Conceptualisation of drug and alcohol addiction as a disease

Letters to the Editor

The conceptualisation of drug and alcohol addiction as a disease has been developed over the past 200 years.

The origin of the disease concept has been credited to Benjamin Rush. Rush's educators conceptualised disease as an imbalance of the nervous system (Martin ,2012).

Therefore, if alcohol was regarded as a central nervous system stimulant, the excessive use of which would cause an imbalance of the nervous system, it is reasonably understandable how Rush then identified alcoholism as a disease, with alcohol as the cause, “loss of control over drinking behaviour being the characteristic symptom, and total abstinence the only effective cure” (Martin, 2012, p. 162).

Over the course of the past 25 years the boundaries of what represents a disease has been expanded to include risk associated with family history, age, lifestyle, and/or environment.

According to Morse and Flavin of the Joint Committee of National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine (as cited in (Martin ,2012) the following definition of disease, clearly illustrates addictions:

Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.

The disease is often progressive and fatal. It is characterised by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic.

Heritability or family history of illness as a risk factor for a number of diseases has been the hallmark for the disease concept in late 20st century medicine.

Several well-designed twin studies have supported the connection between nonspecific genetic factors and the increased risk of developing alcohol addiction among those individuals who consume alcohol.

Studies on the pharmacogenetics of alcohol preference drinking in rodents and the mediators of risk in sons of alcoholic also support the model (Meyer, 2016).

Ripple & Luthar (2018) suggest that the familial influence in the etiology of drug use can be explained by either genetics or family environment.

In the area of substance abuse, most of the evidence supporting genetic transmission has been obtained through family history and family interview investigations rather than by biological and twin/adoption studies.

Studies indicate that instead of drug abuse/dependency being specifically transmitted in families, there is a wide-range of psychopathology that is found to cluster within families of substance abusers one of which may be illicit substance abuse.

Studies addressing the comorbidity of alcoholism with drug abuse have investigated whether or not the clustering of disorders represent one central illness or the co-occurrence of separate disorders.

Within the transmitted cluster of disorders found in drug abusers, it appears that the disorders are transmitted independently of one another.

Regarding the familial transmission of drug abuse versus alcoholism, Ripple & Luthar ( 2016) concluded that there might be evidence that supports the existence of "specific transmissive processes" (p.151 ), which indicate the type of substance used.

In other words, if a parent is an alcoholic, then the offspring will be predisposed to alcoholism and not to the abuse of other kinds of illicit drugs (Ripple & Luthar, 1996).

Ethnic studies also suggest that familial transmission patterns can vary across ethnic groups. Luthar, Merikangas, & Rounsaville (2013) found a significant correlation between paternal alcoholism and offspring substance abuse among African American, but not Caucasian families.

In a study by Ravaja & Keltikangas (2011 ), it was found that regardless of gender, maternal and paternal alcohol intake and getting drunk (index of heavy drinking) were strong predictors of offspring novelty seeking.

According to Gabel et al (2018), novelty seeking is associated with alcohol and drug dependent symptoms among severely disturbed adolescent boys, which indicates a link between parental alcoholism and the increased risk of adolescent substance abuse.

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