatment participation by providing a continuum of care. Other researchers have focused on developing alternative treatment strategies (e.g., telephone-based interventions) that go beyond traditional settings and adaptive treatment algorithms that may improve outcomes for clients who do not respond well to traditional approaches.

Muller CP; Schumann G. To use or not to use: Expanding the view on non-addictive psychoactive drug consumption and its implications. Behavioral and Brain Sciences 34(6): 328-347, 2011. (627 refs.)

Proposing a change to the view on psychoactive drug use in non-addicts touches a sensitive issue because of its potential implications to addiction prevention, therapeutic practice, and drug policy. Commentators raised nine questions that ranged from clarifications, suggested extensions of the model to supporting data previously not regarded, to assumptions on the implications of the model. Here, we take up the suggestions of the commentators to expand the model to behavioral addictions, discuss additional instrumentalization goals, and review the evidence from laboratory animal studies on drug instrumentalization. We consider further the role of sociocultural factors and individual development in the establishment in drug instrumentalization and addiction. Finally, we clarify which implications we think this model may have. We conclude that drug instrumentalization theory can be further applied to other behaviors but will require a sensitive debate when used for drug and addiction policy that directly affects prevention and treatment.

Murphy J. Drug court as both a legal and medical authority. Deviant Behavior 32(3): 257-291, 2011. (26 refs.)

This article explores how addiction is conceptualized in a drug court program. Through observations and interviews in a drug court in a large northeastern city, the author reveals how the court uses ambiguous and inconsistent medicalized language to describe addiction, extending the label of addiction to behaviors not just associated with using drugs, but with selling drugs as well. Ultimately, drug courts incorporate a medicalized notion of addiction to further their own control over drug-related issues, since they become the authority of both the client's treatment and their punishment.

Odlaug BL; Grant JE. Pathologic skin picking. American Journal of Drug and Alcohol Abuse 36(5): 296-303, 2010 , 2010. (66 refs.)

Background: Pathologic skin picking (PSP) is characterized by the repetitive and compulsive picking of skin which results in tissue damage. Objectives: This article sought to examine the evidence supporting the phenomenological, and biological links between PSP and substance use disorders. Methods: A review of the literature examining clinical presentation, comorbid psychiatric conditions, and treatment studies was used to examine the relationship of PSP and substance use disorders. Results: Prevalence rates of PSP range from 1.4-5.4% in the general population, with a much higher preponderance in females and in psychiatric patients. Significant medical complications are common, including scarring and infection. Although some pharmacologic agents (selective serotonin reuptake inhibitors, opioid antagonists, and glutamatergic agents) and non-pharmacologic treatments (habit-reversal therapy, Internet-based treatments, and acceptance-enhanced behavior therapy) have shown early promise in treating this often disabling disorder, evidence-based treatment options are still limited. Conclusions: PSP shares several clinical similarities with substance use disorders including the failure to stop the behavior despite knowledge of the consequences and an associated pleasurable quality while engaging in the activity. Scientific Significance: The consideration of some other impulse control disorders (e. g., pathological gambling) as addictions has helped advance treatment strategies. Conceptualizing PSP as an addiction, in some individuals, may lead to more effective treatment approaches.

Popescu D; Popescu G; Lupu G; Panus V; Neagu-Sadoveanu S; Buda O. Drugs effects on the central nervous system. Forensic implications. Romanian Journal of Legal Medicine 18(3): 231-236, 2010 , 2010. (19 refs.)

Addiction is a wide spread term used in our days. Some of the habits due to routine conditioning are called dependencies, i.e.: eating shopping etc. These are fundamentally different from those due to chronic alcohol intake, drugs, medicines (chemicals), with euphoric effect. For this reason some physicians prefer the term of addiction. Unlike the benign addiction, by conditioning, drug addiction initiates very fast (after 1 or 2 intakes), had a big resistance at treatment and show the phenomena of sever disturbance in withdrawal. In this paper we refer mainly at this kind of dependency. Nervous disturbances that are produced during drugs and even alcohol intakes refer to psychical affective and cognitive processes. The prevailing factor of these processes is the hedonist one.

