The misuse of alcohol inflicts a major toll on individual users, their families, and the wider society. This includes disruptions of family life, violence, absenteeism and problems in the workplace, child neglect and abuse, and excess morbidity and mortality. The World Health Organization estimates that alcohol ranks eighth among global risk factors for death and is the third leading global risk factor for disease and disability. In the United States, alcohol dependence affects four to five percent (...) of the population at any given time. Alcohol dependence also exacts a significant financial toll.... (shrink)

Excessive alcohol use has adverse effects on the central nervous system (CNS) and can lead to alcohol use disorders (AUDs). Recent studies have suggested that myelin reductions may directly contribute to CNS dysfunctions associated with AUDs. Myelin consists of compact lipid membranes wrapped around axons to provide electrical insulation and trophic support. Regulation of myelin is considered as a new form of neural plasticity due to its profound impacts on the computation of neural networks. In this review, the (...) authors first discuss experimental evidence showing how alcohol exposure causes demyelination in different brain regions, often accompanied by deficits in cognition and emotion. Next, they discuss postulated molecular and cellular mechanisms underlying alcohol's impact on myelin. It is clear that more extensive investigations are needed in this important but underexplored research field in order to gain a better understanding of the myelin‐behavior relationship and to develop new treatment strategies for AUDs. (shrink)

Alcohol addiction can lead to health and social problems. It can also affect people's emotions. Emotion plays a key role in human communications. It is important to recognize the people's emotions at the court and infer the association between the people's emotions and the alcohol addiction. However, it is challenging to recognize people's emotions efficiently in the courtroom. Furthermore, to the best of our knowledge, no existing work is about the association between alcohol addiction (...) and people's emotions at court. In this paper, we propose a deep learning framework for predicting people's emotions based on sound perception, named ResCNN-SER. The proposed model combines several neural network-based components to extract the features of the speech signals and predict the emotions. The evaluation shows that the proposed model performs better than existing methods. By applying ResCNN-SER for emotion recognition based on people's voices at court, we infer the association between alcohol addiction and the defendant's emotion at court. Based on the sound source data from 54 trial records, we found that the defendants with alcohol addiction tend to get angry or fearful more easily at court comparing with defendants without alcohol addiction. (shrink)

This article investigates the ability of mental incapacity tests to account for problems of control, through a study of the approach to alcohol dependence and a comparison with the approach to anorexia nervosa, in England and Wales. The focus is on two areas of law where questions of legal and mental capacity arise for people who are alcohol dependent: decisions about treatment for alcohol dependence and diminished responsibility for a killing. The mental incapacity tests used (...) in these legal contexts are importantly different—one involves a ‘cognitive’ test, while the other includes an explicit impaired-control limb—and the comparison provides insight into a longstanding debate about the virtues of one type of test over the other. It is shown that both kinds of test can take control problems into account, but also that both can be interpreted in narrow and wide ways that significantly influence the outcome of the assessment. It is therefore argued that to a large extent, it is not the kind of mental incapacity test that matters, but how the test is interpreted. It is further proposed that value judgements are playing an unrecognised and inappropriate role in shaping this interpretation. This raises concerns about the current approach to assessing the impact of alcohol dependency on the capacity to make decisions about alcohol use or treatment, as well as broader concerns about flexibility within incapacity tests. (shrink)

Ethical frameworks can support professionals’ decision‐making. Here, we identify two ethical frameworks to analyse the best support for families that struggle with parental substance or alcohol abuse. The first framework, which we call ‘the framework of conflicting interests’, is most prominent in the literature. Here, the interests of parents and children are weighed against each other using the medical ethical principles of respect for autonomy, justice, beneficence, and non‐maleficence. The second framework is most prominent in a series of interviews (...) we conducted with alcohol‐dependent parents and professionals working in addiction care and youth care. This framework aligns more with an ethics of care, and starts with the assumption that the interests of people who are close to each other are often intertwined. This framework does not so much look at conflicting interests, but at relationships and vulnerability. We label this the ethics of care framework. In this article, we show the value of both frameworks and how they can support ethical decision‐making. (shrink)

I argue that addiction is not a chronic, relapsing, neurobiological disease characterized by compulsive use of drugs or alcohol. Large-scale national survey data demonstrate that rates of substance dependence peak in adolescence and early adulthood and then decline steeply; addicts tend to “mature out” in their late twenties or early thirties. The exceptions are addicts who suffer from additional psychiatric disorders. I hypothesize that this difference in patterns of use and relapse between the general and psychiatric populations (...) can be explained by the purpose served by drugs and alcohol for patients. Drugs and alcohol alleviate the severe psychological distress typically experienced by patients with comorbid psychiatric disorders and associated problems. On this hypothesis, consumption is a chosen means to ends that are rational to desire: Use is not compulsive. The upshot of this explanation is that the orthodox view of addiction as a chronic, relapsing neurobiological disease is misguided. I delineate five folk psychological factors that together explain addiction as purposive action: strong and habitual desire; willpower; motivation; functional role; and decision and resolve. I conclude by drawing lessons for research and effective treatment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On Concepts and Theories of AddictionLennart Nordenfelt (bio)Keywordsaddiction, disease, will power, autonomy, holistic view of healthThe article "A Liberal Account of Addiction" is a good piece of analytic philosophy applied to psychiatry. It is well-informed both with regard to empirical matters and philosophical conceptualization. The arguments are often—but, as I will show, not always—quite convincing. The conclusions of the paper also have crucial consequences for practice, for the (...) treatment of patients, and for social policy.The authors argue that current scientific understandings of the problem of addiction are fundamentally flawed. They distinguish between two main positions in science: The Disease View and the Willpower View. According to the Disease View, drug-seeking behavior is the direct result of some physiological change in the drug seeker's brain. According to the Willpower View, the addict is no longer rational; he or she uses drugs as a result of a fundamentally non-voluntary process.The authors dismiss the Disease View in the following way. They first note that drug addicts are in many ways rational planners. The addicts may have to think a lot to find the best ways to find the heroin, cigarettes, or alcohol, and they normally act according to this planning. They are not in any simple sense "caused" to act in a particular way. Moreover, referring to recent neurological literature, the authors note that the changes caused by drug addiction—which have to do with activating reward pathways in the brain—are identical with the outcomes of many other human activities that we do not call addiction. "In fact, any pleasurable experience causes dopamine to be released within the brain, activating these reward pathways" (Foddy and Savulescu 2010, 4). These experiences can be the result of coffee drinking, sexual activity, and physical exercise. Thus, the physical changes in the brain are not effects peculiar to the pharmacology of the drugs; they are instead the effects of the pleasure that the subject has experienced.The argument against the Willpower View is lengthy and more involved. The proponent of the Willpower View must argue that there is some flaw in the subject's autonomy. The drug addict is in some sense unable to avoid taking the drug. The authors of the present article scrutinize this idea on the basis of distinguishing between different senses of autonomy: Substantive autonomy and procedural autonomy. They state that we must here be talking about procedural autonomy, namely, autonomy regarded as dependent only on our capacity to process information and make choices in accordance with our preferences. We cannot, as in the case of substantive autonomy, require that the preferences themselves be reasonable. [End Page 27] In such a case, many of our ordinary actions would be judged non-autonomous.The most reasonable Willpower accounts rely on the idea that addicted people in some sense lack self-control. The authors cite different interpretations of the concept of lacking self- control and they conclude that "none of these … theories can say that addicts are necessarily lacking in self-control unless they also make unreasonable normative or false factual claims about the nature of drug- or pleasure-oriented choices" (Foddy and Savulescu 2010, 10). For instance, according to one interpretation the subject does not endorse his own desire for drugs, but takes the drug anyway. According to another interpretation, the addict regrets taking the drug after having done so. Against such claims the authors claim that many addicts indeed endorse their desires for drugs and many addicts do not regret their addictive behavior.So what is the positive account proposed by the authors? They put forward what they call a Liberal View. It contains three claims about addiction: First, we do not know whether an addict values anything more than the satisfaction of his addictive desires; second, we do not know whether an addict behaves autonomously when he uses drugs; and third, addictive desires are just strong regular desires.According to the Liberal View, one has to accept that the addicts may have drug taking as their highest priority and that they do not have any reduced procedural autonomy. The authors say: "Once we abandon normative bias, we must accept... (shrink)

