Tuesday, 28.03.2017

Historical Vocabulary of Addiction

 

Peter R. Martin

 

Introduction

 

Patients who suffer from a loss of control over alcohol and/or drug use or the compulsive seeking and taking of alcohol/drugs despite adverse consequences have not typically interested psychiatrists.  Despite the fact that a significant proportion of all psychiatric patients actually possess such self-destructive out-of-control behaviors, either as their primary psychopathology or as a consequence of their underlying psychiatric disorder (Regier, Farmer, Rae 1990), alcohol and/or drug use disorders have been viewed by psychiatrists as orphan conditions, not of fundamental importance compared to “pure” psychiatric diagnoses uncomplicated by alcohol/drug use.  However, this viewpoint becomes untenable if it is recognized that so many patients thought to have a “pure” psychiatric diagnosis may actually have a co-occurring drug/alcohol use disorder of which the treating psychiatrist is unaware; hence, the manifest psychopathology in such patients may actually be influenced by neuropsychopharmacologic effects of the substance(s) they use in an uncontrolled manner.  Such patients may not respond to “appropriate” treatment of their “pure” disorder if the alcohol/drug use disorders are not also addressed. 

Substances that are commonly self-administered in an out-of-control manner must always be considered in psychiatry and neuropsychopharmacology because they:  1) have yielded some compelling clues to the pathophysiology of many psychiatric disorders; and 2) are increasingly recognized as potential “lead compounds” in the search for novel pharmacotherapies, especially for patients who are not responsive to standard treatments.  For example, stimulant-induced psychosis has long been considered a heuristic model of the psychopathology of schizophrenia and other psychoses (Snyder, Banerjee, Yamamura, Greenberg 1974; Kety 1959).  Cannabis use has emerged as a fundamentally important etiologic factor in development of schizophrenia in young people (Andreasson, Engstrom, Allebeck, Rydberg 1987).  In addition, despite their recognized abuse liability, both opioids (Carlson, Simpson 1963) and stimulants (Hare, Dominian, Sharpe 1962), have a long history of use in treatment of major depressive disorder.  More recently, dissociative anesthetics, also with significant abuse liability, have been found beneficial in treatment of depressed patients (Berman et al. 2000) due to glutamatergic actions, thereby expanding the scope of our understanding of the pathogenesis of depression beyond the biogenic amines (Paul, Nowak, Layer, Popik, Skolnick 1994).  Accordingly, it seems justified that the pathogenesis, nosology, and treatment of substance-related and addictive disorders per idem be seriously considered in our conceptualization of the field of neuropsychopharmacology.  Indeed, co-occurring alcohol/drug use disorders may actually represent the typical course of some psychiatric disorders characterized by mood instability, and hence, the so-called “pure” form is the exception rather than the rule  and their pathogenesis and treatment may not truly be possible without a firm grasp of the alcohol/drug use component of these disorders (Rich, Martin 2014).

The logical rapprochement of the study of alcohol/drug use and other psychiatric disorders within the realm of psychiatry and neuropsychopharmacology should lead to a more complete understanding by psychiatrists of the vocabulary of addiction.  This involves an appreciation not only of the meaning of the words used to convey our understanding of alcohol/drug use and related disorders but also their historical origins.  My goal over the coming months is to prepare “vignettes” of the words that are commonly used in addiction psychiatry encompassing their origins, historical development as well as the common usage as independent entries in a Historical Vocabulary of Addiction. Ultimately, the goal is to incorporate these entries into an e-book which would be of value in education of psychiatrists.

 

References:

Andreasson S, Engstrom A, Allebeck P, Rydberg U.  A Longitudinal Study of Swedish

Conscripts. The Lancet  1987; 330, 1483-86.

Berman RM, Cappiello A, Anand A, Oren DA, Heninger GR, Charney DS, et al.  Antidepressant

effects of ketamine in depressed patients. Biological Psychiatry 2000; 47, 351-4.

Carlson ET, Simpson MM. Opium as a Tranquilizer. American Journal of Psychiatry

1963; 120, 112-117.

Hare EH, Dominian J, Sharpe L. Phenelzine and Dexamphetamine in Depressive Illness. British

Medical Journal 1962; 1: 9-12.

Kety SS. Biochemical Theories of Schizophrenia. Science 1959;  129: 1528-1532.

Paul IA, Nowak G, Layer RT, Popik P, Skolnick P. Adaptation of the N-methyl - D - aspartate

receptor complex following chronic antidepressant treatments. Journal of Pharmacology and

Experimental Therapeutics 1994;  269, 95-102.

Regier DA, Farmer ME, Rae DS. Comorbidity of mental disorders with alcohol and other drug

abuse: Results from the epidemiologic catchment area (eca) study. JAMA 1990; 264, 2511-2518.

Rich SJ, Martin PR. Chapter 33 - Co-occurring psychiatric disorders and alcoholism. In

Sullivan EV, Pfefferbaum A, Eds. Handbook of Clinical Neurology Alcohol and the Nervous

System (Volume 125). Amsterdam: Elsevier; 2014, pp. 573-88.

Snyder SH, Banerjee, SP,Yamamura HI, Greenberg D. Drugs, neurotransmitters, and

schizophrenia. Science 1974; 184, 1243.

 

 

Peter R. Martin

October 20, 2016