Reynaud M; Karila L; Blecha L; Benyamina A. Is love passion an addictive disorder? American Journal of Drug and Alcohol Abuse 36(5): 261-267, 2010 , 2010. (79 refs.)

Aims: Inquiry regarding the relationship between passionate love and addiction has long been a topic of intense debate. Recent advances in neurobiology now allow for an examination between these two states. Methods: After describing the clinical distinctions between "love passion," "love addiction," and "sex addiction," we compare clinical, neuropsychological, neurobiological, and neuroimaging data on love, passion, pathological gambling (PG) and substance dependence. Results: There are no recognized definitions or diagnostic criteria for "love addiction," but its phenomenology has some similarities to substance dependence: euphoria and unrestrained desire in the presence of the love object or associated stimuli (drug intoxication); negative mood, anhedonia, and sleep disturbance when separated from the love object (drug withdrawal); focussed attention on and intrusive thoughts about the love object; and maladaptive or problematic patterns of behavior (love relation) leading to clinically significant impairment or distress, with pursuit despite knowledge of adverse consequences. Limited animal and human studies suggest that brain regions (e. g., insula, anterior cingulated [ACC], orbitofrontal [OFC]) and neurotransmitters (dopamine) that mediate substance dependence may also be involved with love addiction (as for PG). Ocytocin (OT), which is implicated in social attachment and mating behavior, may also be involved in substance dependence. There are no data on the epidemiology, genetics, co-morbidity, or treatment of love addiction. Conclusion: There are currently insufficient data to place some cases of " love passion" within a clinical disorder, such as " love addiction," in an official diagnostic nomenclature or to firmly classify it as a behavioral addiction or disorder of impulse control. Further clinical and scientific studies are needed to improve our understanding and treatment of this condition. For these studies, we propose new criteria for evaluating addiction to love.

Reynaud M; Karila L. From substance dependence to addiction: Impact of a conceptual shift on therapeutic approaches? (review). Current Pharmaceutical Design 17(14): 1321-1322, 2011. (15 refs.)

Switching from the concept of substance or alcohol dependence to that of addiction has profoundly modified our ways of approaching, treating and organizing the care of this disease. This more complex and subtle approach gives less importance to the substance and its effects and focuses more on the initiation of pathological behavior. It is important to keep in mind that the addictive process associates a substance (more or less addictive), an individual (more or less vulnerable) and an environment (more or less condoning). Today, it is no longer possible to consider that a drug acts on only one receptor or one system. Current understanding of inner regulation mechanisms integrates the interactions between the various stimulated brain pathways. Addiction treatments which should benefit from advances in genetics, neuropsychology and neuroimaging could be increasingly individualized in the years to come. The "addictology" approach has triggered thinking about other therapeutic approaches such as modification of therapeutic objectives toward "risk reductions" or applying this model to behavioral addictions (food, sex, sport, gaming...). This conceptual shift seems to enrich clinical analysis, the therapeutic possibilities and the avenues for research.

Russell C; Davies JB; Hunter SC. Predictors of addiction treatment providers' beliefs in the disease and choice models of addiction. Journal of Substance Abuse Treatment 40(2): 150-164, 2011. (58 refs.)

Addiction treatment providers working in the United States (n = 219) and the United Kingdom (n = 372) were surveyed about their beliefs in the disease and choice models of addiction, as assessed by the 18-item Addiction Belief Scale of J. Schaler (1992). Factor analysis of item scores revealed a three-factor structure, labeled "addiction is a disease," "addiction is a choice," and "addiction is a way of coping with life," and factor scores were analyzed in separate hierarchical multiple regression analyses. Controlling for demographic and addiction history variables, treatment providers working in the United States more strongly believe addiction is a disease, whereas U.K.-based providers more strongly believe that addiction is a choice and a way of coping with life. Beliefs that addiction is a disease were stronger among those who provide for-profit treatment, have stronger spiritual beliefs, have had a past addiction problem, are older, are members of a group of addiction professionals, and have been treating addiction longer. Conversely, those who viewed addiction as a choice were more likely to provide public/not-for-profit treatment, be younger, not belong to a group of addiction professionals, and have weaker spiritual beliefs. Additionally, treatment providers who have had a personal addiction problem in the past were significantly more likely to believe addiction is a disease the longer they attend a 12-step based group and if they are presently abstinent.