THE ESSAY DEMONSTRATES THE SUBTLETY OF ALCOHOLICS ANONYMOUS on sin and addiction. It suggests a parallel between Aquinas's understanding of acedia and invidia as the two vitia capitalia most directly undermining of God's caritas and AA founder Bill Wilson's understanding of two contemporary deadly sins, self-pity and resentment, as the "root" of alcoholics' troubles. I argue that AA's understanding of sin and addiction is relevant far beyond the lives of alcoholics. Indeed, its understanding could help the Christian tradition (...) rediscover the "soul" of its sin-talk, aiding all of us in discerning our sin and in recovering from sin in our lives. (shrink)

Rationalist accounts of self-knowledge are motivated in important part by the claim that only by looking to our reasons to discover our beliefs and desires are we active in relation to them and only thereby do we take responsibility for them. These kinds of account seem to predict that self-knowledge generated using third-personal methods or analogues of these methods will tend to undermine the capacity to exercise self-control. In this light, the insistence by treatment programs that addicts acknowledge that they (...) are addicts seems puzzling. I argue that because addicts—and perhaps ordinary akratics, to some extent at least, too—are vulnerable to losing control of their actions via losing control over their beliefs, advising them to look to their reasons for actions is counterproductive and facilitates loss of control. In contrast, an insistence on what I call impersonal self-knowledge, knowledge of some of one's states and dispositions generated by third-personal means, may help to reestablish control. (shrink)

International media have reported cases of pregnant women who have had their children apprehended by social services, or who were incarcerated or forced into treatment programs based on a history of substance use or lack of adherence to addiction treatment programs. Public discourse on the biology of addiction has been criticized for generating stigma and a diminished perception of self-control in individuals with an addiction, potentially contributing to coercive approaches and criminalization of women who misuse substances during (...) pregnancy. We explored whether this is the case based on literature from social psychology, ethics, addiction research, science communication, and philosophy. The literature shows that the relationship between public discourse on biological aspects of addiction and issues such as stigma and perceptions of diminished self-control are unclear, largely due to the complexity of these phenomena. However, concerns about the biological approach are nevertheless legitimate given the broader social and policy context of women’s health. (shrink)

A eulogy on the late Bernard Stiegler, reflecting on Ekin Erkan's friendship with Stiegler and Stiegler's influence on the philosophical study of technology, stoking a comparative review between Stiegler and other thinkers in analytic and continental traditions.

In lieu of an abstract, here is a brief excerpt of the content:Trauma, Addiction, and Temporal Bulimia in Madame BovaryElissa Marder (bio)Lisez, et ne rêvez pas. Plongez-vous dans de longues études. Il n’y a de continuellement bon que l’habitude d’un travail entêté. Il s’en dégage un opium qui engourdit l’âme [Read and do not dream. The only thing that is continually good is the habit of stubborn work. It emits an opium that numbs the soul].—Gustave Flaubert to Louise ColetMadame (...) Bovary I daresay is about bad drugs.—Avital Ronell, Crack WarsIf Flaubert’s Madame Bovary remains so timely, it is because its heroine, Emma, suffers from the quintessential malady of modernity, the inability to incorporate time into experience. Emma’s missed encounter with her own life, her inability to “get a life,” as we say now in America, renders her our contemporary in the strangest sense of the word. She is our contemporary not because we live in the same time but because her failure to live in time has come to define our own. Paradoxically, Emma Bovary has been so well preserved (she is, in some sense, “more alive” now than ever) because she incarnates and inaugurates a modernity that can be defined by the erosion of the possibility of living in time. In Flaubert’s minute and meticulous descriptions of the particular temporal disorders that afflict Emma (as we shall see, she can neither bear witness to an event nor remember one, she can neither live in the present nor project a future, she is incessantly subject to bouts of involuntary forgetting even as she is preoccupied by obsessive rites of recollection, she attempts simultaneously to conjure up time and to stop it), we can read the prophetic traces of a depiction of the temporal structure of the many forms of trauma and addiction that have come to define contemporary American culture.But before turning to Flaubert’s prescient and powerful analysis of how Emma Bovary suffers from a “temporal disorder,” let us take a brief look at how the notions of trauma and addiction have been described in a contemporary analysis of modern culture. In his recent book On Flirtation, the British child psychoanalyst Adam Phillips redescribes ordinary neurosis as a traumatic response to an inability to live in time. He writes:People come to psychoanalysis when there is something they cannot forget, something they cannot stop telling themselves, often by their actions, about their lives. And these dismaying repetitions—this unconscious limiting or coercion of the repertoire of life stories—create the illusion of time having stopped (or [End Page 49] rather, people believe—behave as if they have stopped time). In our repetitions we seem to be staying away from the future, keeping it at bay.[153]Phillips goes on to explain that “[f]or Freud these repetitions are the consequence of a failure to remember.... Whatever cannot be transformed, psychically processed, reiterates itself. A trauma is whatever there is in a person’s experience that resists useful redescription. Traumas, like beliefs, are ways of stopping time” [153–54]. Phillips’s argument rings with a seductive simplicity: neurosis is defined as a temporal disorder, and the contemporary psychoanalytic “cure” does nothing less than promise time. It presumably offers the subject the option of accepting the contingencies of living in time over the pleasure and pain that attend the attempt to stop it.Nonetheless, Phillips’s claim, that contemporary neurosis can be expressed as an attempt to stop time, should perhaps make us pause. Stopping time, in the time of Balzac, Gautier, Baudelaire, and Flaubert, was once conceived of as part of the privileged domain reserved for art and the artist. We might have naively assumed that in the realm of the “real world,” for “real people” time remains an implacable fact of life. The task of falling out of time, after all, would seem to necessitate either an accident of enormous magnitude (a trauma in the traditional sense) or the reliance upon an external substance—hashish, opium, alcohol, or cocaine—one of those mind-altering substances that so preoccupied the nineteenth-century advocates of paradis artificiels. So what is surprising and particularly suggestive... (shrink)

