Toward a Comprehensive Theory of Alcoholism
Toward a Comprehensive Theory of Alcoholism
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走向酒精中毒的综合理论
DOI：
10.1111/j.1749-6632.1994.tb24717.x
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发表时间：
1994
影响因子：
5.2
通讯作者：
R. Meyer
中科院分区：
文献类型：
--
作者：
R. Meyer
一个全面的酒精中毒理论必须考虑到酒精中毒的异质性，疾病的自然史，以及酒精依赖的核心综合征的存在。此外，已确定的风险因素，如酗酒家族史和/或反社会人格障碍的存在，存在于一些酗酒患者，而不是在其他人。这些问题的复杂性有时助长了关于“疾病概念”的辩论。疾病概念的反对者认为，酒精中毒并不总是遵循一个明确的过程，具有一系列特征性的症状，而支持者则认为，医学上的许多疾病都存在与酒精中毒相同的发病、进展和严重程度的变异性。事实上，我们需要在临床医学、公共卫生和精神病学中不断发展的“疾病”定义的背景下来看待酗酒中疾病概念的历史。如果在酒精中毒的症状和后果范围内存在明确的疾病，则在DSM-111-R'和ICD 10 2中描述的酒精依赖的制剂中发现。这些标准是指一组认知，行为和生理症状，表明该人对酒精的控制受损，尽管有不良后果，但仍继续饮酒。该标准主要基于Edwards和Gross于1976年提出的“酒精依赖综合征”的症状。DSM-IV 4中的酒精依赖标准与DSM-111-R非常接近，但有一些微小的变化。虽然这些疾病分类学中的依赖性结构是明确分类的，但依赖性的严重程度可以沿着一个连续体进行量化。严重依赖可能与残疾增加有关，但酒精相关残疾也可能受到遗传、人口统计学和环境因素以及共病精神病、生物医学或物质使用障碍的显著影响。医学中“疾病”的界限已经扩大到包括对人群中风险因素（遗传特征、环境、人类行为）的关注，这些风险因素可能证明对个体进行干预以降低随后病理学的风险是合理的。该表述涉及“正常”或“异常”的定义（例如，胆固醇水平），关于这一点可能存在争议，因为这些指标确定的是群体中的相对风险，而不是个体风险。在这个框架内，人类行为也可以作为一个风险因素，以及一个杠杆，可以影响减少遗传和环境来源的疾病风险。酒精滥用（DSM-111-R和DSM-IV）和有害使用（ICD-10）等诊断可能需要基于假定风险进行干预，但出于所有意图和目的，这些类别与疾病结构无关。如果疾病结构具有任何有效性，它应该与两个重要的临床现象具有某种预测关系：戒断一段时间后再次使用的倾向和依赖综合征要素的快速恢复
A comprehensive theory of alcoholism must take into account the heterogeneity of alcoholic symptomatology, the natural history of the disorder, and the presence of a core syndrome of alcohol dependence. Moreover, identified risk factors, such as a family history of alcoholism and/or the presence of antisocial personality disorder, are present in some alcoholic patients and not in others. The complexity of these issues has sometimes served to fuel the debate on the “disease concept.” Opponents of the disease concept argued that alcoholism did not always follow a clearcut course with a characteristic train of symptoms, whereas advocates argued that many diseases in medicine present with the same variability of onset, progression, and severity as alcoholism. Indeed, the history of the concept of disease in alcoholism needs to be seen in the context of our evolving definitions of “disease” in clinical medicine, public health, and psychiatry. If there is an explicit disease within the spectrum of symptoms and consequences of alcoholism, it is found within the formulation of alcohol dependence described in DSM-111-R’ and ICDlo2. These criteria refer to a cluster of cognitive, behavioral, and physiological symptoms that indicate that the person has impaired control over alcohol and continues to drink despite adverse consequences. The criteria are based largely on the symptom complex proposed as the “alcohol dependence syndrome” by Edwards and Gross’ in 1976. With some minor changes, the proposed criteria for alcohol dependence in DSM-IV4 adhere closely to DSM-111-R. Although the dependence construct in these nosologies is explicitly categorical, severity of dependence may be quantified along a continuum. Severe dependence may be associated with increased disability, but alcohol-related disabilities may also be significantly influenced by genetic, demographic, and environmental factors as well as by the presence of co-morbid psychiatric, biomedical, or substance use disorders.s The outcome of alcoholism treatment may be affected by both severity of dependence and severity of alcohol-related disabilities.h To a great degree, the boundaries of “disease” within medicine have been expanded to include a concern about risk factors within populations (heritable traits, the environment, human behavior) that might justify intervention with individuals to reduce the risk of subsequent pathology. This formulation involves definitions of “normal” or “abnormal” (e.g., cholesterol levels), about which there may be controversy, because these identify relative risk in a population and not individual risk. Within this framework, human behavior can also serve as a risk factor as well as a lever which can be influenced to reduce both heritable and environmental sources of risk of disease. Diagnoses such as alcohol abuse (DSM-111-R and DSM-IV) and harmful use (ICD-10) may warrant intervention on the basis of presumed risk, but for all intents and purposes, these categories stand apart from the disease construct. If the disease construct has any validity, it should bear some predictive relationship to two important clinical phenomena: a tendency to use again after a period of abstinence and the rapid reinstatement of the elements of the dependence syndrome
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影响因子：
56.9
作者：
CLONINGER, CR
通讯作者：
CLONINGER, CR
酗酒者的类型，I。基于脆弱性和严重性指标的经验推导的类型学的证据。
影响因子：
--
作者：
Babor,TF;Hofmann,M;DelBoca,FK;Hesselbrock,V;Meyer,RE;Dolinsky,ZS;Rounsaville,B
通讯作者：
Rounsaville,B
酒精中毒合理药物治疗的前景。
DOI：
--
发表时间：
1989
期刊：
The Journal of clinical psychiatry
影响因子：
--
作者：
Meyer,RE
通讯作者：
Meyer,RE
药物依赖综合征概念作为解释和预测复发的组织原则。
DOI：
--
发表时间：
1986
期刊：
NIDA research monograph
影响因子：
--
作者：
Babor,TF;Cooney,NL;Lauerman,RJ
通讯作者：
Lauerman,RJ
单次服用氟马西尼即可逆转酒精依赖和耐受性。
DOI：
--
发表时间：
1991
期刊：
The Journal of pharmacology and experimental therapeutics
影响因子：
--
作者：
Buck,KJ;Heim,H;Harris,RA
通讯作者：
Harris,RA