Samokhvalov AV; Popova S; Room R; Ramonas M; Rehm J. Disability associated with alcohol abuse and dependence. Alcoholism: Clinical and Experimental Research 34(11): 1871-1878, 2010 , 2010. (76 refs.)

Background: Alcohol use disorders (AUD), i.e., alcohol dependence and abuse, are major contributors to burden of disease. A large part of this burden is because of disability. However, there is still controversy about the best disability weighting for AUD. The objective of this study was to provide an overview of alcohol-related disabilities. Methods: Systematic literature review and expert interviews. Results: There is heterogeneity in experts' descriptions of disabilities related to AUD. The major core attributes of disability related to AUD are changes of emotional state, social relationships, memory and thinking. The most important supplementary attributes are anxiety, impairments of speech and hearing. Conclusions: This review identified the main patterns of disability associated with AUD. However, there was considerable variability, and data on less prominent patterns were fragmented. Further and systematic research is required for increasing the knowledge on disability related to AUD and for application of interventions for reducing the associated burden.

Schenker M. The disease concept. (Chapter 2). IN: Brizer D; Castandea R, eds. Clinical Addiction Psychiatry. New York: Cambridge University Press, 2011

Seear K; Fraser S. The 'sorry addict': Ben Cousins and the construction of drug use and addiction in elite sport. Health Sociology Review 19(2): 176-191, 2010 , 2010. (53 refs.)

Australian Football League (AFL) player Ben Cousins is one of the most highly acclaimed and recognised athletes in Australia. Followed closely in the media, his off-field activities are subject to as much attention and speculation as those on the field. In 2007, Cousins and his family confirmed long-standing rumours that he was an illicit (non-performance enhancing) drug user. Following a series of incidents, his football contract was terminated and Cousin's publicly entered drug rehabilitation. In this article we explore the multiple extant accounts of Cousins' drug use. We examine media representations of his drug use, including accounts from a range of key stakeholders, and we also look at Cousins' public accounts of his own drug use. What emerges is paradoxical picture both of Cousins himself and of drug users more broadly. Cousins is simultaneously positioned as in control and out of control, as manipulative and as subject to the manipulations of his 'addiction', as criminal and victim, as culpable and innocent. In the process, he acts as a figure through which contemporary understandings of the nature and implications of addiction are produced and reproduced. What is addiction? If as many now take for granted, it is a disease requiring a medical response, what can be said about the agency and responsibility of the 'addict' in the context of elite sport? How do mainstream understandings of elite sportsmen as intrinsically masterful, commanding and physically exemplary mesh with assumptions about drug addicts as passive and physically compromised? In considering this intersection of discourses of elite sports and of addiction, we also explore some of the unique dimensions of the Cousins case including the challenge his embodied athleticism poses to understandings of his drug use, and the significance attributed to his rehabilitation and 'comeback' in 2009. We conclude with some reflections on the ways in which Cousins' case troubles certainties about drug use, and on the strategic efficacy of disease models of addiction in Australia.

Smith DE; Lee DR; Davidson LD. Health care equality and parity for treatment of addictive disease. Journal of Psychoactive Drugs 42(2): 121-126, 2010. (32 refs.)

Substance abuse represents a significant underlying cause of the health issues faced in the United States, which severely impacts the nation's health care system and economy. Recently enacted parity legislation mandates that benefits for addiction and mental health treatment be provided on an equal footing with those for treatment for physical health. Diversion and abuse of prescription medications is growing in young people, with much of the diversion occurring between family and friends. Addiction has been accepted by mainstream medicine as a brain disease, and is associated with many other medical disorders. Early intervention and treatment for addiction provides extraordinary cost-benefit outcomes. Additional training for addiction professionals will be necessary. Stigmatization of substance abusers continues to exist at the state and federal levels, although research during the past 10 years indicates that patient compliance and relapse rates for substance abusers are not significantly different than those for individuals with other chronic diseases, e.g. diabetes, hypertension, and cardiac issues. While parity for addiction treatment has become policy at the federal level, great challenges lie ahead in funding access, facilities, and training, as well as redirecting societal perceptions and legislated penalties.