Recent experiments have shown that when individuals with a substance use disorder are confronted with drug-related cues, they exhibit an automatically activated tendency to approach these cues. The strength of the drug approach bias has been associated with clinically relevant measures, such as increased drug craving and relapse, and activations in brain reward areas. Retraining the approach bias by means of cognitive bias modification has been demonstrated to decrease relapse rates in patients with an alcohol use disorder and to (...) reduce alcohol cue-evoked limbic activity. Here, we review empirical and theoretical literature on the drug approach bias and explore two distinct models of how the drug approach bias may be embodied. First, we consider the “biological meaning” hypothesis, which grounds the automatic approach bias in the natural meaning of the body. Second, we consider the “sensorimotor hypothesis,” which appeals to the specific sensorimotor loops involved in the instantiation of addictive behaviors as the basis of the automatic approach bias. In order to differentiate between the adequacies of these competing explanations, we present specific, predictions that each model should make. (shrink)

ABSTRACT This article reports the result of a survey about causal beliefs, normative conceptions and moral evaluations of addicts and addiction in the general population. Specifically, we focused on four issues: To what extent are the normative conceptions of addiction current in the philosophical and scientific literature reflected in laypersons' conception of addiction? How do laypersons rate addicts on perceived responsibility? Which factors influence laypersons' responsibility attributions in the context of addiction? What feelings and attitudes (anger/sympathy/help-giving (...) intentions) do laypersons have toward addicts? We found that, although laypersons seem to assume a weakness view of addiction, their patterns of responsibility attributions vary depending on type of drugs combined with perceived severity of outcome, where the latter even overrides the attributional effects of the actor's perceived control over events. Some explanations of the data are suggested, and various consequences with respect to help-giving behavior, are discussed. (shrink)

Does addiction to heroin undermine the voluntariness of heroin addicts' consent to take part in research which involves giving them free and legal heroin? This question has been raised in connection with research into the effectiveness of heroin prescription as a way of treating dependent heroin users. Participants in such research are required to give their informed consent to take part. Louis C. Charland has argued that we should not presume that heroin addicts are competent to do this since (...) heroin addiction by nature involves a loss of ability to resist the desire for heroin. In this article, I argue that Charland is right that we should not presume that heroin addicts are competent to consent, but not for the reason he thinks. In fact, as Charland's critics correctly point out, there is plenty of evidence showing that heroin addicts can resist their desire for heroin. These critics are wrong, however, to conclude from this that we should presume that heroin addicts are competent to give their voluntary consent. There are, I shall argue, other conditions associated with heroin addiction that might constrain heroin addicts' choice in ways likely to undermine the voluntariness of their consent. In order to see this, we need to move beyond the focus on the addicts' desires for heroin and instead consider the wider social and psychological circumstances of heroin addiction, as well as the effects these circumstances may have on the addicts' beliefs about the nature of their options. (shrink)

‘Twelve Step' recovery programmes such as Alcoholics Anonymous teach that an alcoholic, or other addict, has a disease, and needs to accept that she is ‘powerless' over her addiction before recovery can begin. However, the disease model of addiction has been criticised on the grounds that some addicts recover without external intervention. This critique is questionable, not because such recovery does not occur, but because many genuine diseases are self-limiting. However, the disease model is better criticised on other (...) grounds. Central here is the idea of powerlessness. This article explores various supposed instances of powerlessness, including that induced by extreme fear, provocation and obsessive-compulsive disorder. It is argued that while addiction is a genuine phenomenon, it is strictly inaccurate to describe it as a lack of power. However, there is a deeper sense in which the autonomy of addicts is compromised, although this does not show that addiction is a disease. (shrink)

This essay is framed by the work of Edward Sampson (1993), and is a sociohistorical analysis of the institutional vicissitudes in American history that have formed the ground of our current version of the “truth” about drugs, alcohol, the drug addict and the alcoholic. The drug and alcohol discourse has been used throughout American history to institute and maintain normative ideals. These ideals are contoured by Western individualistic understandings of human being. They revolve around a theme of freedom (...) seen as access to unlimited possibilities, which arises as a right for those individuals who are self-reliant. Alcoholics and addicts have been used as political identities, silently portraying the opposite and living out the underside of these normative ideals. As political identities they are used discursively to maintain mainstream illusions of self-reliance and to hide the falsehood of the capitalist promise of unfettered access to unlimited possibilities. Capitalist interests flourish through the maintenance of these illusions, and are able to disown responsibility via the silencing, through embodiment, of those who have been marginalized. This self-celebratory discourse is, hence, a monologue that undermines the possibility of hierarchical revolutions. Encapsulated in the embodiment of the alcoholic and addict are the covering over of political conflicts, the leveling down of difference, and the marginalizing of those who represent dialogical possibility. Twelve-step mutual help organizations participate in self-celebratory monologues that maintain the version of truth supportive of the agendas of the wealthy; however, they also offer an other-centered strategy by which dialogue again becomes possible. (shrink)

