Survey of studies on alcoholism

The Etiologic, Theory-Based, Ontogenetic Hierarchical Framework of Alcohol Use Disorder: A Translational Systematic Review of Reviews

Modern nosologies (e.g., ICD-11, DSM-5) for alcohol use disorder (AUD) and dependence prioritize reliability and clinical presentation over etiology, resulting in a diagnosis that is not always strongly grounded in basic theory and research. Within these nosologies, DSM-5 AUD is treated as a discrete, largely categorical, but graded, phenomenon, which results in additional challenges (e.g., significant phenotypic heterogeneity). Efforts to increase the compatibility between AUD diagnosis and modern conceptualizations of alcohol dependence, which describe it as dimensional and partially overlapping with other psychopathology (e.g., other substance use disorders) will inspire a stronger scientific framework and strengthen AUD's validity. We conducted a systematic review of 144 reviews to integrate addiction constructs and theories into a comprehensive framework with the aim of identifying fundamental mechanisms implicated in AUD. The product of this effort was the Etiologic, Theory-Based, Ontogenetic Hierarchical Framework (ETOH Framework) of AUD mechanisms, which outlines superdomains of cognitive control, reward, as well as negative valence and emotionality, each of which subsume narrower, hierarchically-organized components. We also outline opponent processes and self-awareness as key moderators of AUD mechanisms. In contrast with other frameworks, we recommend an increased conceptual role for negative valence and compulsion in AUD. The ETOH framework serves as a critical step towards conceptualizations of AUD as dimensional and heterogeneous. It has the potential to improve AUD assessment and aid in the development of evidence-based diagnostic measures that focus on key mechanisms in AUD, consequently facilitating treatment matching.

Engaging problem drinkers in a general hospital setting

Objective:To determine the level of engagement as defined by return for out-patient appointment in patients referred for alcohol counselling in a general hospital.Method:The hospital was offered a service with counselling within 24 hours for patients who were identified by ward staff as having alcohol related problems. Referred patients were interviewed on the ward by a nurse who specialised in alcohol counselling. Follow-up appointments were offered.Results:60% of those given counselling returned for further counselling as out-patients. 83% of women counselled were engaged compared with 42% of men (p<0.05). The mean SADD (a measure of alcohol dependency) score was 23.9 in those subjects who were engaged and 18.6 in those not engaged (p<0.05), indicating greater dependency in the former group.Conclusions:Although these patients had not actively sought help with their drinking 60% returned for counselling as out-patients. Women and those with high levels of alcohol dependency were more likely to seek further counselling.

Beyond the Disease Concept of Addiction: Drug Use as a Way of Life Leading to Predicaments

The origins, vicissitudes and limitations of the disease concept amd medical model of drug use are examined. It is proposed that the disease concept is a reaction to the moralism or neglect of previous times. However the concept omits the human element.

‘Way of life’—a model taking into account the interaction between drug, person and environment—is proposed, drug dependence being present when drug use, as a way of life, is given a high priority.

Persons with drug dependence may find themselves in a ‘predicament’ and may need help to get their ways of life in balance again.

Various implications of this proposed model are explored.