Stanford M; Banerjee K; Garner R. Chronic care and addictions treatment: A feasibility study on the implementation of post-treatment continuing recovery monitoring. Journal of Psychoactive Drugs Supplement 6: 295-302, 2010 , 2010. (6 refs.)

In the treatment of drug addiction, as with other chronic conditions, the effects of treatment are significant but not long lasting after discharge unless continuing monitoring is provided. Efforts to help patients sustain positive treatment outcomes are generally directed to community support. Post-discharge checkups can help patients evaluate their behavior and recovery-related issues similar to a person with diabetes reporting on blood sugar levels and diet and exercise patterns. The challenge for providers is to raise awareness of the importance of continuing recovery monitoring and the responsibility of the treatment program to build a more seamless continuum of care for patients who have completed a primary treatment episode. This article reviews a pilot project of the Department of Alcohol & Drug Services of Santa Clara County, California that tested the feasibility of implementing a continuing recovery monitoring (CRM) service using post-discharge telephone check-ups for volunteer patients (N = 32) who completed treatment. The aims of the study were to (a) develop a model for continuing recovery monitoring, (b) gather data on the model's utility including identifying organizational and logistical challenges and, (c) describe several changes needed in the system of care to add CRM. The study showed that the model of continuing recovery monitoring is a feasible way to extend a system's existing continuum of care.

Sussman S; Reynaud M; Aubin HJ; Leventhal AM. Drug addiction, love, and the higher power. Evaluation & the Health Professions 34(3), 2011. (25 refs.)

This discussion piece suggests that reliance on a Higher Power in drug abuse recovery programs is entertained among some addicts for its psychobiological effects. Prayer, meditation, early romantic love, and drug abuse may have in common activation of mesolimbic dopaminergic pathways of the brain and the generation of intense emotional states. In this sense, reliance on a Higher Power may operate as a substitute addiction, which replaces the psychobiological functions formerly served by drug use. Implications of this perspective are discussed.

Travis T. The Language of the Heart: A Cultural History of the Recovery Movement from Alcoholics Anonymous to Oprah Winfrey.. Chapel Hill, NC: The University of North Carolina Press, 2010

This book, authored by a cultural historian, traces the history of recovery movements in the United States, from the earliest days of Alcoholics Anonymous to the present day, and examines their connections to broader historical and cultural currents. It is based on the extensive examination of archival documents. The author discusses the relationship of the recovery movement to the broad American tradition of self-help, highlighting the roles that gender, mysticism, and print culture have played in that development. Organized into three parts, Part I examines the origins of the recovery movement in the experiences of Alcoholics Anonymous, its philosophy, its postulating alcoholism as a disease, but different than the usual definitions of disease, as it is not limited to the physical body. The debt to earlier Protestant Evangelical fellowships is recognized, but the differences are are significant. Shorn from specific religious content, it embraces spirituality. The goal was not only embrace sobriety, but also to renounce toxic self-centeredness in favor of humility and service. Part II focus upon the importance of print media in the history of the recovery movement. This too represents a legacy from the evangelical Protestantism and from "new thought Christianity" which William James discussed. While formed in 1935, by 1951, AA had begun publishing conference approved literature. For a group with little formal organization, this was in effect its "glue". In 1971, Hazelden a leading treatment program also established a publishing arm. The expansion of the recovery movement beyond AA is also discussed. There were other twelve-step programs modeled after AA, but also growing attention to behaviorial addiction. Of note was the attention to co-dependency, a word that has become part of the culture. Part III considers the nature of the recovery movement in the past decade. A component is seen as attention to empowerment, and efforts to escape/confront the psychological consequences of social conditions and social hierarchies. The thread which ties these to earlier efforts is the appearl to spiritual solutions to problems of gender and power.

Volkow ND; Baler RD; Goldstein RZ. Addiction: Pulling at the neural threads of social behaviors. (editorial). Neuron 69(4): 599-602, 2011. (19 refs.)