This article explores the phenomenon of Internet addiction and its possible amelioration, from both Eastern and Western philosophical perspectives. Internet addiction is caused by the excessive use of the Internet and its resulting dependence, having negative effects on human well-being. The ideas of a key ancient Chinese Daoist thinker Zhuangzi 莊子 and his Western contemporaries, the Stoics, as viewed through the world, the things and beings in it, and their relationships, offer insights which may be used to (...) alleviate these effects. The application of and comparison between the two ancient philosophies in addressing the issue of Internet addiction can give us inspiration to confront the challenges of technological enslavement in general and Internet addiction in particular. This is no doubt a help in our pursuit of well-being. (shrink)

The Second Vatican Council called for moral theology to be more firmly rooted in scripture, yet bioethical reflection on alcohol use and addiction often fails to provide a rigorous scriptural analysis of these problems. Themes related to alcohol use, abuse, and addiction recur throughout scripture. This article begins by examining these themes in the Old and New Testaments. Some synthetic comments related to alcohol use and eschatological themes are then offered. The article concludes that the (...) Bible does not condemn moderate alcohol use, but it frequently condemns drunkenness as a source of harm, part of the dominion of sin, and unsuitable for God’s people. Practical applications related to catechesis, priestly formation, and recovery are offered. (shrink)

Background: Previous research has identified a link between the loss of a significant person, grief complications, and substance abuse. People with substance use disorder (SUD) are more vulnerable to complicated grieving symptoms following loss. From sociocognitive theories, the model of coping with stress assumes that substance use is one of the responses used to cope with traumatic life events. The main objective of this study is to identify the coping strategies of people with SUD and to analyze their relationship to (...) complicated grief (CG).Methods: A sample of 196 bereaved drug-dependent patients was assessed, after providing written consent, in sociodemographic variables, drug and bereavement related characteristics, CG symptomatology (Inventory of Complicated Grief) and coping strategies (Coping Strategies Inventory).Results: There are differences in relation to the coping strategies used among patients with CG, using more those focused on emotional expression, social withdrawal, wishful thinking, and self-criticism.Conclusion: We can conclude that, in general, CG in patients with SUD is more associated with the use of less adaptive coping strategies. This data can contribute to a better understanding of the different variables involved in the grieving process among people with SUD. It is important to point out the clinical implications of addressing what the coping strategies associated with improved grief outcomes among people with addiction problems are. (shrink)

Dopamine is critically important in the neural manifestation of motivated behavior, and alterations in the human dopaminergic system have been implicated in the etiology of motivation-related psychiatric disorders, most prominently addiction. Patients with chronic addiction exhibit reduced dopamine D2 receptor (DRD2) availability in the striatum, and the DRD2 TaqIA (rs1800497) and C957T (rs6277) genetic polymorphisms have previously been linked to individual differences in striatal dopamine metabolism and clinical risk for alcohol and nicotine dependence. Here, we investigated (...) the hypothesis that the variants of these polymorphisms would show increased reward-related memory formation, which has previously been shown to jointly engage the mesolimbic dopaminergic system and the hippocampus, as a potential intermediate phenotype for addiction memory. To this end, we performed functional magnetic resonance imaging (fMRI) in 62 young, healthy individuals genotyped for DRD2 TaqIA and C957T variants. Participants performed an incentive delay task, followed by a recognition memory task 24 h later. We observed effects of both genotypes on the overall recognition performance with carriers of low-expressing variants, namely TaqIA A1 carriers and C957T C homozygotes, showing better performance than the other genotype groups. In addition to the better memory performance, C957T C homozygotes also exhibited a response bias for cues predicting monetary reward. At the neural level, the C957T polymorphism was associated with a genotype-related modulation of right hippocampal and striatal fMRI responses predictive of subsequent recognition confidence for reward-predicting items. Our results indicate that genetic variations associated with DRD2 expression affect explicit memory, specifically for rewarded stimuli. We suggest that the relatively better memory for rewarded stimuli in carriers of low-expressing DRD2 variants may reflect an intermediate phenotype of addiction memory. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 45, no. 1. © 2019 by Feminist Studies, Inc. 209 Trysh Travis Toward a Feminist History of the Drug-Using Woman— and Her Recovery In 1995, public health scholars Laura Schmidt and Constance Weisner published “The Emergence of Problem-Drinking Women as a Special Population in Need of Treatment.”1 The article, aimed at specialists in the growing field of behavioral sciences, explored the history of medpsych attitudes toward women (...) drinkers. That history had been characterized, until the 1970s, by ignorance and neglect, but it began to shift in the wake of Second Wave feminism and what Schmidt and Weisner called “the women’s alcoholism movement.”2 To be fair, attitudes toward male drinkers had also long been inchoate. But beginning in the 1940s, advocacy by a handful of scientific and legal professionals, as well as the mutual aid group Alcoholics Anonymous (founded in 1935) and the National Council on Alcoholism (founded in 1944), created a new vision, which went on to be underwritten by federal funding and private insurance.3 “Alcoholism is a disease 1. Laura Schmidt and Constance Weisner, “The Emergence of Problem-Drinking Women as a Special Population in Need of Treatment,” in Recent Developments in Alcoholism, Vol. 12: Women and Alcoholism, ed. Marc Galanter (New York: Plenum Press, 1995), 309–334. 2. Ibid., 310. 3. The organization was originally called the National Committee for Education on Alcoholism; it became the National Council on Alcoholism in 1950 and changed to the current National Council on Alcoholism and Drug Dependence in 1990. 210 Trysh Travis Books Discussed in This Essay Lady Lushes: Gender, Alcoholism, and Medicine in Modern America. By Michelle L. McClellan. New Brunswick, NJ: Rutgers University Press, 2017. The Recovery Revolution: The Battle over Addiction Treatment in the United States. By Claire D. Clark. New York: Columbia University Press, 2017. Addicted to Rehab: Race, Gender, and Drugs in the Era of Mass Incarceration. By Allison McKim. New Brunswick, NJ: Rutgers University Press, 2017. Through a Trauma Lens: Transforming Health and Behavioral Health Systems. By Vivian Barnett Brown. New York: Routledge, 2017. and the alcoholic a sick person,” argued National Council on Alcoholism founder Marty Mann in a host of magazine articles beginning in the late 1940s. From that assertion followed the beliefs that “the alcoholic can be helped and is worth helping” and that “alcoholism is a public health problem and therefore a public responsibility” (29).4 Behind Mann’s carefully gender-neutral language lay an image of the alcoholic as a white man from the respectable middle classes. The mid-century legitimation of that man’s problems, Schmidt and Weisner argue, paved the way for “problem-drinking women” to finally come into focus half a century later. Schmidt and Weisner’s article centers on the ways the Great Society funding streams that first steered funds to community-based alcohol and drug treatment changed during the 1980s. But along the way, they briefly explore organized feminism’s views of alcohol- and drug-using women. They note that Second Wave feminists had dealt aggressively with behavioral health issues such as domestic violence, child sexual 4. Marty Mann, “Can We Conquer Alcoholism?” Health (1947): 12–13, 29–30. Trysh Travis 211 abuse, and rape—all of which correlated closely with substance use and abuse. But they see no feminist activism around alcohol or drugs. Instead, “representatives from organizations in the broader feminist and women ’s health movements” were “conspicuously absent” from the women’s alcoholism movement, which consisted chiefly of activists motivated by alcohol issues, not gender.5 Interest in—and action on—women’s alcohol and other drug use consequently became the province chiefly of clinicians and policy makers, not movement women. Although many of those professionals saw substance-using women’s needs as important and worthy of services, few viewed them through the lenses of gender and power. The blind spot that Schmidt and Weisner observe among feminist activists is interesting not only for what it tells us about a conceptual boundary of Second Wave feminism (both liberal and radical) but also for the way it points to a gap in the feminist scholarship that is ostensibly a central legacy of the earlier movement. Like... (shrink)

The success of deep brain stimulation (DBS) for movement disorders and the improved understanding of the neurobiologic and neuroanatomic bases of psychiatric diseases have led to proposals to expand current DBS applications. Recent preclinical and clinical work with Alzheimer's disease and obsessive-compulsive disorder, for example, supports the safety of stimulating regions in the hypothalamus and nucleus accumbens in humans. These regions are known to be involved in addiction and overeating associated with obesity. However, the use of DBS targeting these (...) areas as a treatment modality raises common ethical considerations, which include informed consent, coercion, enhancement, threat to personhood, and manipulation of the reward center. Pilot studies for both of these conditions are currently investigational. If these studies show promise, then there is a need to address the ethical concerns related to the initiation of clinical trials including the reliability of preclinical evidence, patient selection, study design, compensation for participation and injury, cost-effectiveness, and the need for long-term follow-up. Multidisciplinary teams are necessary for the ethical execution of such studies. In addition to establishing safety and efficacy, the consideration of these ethical issues is vital to the adoption of DBS as a treatment for these conditions. We offer suggestions about the pursuit of future clinical trials of DBS for the treatment of addiction and overeating associated with obesity and provide a framework for addressing ethical concerns related to treatment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Surrender Versus Control:How Best Not to DrinkMark D. Rego (bio)Keywordsaddiction, Alcoholics Anonymous, will, St. AugustineI recall as a teenager noticing that some people modified nouns in, what sounded to me, a peculiar way. A friend's mother who was taking an automotive repair course said, " We're going to learn to fix the brakes next week." The same folks would also use the possessive for common nouns in phrases like: (...) "I'll be ready after I take my shower." Although not incorrect, I believe this type of usage reflected a different attitude about brakes, showers, and other things. These tended to be more hands-on people and thus, in my understanding at least, had a more particular relationship with things in their world than others for whom objects were examples of types of things.This brief vignette serves as an introduction to my qualified enthusiasm for the project taken up by Allison Mitchell in her paper, "Taking Mentality Seriously: A Philosophical Inquiry into the Language of Addiction and Recovery" (Mitchell, 2006). Indeed, as a practicing psychiatrist I would be hard pressed not to endorse the use of language as a key to deeper aspects of experience.My following remarks are mostly contra Mitchell's hypothesis, but before beginning I name one more reason I think this project is worthwhile. In spite of much research and recitations of the motto "treatment works," we do not presently have a reliable treatment for addiction. The linguistic portrait painted by Mitchell allows us to view our treatments in vivo and reflect upon what we see. (For the purpose of this commentary, I consider alcoholism and Alcoholics Anonymous [AA] as a general example of addiction and treatment.)Medication treatment remains almost inconsequential except when applied for comorbid psychiatric disorders rather than the primary addiction. Even then it rarely serves to undo some form of self-medication, but instead only offers an important leg up in battling the addiction.Research and much experience has shown AA to be the single best treatment for alcoholism (Vaillant and Hiller-Sturmhofel 1996). Some investigators have proposed underlying mechanisms for its efficacy (some, like "creating dependency" run very counter to Mitchell) (Vaillant 2005). AA's success is highly dependent upon attendance (McCrady et al. 2004), which can of course be a marker for getting better in the first place and not solely a cause of improvement (i.e., people who are doing better attend more meetings not vice- versa). Even within AA, the dropout rate is quite high (Martin et al. 1996). Workers in this area [End Page 223] have raised questions about AA's approach and have proposed other avenues to sobriety, including interpersonal, cognitive–behavioral, and relapse prevention programs (Witkiewitz and Marlatt 2005, 2004; O'Dwyer 2006). Lamentably, some very large studies failed to show any effective ability to match up alcoholics with a particular treatment modality (Church 2004; Read 2004).Given the lack of clarity with which we still work, I think an approach like Mitchell's is a welcome call for serious reflection. The limitations of a linguistic analysis place an unfortunate constriction on implications to be drawn.Mitchell's chief concern is that the language of recovery, as reflected in twelve-step programs, betrays and even fosters a degree of passivity, which leaves the addict without an adequate sense of agency and autonomy with which to combat addiction. From a more philosophical perspective, Mitchell believes this is due to an incomplete philosophical materialism; one that lacks "mentality" (i.e., the sense that part of our physical being is made up of mental activities such as emotions, motivations, beliefs, etc.). This attitude is manifest in a "pretheoretic conception of the self" that leaves the addict with a dearth of self-awareness as a mental agent of action and change.In place of the standard recovery model in use today, Mitchell suggests cultivating a sense of self that values and fosters engaged agency that is both capable of self-control and responsive to external obligations.A Few ConcernsFirst, I will offer a few concerns about premises at work within the paper. Then, I outline an attempt to make sense of the... (shrink)