Addiction coopts the brain's neuronal circuits necessary for insight, reward, motivation, and social behaviors. This functional overlap results in addicted individuals making poor choices despite awareness of the negative consequences; it explains why previously rewarding life situations and the threat of judicial punishment cannot stop drug taking and why a medical rather than a criminal approach is more effective in curtailing addiction.

Vrecko S. Birth of a brain disease: Science, the state and addiction neuropolitics. History of the Human Sciences 23(4): 52-67, 2010 , 2010. (79 refs.)

This article critically interrogates contemporary forms of addiction medicine that are portrayed by policy-makers as providing a 'rational' or politically neutral approach to dealing with drug use and related social problems. In particular, it examines the historical origins of the biological facts that are today understood to provide a foundation for contemporary understandings of addiction as a 'disease of the brain'. Drawing upon classic and contemporary work on 'styles of thought', it documents how, in the period between the mid-1960s and the mid-1970s, such facts emerged in relation to new neurobiological styles of explaining and managing social problems associated with drug abuse, and an alliance between a relatively marginal group of researchers and American policy-makers who were launching the 'War on Drugs'. Beyond illustrating the political and material conditions necessary for the rise of addiction neuroscience, the article highlights the productivity of neurobiological thought styles, by focusing on the new biological objects, treatments and hopes that have emerged within the field of addiction studies over the last several decades.

Windle M. A multilevel developmental contextual approach to substance use and addiction. BioSocieties 5(1, special issue): 124-136, 2010. (36 refs.)

Emerging technological advances in genetics and neuroscience have spawned innovative or elaborated conceptual models in the field of addiction science, as well as contributed to the mushrooming of new knowledge. By addictions, reference is made to chronic, often relapsing disorders typified by obsession, compulsion or physical or psychological dependence. In this article it is proposed that a multilevel developmental contextual approach to substance use and addictions provides a useful framework for integrating existing studies across disciplines and serving as a generative guide to intriguing novel research questions. The multilevel developmental contextual approach emphasizes multiple-factor influences on substance use and addiction, the conjoint influence of variables from different levels of analysis (for example, genetic, biochemical, physiological, cognitive, social, neighborhood, societal), and dynamic, probabilistic behavior-outcome relations (that is, the occurrence as well as the nature of expression of substance problems and addiction depend on a range of emerging, interactive factors that may vary across individuals and over time). The approach is illustrated with a long-term prospective study of predictors of binge drinking from adolescence to young adulthood and a description of the role of brain processes and mechanisms involved in the development and expression of alcohol use during adolescence.

Yates R; Malloch M, eds. Tackling Addiction: Pathways to Recovery. London: Jessica Kingsley, 2010

The construct of 'recovery' gets considerable attention. However, the its meaning is ambiguous. This edited collection brings together the thoughts and experiences of researchers, practitioners and service users from the fields of health, addiction and criminal justice. Chapters cover the influence of crime and public health in UK drug policy; the ongoing emphasis on substitute prescribing; the role of recovery groups and communities; gendered differences in the recovery process; and implications for responses aimed at supporting women. "Tackling Addiction" will be essential reading for practitioners, researchers, policy makers and students in the fields of addiction, social care, psychology and criminal justice.

Young LB. Joe Sixpack: Normality, deviance, and the disease model of alcoholism. Culture & Psychology 17(3): 378-397, 2011. (107 refs.)

The advantages of the disease model of alcoholism are well known, but the disadvantages have received little attention. The model's dominance has forestalled consideration of alternative and potentially valuable theories. It reinforces the value of normality even as it marks alcoholics as deviant. It suggests problem drinkers can diagnose themselves. These disadvantages are traceable to narrowly constructed scientific discourses: science-as-positivism, alcoholism-as-disease, and the individual-as-scientist. As a result, problem drinkers pondering a diagnosis of alcoholism emphasize the positivist concepts of central tendency, objectivity, and prediction/control. Positivism reinforces the value of normality even as a disease diagnosis threatens to mark the personal identity as deviant. In this circumstance, continuing to drink while manipulating drinking variables is rational. Alcoholism theory would benefit if researchers extended conceptualizations beyond the disease model. Alcoholism treatment would benefit if treatment professionals challenged social norms, emphasized subjectivity, and determined the parameters of the drinker's self-control.