Chapter 51 focuses on the subjective side of alcoholism, specifically about what memoirs of alcoholism teach about alcoholism, and argue that a common theme in many memoirs is that drinking, sometimes heavy drinking, a prerequisite of addiction, was modelled, endorsed, and eventually achieved in a way that involves deep identification, and also argues that alcoholic memoirs, even assuming that they suffer from objectivity problems such as the latter, nonetheless serve an important function, and not just whatever cathartic function they (...) serve for the author. (shrink)

This study modelled associations between gender, ruminative cognitive style, alcohol use, and the time course of negative affect over the course of 43,111 random assessments in the natural environment. Participants completed 49 days of experience sampling over 1.3 years. The data indicated that rumination at baseline was positively associated with alcohol dependence symptoms at baseline as well as higher negative affect over the course of the study. Consistent with negative reinforcement models, drinking served to decrease the persistence (...) of negative affect from moment to moment. However, this ameliorative effect of drinking was evident only among women, suggesting an increased risk for negative reinforcement driven drinking behaviour. In addition, rumination appeared to counteract the desired effects of alcohol on mood among women. This suggests that women who ruminate more may be motivated to consume larger amounts of alcohol to achieve the desired effects. Overall, the results indicate that ruminative cognitive style and the persistence of negative affect from moment to moment may reflect an individual vulnerability for the development of alcohol use disorder especially among women. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Can't Say "No" to That!(A "Difficult Patient" Story)Ingrid BergAs a sequela of COVID-19, my rural Wisconsin hospital has been jam-packed for months with patients for whom we routinely provide care and many for whom we do not. An exodus of health care workers and other constraints have made the transfer of critically ill patients very difficult. In this disquieting "new-normal" of our work life, we routinely must call (...) bigger cities throughout our state to find beds for complex patients.So, it was not surprising when a young patient, an IV drug user in sepsis from a heart infection, was admitted to me in the middle of the night. In less disheartening times, before the pandemic, this patient would have been transferred promptly to the big-city hospital. Now, though, the possibility of finding an open bed is next to impossible. Resigned, I placed admission orders, continued antibiotics and fluids, and crossed my fingers. Then the unexpected happened: a bed opened up, and we could send her at once!The patient had a harsh heart murmur. It was likely that a "vegetation" was clinging to the valve, between the right upper and lower chambers of her heart. A vegetation is a clump of debris, such as platelets, clotting proteins, and bacteria that is a menace to the body. Her chest imaging looked like her infection had already spread to her lungs.A definitive diagnosis for endocarditis requires a special ultrasound with a probe that goes down through the esophagus, a procedure performed by cardiologists. It's a serious infection, one that requires weeks of IV antibiotics and is best monitored by infectious disease specialists. Sometimes, cardiothoracic surgeons are called upon to strip away the infection at the site, depending on how badly the valve has been slayed or the size of the vegetation. My only recommendation for a young, otherwise healthy patient in this scenario, is transfer.All of these reasons for transfer were lolling around in my tired head when the night-time [End Page 14] nursing supervisor approached me and said, "We have a problem." When the patient was updated about the transfer, she balked: "She says she is tired and refusing to go," the supervisor began. "She doesn't feel like getting into an ambulance in the middle of the night and she doesn't care if her condition is life-threatening. She knows we can't force her to go and she will only talk about it again in the morning."The cartoon version of myself at that moment had bugged-out eyes, a dropped jaw, fists tight and clenched at my sides, and steam coming out of my head. I can look past a patient's self-neglect, poor medication adherence, abysmal communication, alcohol and drug addiction, and other crimes. But saying no to a bed at a tertiary care facility? Unacceptable!I marched down the quiet hallway and into her room. She was lying on her side, facing the door, one IV in a thin arm. I was confident I could reason with her once I explained the scarcity of beds and the medical necessity of transfer. But she was having none of it. I was calm until I could no longer maintain my cool: "You can't give up this bed!""Maybe in the morning," she insisted, yawning. "But not now. I am tired and want to rest!""But there might not be a bed in the morning," I countered. "And your infection can be life-threatening." (This is true, but we both knew she wasn't dying at this very moment.)"I am not going anywhere!" She raised her voice and then closed her eyes.And she was right. I had no choice but to keep her. I could not kick her out of the hospital because she was making a poor choice, and I was frustrated for having to manage the fallout of that decision. Giving her antibiotics and fluid boluses to bolster her blood pressure was certainly within my scope of practice. And fretting. Fretting is always within my scope of practice; not that my scope of practice matters when all the big... (shrink)

Patients suffering from mental disorders are often not treated on an equal basis with patients suffering from organic diseases. In Germany, for example, alcohol-dependent patients will be detoxified on a clinical ward to ensure that they survive acute alcohol withdrawal; however, medical insurances often do not cover treatment costs for a therapy for the addictive behavior that underlies the acute alcohol problem. While patients suffering from diabetes mellitus can also display personally harmful choices and, for example, consume (...) sugar although they know that this is detrimental for their health, medical insurances pay for the acute hyperglycemic shock treatment as well as for dietary and medical treatment of the .. (shrink)

Adolescent decisions, especially in novel contexts, are often guided by affective evaluations rather than knowledge of the risks and probabilities of different outcomes. In this study, we used the affect-driven exploration model to illustrate how affective evaluations can play a critical role in driving early use of cigarettes, as well as the adaptive function of the resulting experiential learning in informing future affect and cigarette use. We analyzed five waves of data collected from a large, diverse community sample of adolescents (...) who were followed from early to late adolescence during years 2004–2010 to model trajectories of positive affect and risk perceptions and examined the associations of these trajectories with their self-reported cigarette use and dependence symptoms. Consistent with the ADE model, early initiators reported higher levels of positive affect at baseline, which we argue may have led them to try cigarettes. Notably, most early initiators reported a decline in positive affect over time, suggesting an experience-based shift in affective evaluations associated with cigarette use. Risk perceptions associated with cigarette use did not emerge as a significant predictor of cigarette use or subsequent dependence. Therefore, for deterring adolescent cigarette use, efforts to influence affect may be more effective than directly influencing risk perceptions. Despite the affective basis for initiating cigarette use, few adolescents engaged in early use or developed symptoms of dependence. Majority of those who engaged in early cigarette use showed a decline in positive affect, with corresponding increase in risk perceptions over time. Some early users may indeed continue to engage in cigarette use, but this is likely driven by the addictive properties of the drug. Overall these findings challenge the popular stereotype of impulsive and emotionally reactive behaviors during adolescence, and suggest a more nuanced interpretation of adolescent risk behavior. (shrink)

This study aimed to investigate the common predictive factors between social media addiction and eating disorder symptoms, in a group of Chinese female college students. A total of 216 students completed the behavioral assessments of cognitive flexibility and sustained attention, as well as the questionnaires on anxiety, social media dependence, and eating disorders. The results indicate that SMA is significantly correlated with EDS. Structural equation modeling was used to test the model in which state anxiety, cognitive flexibility, and (...) sustained attention predicted social gain and EDS. Additionally, the results confirmed the mediating role of cognitive flexibility and sustained attention between state anxiety and SMA/EDS in the participants. The findings revealed that in the sample group, state anxiety was related to SMA and EDS through cognitive flexibility and sustained attention. These proposals reflect the significance of improving cognitive flexibility/sustained attention and reducing state anxiety to prevent EDS and SMA in female college students. (shrink)

Introduction: Alcohol approach bias, the tendency to automatically move toward alcohol cues, has been observed in people who drink heavily. However, surprisingly, some alcohol-dependent patients demonstrate an alcohol avoidance bias. This inconsistency could be explained by the clinical or demographic profile of the population studied, yet this has not been examined in approach bias modification trials to date. We aimed to determine the proportion of patients with an approach or avoidance bias, assess whether they differ on (...) demographic and drinking measures, and to examine the clinical correlates of approach bias.Method: These research questions were addressed using baseline data from 268 alcohol-dependent patients undergoing inpatient withdrawal treatment who then went on to participate in a trial of ABM.Results: At trial entry, 155 had an alcohol approach bias and 113 had an avoidance bias. These two groups did not differ on any demographic or relevant drinking measures. Approach bias was significantly and moderately associated with total standard drinks consumed in the past 30 days but no other indices of alcohol consumption or problem severity.Conclusion: Whilst the majority of alcohol-dependent patients showed an alcohol approach bias, those with an avoidance bias did not differ in demographic or clinical characteristics, and the strength of approach bias related only to recent consumption. Further research is needed to develop more accurate and personally tailored measures of approach bias, as these findings likely reflect the poor reliability of standard approach bias measures. (shrink)

We can think about the use of controlled substances in the treatment of anxiety disorders in two simple but diametrically opposed ways. First, we can say that anxiety disorders are trivial and require only acts of willpower, or, if anxiety disorders do require treatment, they are better treated without the use of benzodiazepines. When BZs are used to treat anxiety, they pose grave risks of addiction to the patients to whom these medicines are prescribed; they relieve patients’ symptoms, but (...) are the equivalent of a pharmacological “roach motel,” a haven into which many unsuspecting patients enter, but from which few emerge without becoming addicted. Patients must then face terrible struggles to free themselves of dependence on BZs, and this compounds the problem for which they sought treatment. Furthermore, the large number of prescriptions for BZs are a threat to the public health because these drugs are widely abused by alcoholics and drug addicts. (shrink)

BackgroundDepression and alcohol dependence are among the most prevalent psychiatric disorders that commonly co-occur. Therefore, gaining a better grasp of factors related to this comorbidity is particularly interesting for clinicians. Past research has highlighted the significant role that time perspective and family history of alcohol dependence play in the occurrence of depression and AD. However, much remains unexplored in the understanding of the association between them. This study explored how temporal profile and other sociodemographic characteristics of (...) patients diagnosed with AD impact the severity of depression and AD in them.MethodsThis study was multi-centered, including 381 patients. Cross-sectional information was collected from both inpatient and outpatient psychiatric clinics in China. Data were acquired using validated self-report scales, including Michigan Alcoholism Screening Test, Zung Self-Rating Depression Scale, and Zimbardo Time Perspective Inventory-Chinese version. Multiple linear regression analyzes were conducted to control social demographic variables and construct prediction models to inspect the influence factors of variables. Moderation models were constructed to inspect further interplay between variables using hierarchical regression and PROCESS Macro.ResultsResults showed that of all the patients in Chinese psychiatry clinics diagnosed with AD according to the International Classification of Diseases-10, 59.9% met the criteria of depression according to the questionnaire, and time perspective was correlated with the severity of depression. Furthermore, using regression analysis, we found that time perspective and depression could predict AD severity. The moderating role of a past negative time perspective and FH was confirmed between depression and AD. We found that, in our study, only in patients with FH and relatively moderate to high scores of past negative time perspective could the severity of depression predict the severity of AD. Therefore, during the treatment and care of patients with AD, their depression level, time perspective score, and FH should be considered. (shrink)

The sorites problem often arises for wrongdoing. In cases of substance use, a father has a drink, which, by itself, does not result in alcohol addiction. But he has another drink and another, until he develops an alcoholism that results in severe harm to his wife and children. Such cases present an interesting puzzle for thinking about moral responsibility because although long-term drinking caused harm to his family, the father likely never chose to drink long-term. Instead, typical drinkers (...) are always making short-term decisions about alcohol consumption: whether one wants to have a beer now, whether one goes out with one’s buddies to the bar tonight, etc. That these individually harmless choices added up to a harmful long-term pattern of drinking was, in a sense, accidental. This article develops a framework for analyzing moral responsibility in such cases. (shrink)

The psychopharmacology of alcohol dependence is today poised at interesting crossroads. Three major drugs Naltrexone, Disulfiram and Acamprosate have been tried and tested in various trials and have many meta-analyses each to support them. While Naltrexone may reduce craving, Acamprosate scores on cost effectiveness worldwide with Disulfiram being an alcohol deterrent drug. Studies support, refute and criticize the use of each of these drugs. Combining one or more of them is also a trend seen. The most important (...) factor in efficacy has been the combination of psychosocial treatment with medication. Studies from the early 1970s to date have been reviewed and the findings presented in a manner useful for the busy clinician to judge the best pharmacological option in the management of alcohol dependence. The role of depot disulfiram, naltrexone, and medications like Topiramate and SSRIs under research for alcohol dependence, are also addressed. (shrink)

The Diagnostic Statistical Manual of the American Psychiatric Association defines substance dependence, more commonly known as “drug addiction,” as “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that usually results in tolerance, withdrawal, and compulsive drug-taking behavior.” If drug addiction is a matter of compulsion, as this definition suggests, then is it correct to say that a drug (...) addict chooses to take their drug of choice? Similarly, does it make sense to say that a person in the grip of fear really chooses to flee from what frightens them? In this book, Jon Elster argues that in general drug addicts and people subject to powerful emotions should be interpreted as making choices. Although there is a compulsion to choose, there is choice nonetheless. This is different from cases where there is a compulsion to act but no choice. But what kind of choice is this? And are such choices rational or not? These are among the central questions addressed in this book. (shrink)

The importance of the spiritual dimension in the lives of people living in conditions of poverty and social exclusion and the often-critical role of faith-based organisations has gained increasing relevance in development research and practice. A growing line of research focuses on how to integrate the faith dimension into the evaluation of social programmes and on quantifying the effects of faith. The objective of this article is to propose a framework for integrating a spiritual dimension into the design and practice (...) of impact evaluation by using the concept of integral human development. Integral human development emerged within the Catholic social tradition, but is not specific to it. It is a perspective on human development that integrates the material and spiritual, recognises the interdependence between humans and their environment or territory and demands change at both the individual and collective levels. This framework is then applied to the design of an impact evaluation of a faith-based programme that accompanies people with drug and alcohol addictions in Argentina. The article highlights the following characteristics of an integral impact evaluation: the interaction between multiple well-being dimensions; the use of knowledge and methods of analysis from multiple disciplines; the importance of understanding the diverse pathways to improvements in well-being; the assessment of the spiritual dimension through changes in one's relationships with oneself, others and the environment; and the importance of assessing personal change within the context of social and community transformation. (shrink)

Public policy on alcohol in the UK relies on health promotion campaigns that encourage individuals who misuse alcohol to make healthier choices about their drinking. Individuals with alcohol-dependence syndrome have an impaired capacity to choose health. As a result, individuals with the worst alcohol misuse problems lie largely outside the reach of choice-based policy. However, such policy has been widely criticized and efforts to reform it are underway. This paper argues that the British Medical Association's (...) recent attempt to improve policy on alcohol in the UK by introducing strategies which have been shown to control drinking within populations still gives insufficient attention to alcohol dependence. This is because it fails accurately and consistently to characterize alcohol dependence and gives insufficient attention to the social challenges it presents. (shrink)

In what sense is a person addicted to drugs or alcohol incompetent, and so a legitimate object of coercive treatment? The standard tests for competence do not pick out the capacity that is lost in addiction: the capacity to properly regulate consumption. This paper is an attempt to sketch a justificatory framework for understanding the conditions under which addicted persons may be treated against their will. These conditions rarely obtain, for they apply only when addiction is extremely (...) severe and great harm threatens. It will be argued also that to widen the measures currently in place in some jurisdictions, though philosophically well-motivated, would require very strong evidence of a set of conditions disposing a person to an addictive future. It is doubtful that any such currently available evidence is strong enough to justify coercive treatment. Nevertheless, coercive treatment of addiction is already a reality, with the potential for more, and so some discussion will be presented regarding the extraordinary safeguards necessary to prevent misapplication of such treatment policies. (shrink)

In this paper, I argue that the thought and behavior involved in drug dependence is associated with a certain pre-theoretic conception of the self that finds philosophical expression as a grossly simplified form of materialism. Addicts tend not to take mentality seriously: They do not understand themselves as minded beings capable of self-awareness and development through intentional action. Recognizing the practical implications of accepting this philosophically unconvincing view, I argue, encourages a modification of self-conception that is instrumental to the (...) process of recovery from addiction. Using a combination of philosophical analysis and close reading of a trio of narratives that describe drug dependence and recovery, I pursue the possibility that rehabilitation may involve the clarification and alteration of self-conception in such a way that emphasizes autonomous agency and certain values that have not yet been embraced by twelve-step programs, namely, integration, apprehension, moderation, and self-discipline. The rich and substantial history of analytic–philosophical thought about the self is of immense practical value to people impacted by drug dependence and/or engaged in recovery from it; philosophy offers us a set of investigative tools, terms, and concepts that may help to map the different cognitive routes to successful self-rehabilitation. A philosophical consideration of the use of self-related words and ideas within the context of narratives of addiction and recovery may bear directly and significantly on the improvement of the lives of those persons who struggle to overcome drug dependence. (shrink)

This article explores and defends the claim that addictive desires—for alcohol in particular—are partly explained by the motive of self-escape. We consider how this claim sits with the neurophysiological explanation of the strength of addictive desires in terms of the effect addictive substances have on the dopamine system. We argue that nothing in the neuroscientific framework rules out pluralism about the causes of addictive desire.

The current dominant perspective on addiction as a brain disease has been challenged recently by Marc Lewis, who argued that the brain-changes related to addiction are similar to everyday changes of the brain. From this alternative perspective, addictions are bad habits that can be broken, provided that people are motivated to change. In that case, autonomous choice or “free will” can overcome bad influences from genes and or environments and brain-changes related to addiction. Even though we concur (...) with Lewis that there are issues with the brain disease perspective, we also argue that pointing to black swans can be important, that is: there can be severe cases where addiction indeed tips over into the category of brain disease, but obviously that does not prove that every case of addiction falls into the disease category, that all swans are black. We argue that, for example, people suffering from Korsakoff’s syndrome, can be described as having a brain disease, often caused by alcohol addiction. Moreover, the brain changes occurring with addiction are related to choice-behaviour, habit formation and insight, hence essential mental abilities to break the addiction. We argue for a more graded perspective, where both black swans and white swans are rare, and most cases of addiction come as geese in different shades of gray. (shrink)