Thomas A. Ban
Neuropsychopharmacology in Historical Perspective
Education in the Field in the Post-Neuropsychopharmacology Era
Background to An Oral History of the First Fifty Years
Addiction (Volume Six): 1.Addiction Psychiatry
Volume Six of this series is dedicated to addiction. The word itself refers to a group of disorders - alcohol, amphetamine, barbiturate, cannabis, cocaine and opioid abuse and dependence; phencyclidine and hallucinogen abuse; and tobacco dependence - that were classified in the in the Third Edition of the Diagnostic and Statistical Manual of the American Psychiatric Association of Mental Disorders (DSM-III) and subsequent classifications, such as Substance Use Disorders (American Psychiatric Association 1980).
In volumes Two, Three, Four and Five of this series the focus is on different methodologies used in the study of psychotropic drugs; in Volume Six the focus shifts to the employment of these methodologies in the study of “addiction,” a class of disease (Ban 2011a; Fink 2011; Gershon 2011; Kleber 2011; Levine 2011; Sulser 2011). Thus, while previous volumes dealt with interviewees’ contributions to the development of behavioral pharmacology, neurophysiology, neuropharmacology, psychopharmacology and neuropsychopharmacology, Volume Six deals with interviewees’ contributions to the elucidation of the biological underpinning of addiction and to the development of rational pharmacological treatments for addiction (Hollister 1996; Wikler 1957).
Addiction psychiatry is a relatively new field. It was separated in the 1950s from “pharmacological psychiatry” which dealt with all “chemical intoxications” (accidental, industrial and medicinal). Such intoxications included those caused by substances that may lead to addiction assumedly through their “pleasing psychological effects” (Mayer-Gross, Slate and Roth 1960). The mental manifestations of chemical intoxications share the basic syndromes of “symptomatic psychoses,” described in 1909 and 1910 by Karl Bonhoeffer (Bonhoeffer 1909, 1910). The difference between the two is in the superimposed mental (psychological) effects of the different “addictive drugs.”
By standardizing the language of “addiction” between 1950 and ’57 in a series of Technical Reports, the World Health Organization (WHO)had a major impact on the development of “addiction psychiatry” (Gregory 1960). Alcoholism was defined by WHO first, as any form of drinking which goes beyond the customary dietary use or social drinking customs of the community (World Health Organization 1951, 1952a). Drug addiction was defined as a state of periodic or chronic intoxication produced by the repeated consumption of a natural or synthetic drug that is detrimental to society and the individual. It was characterized by an overpowering desire or need (compulsion) to continue taking the drug and obtain it by any means, a tendency to increase the dose (tolerance) and a psychic (psychological) and sometimes physical dependence on its effects (World Health Organization 1952b).
Drug habituation was separated from drug addiction and characterized by a desire, but not a compulsion, to continue taking the drug. In drug habituation there is no tendency to increase the dose (tolerance) and even if there is some degree of psychic dependence on the effects of the substance, physical dependence with an abstinence syndrome is absent and the continuous taking of the drug has no detrimental effect on the individual (World Health Organization 1950).
Tolerance was defined as an “adaptive state” and characterized by diminishing response to the same quantity of a given drug. It is demonstrable by increasing dose requirements to produce the same degree of pharmacological effects (World Health Organization 1967).
Drugs with a potential to produce addiction were divided into three groups by the WHO. Substances of the first group produce compulsive craving, dependence and addiction in any individual if administered in a sufficiently high dose for a sufficiently long time. In the pathogenesis of addiction with these drugs, pharmacological action is paramount and psychological makeup is adjuvant. Substances of the second group differ from the first by not producing compulsive craving, they merely increase desire and encourage habituation. In the pathogenesis of habituation with these drugs psychological make-up is paramount and pharmacological action is adjuvant. Substances in the third group differ from both the first and the second group; they produce compulsive craving, dependence and addiction, but in those individuals only who seek to find an escape in drugs. In the pathogenesis of addiction with these drugs pharmacological action plays a prominent role but psychological make-up is the determining factor (Isbell and White 1953; World Health Organization 1954).
In 1964 the World Health Organization replaced the term drug addiction with the term drug dependence and defined drug dependence as a state of psychic or physical dependence on a chemical which develops after periodic or continuous administration (World Health Organization 1964). Reviewing drug dependence, its significance and characteristics in the Bulletin of WHO in 1965, Eddy, Halbach, Isbell and Sievers emphasized that drug dependence and drug abuse might occur without the development of demonstrable tolerance (Eddy, Halbach, Isbell and Sievers 1965;Kaplan and Sadock 1988; World Health Organization 1965, 1967).They also pointed out that the characteristics of drug dependence vary with the agent involved (Ban 1969, 2011b).
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition. DSM-III. Washington: American Psychiatric Association; 1980. p.17.
Ban TA. Psychopharmacology. Baltimore: TheWilliams and Wilkins Company; 1969.
Ban TA, editor. An Oral History of Neuropsychopharmacology. The First Fifty Years Peer Interviews. Brentwood: American College of Neuropsychopharmacology; 2011a.
Ban TA. Preface. In Kleber H,editor. Addiction.Volume Six.(In Ban TA, editor. An Oral History of Neuropsychopharmacology. The First Fifty Years Peer Interviews.) Brentwood: American College of Neuropsychopharmacology; 2011b, pp. ix – xxvi.
Bonhoeffer K. Zur Frage der`exogenen Psychosen. Neur Zbl 1909; 32: 499-505.
Bonhoeffer K. Die Symptomatischcn Psychosen. Leipzig: Deuticke; 1910.
Eddy NB, Halbach H, Isbell H, Sievers MH. Drug dependence. Its significance and characterization. Bulletin of the World Health Organization 1965; 32: 721-33.
Fink M, editor. Neurophysiology.Volume Two. (In Ban TA, editor. An Oral History of Neuropsychopharmacology. The First Fifty Years Peer Interviews). Brentwood: American College of Neuropsychopharmacology; 2011.
Gershon S, editor. Neuropsychopharmacology. Volume Five. (In Ban TA, editor. An Oral History of Neuropsychopharmacology. The First Fifty Years Peer Interviews). Brentwood: American College of Neuropsychopharmacology; 2011.
Gregory I. Psychiatry Biological and Social. Philadelphia: Saunders; 1961. p. 490-510.
Hollister LE. Review of Wikler’s The Relation of Psychiatry to Pharmacology. In: Ban TA, Ray OS, editors. A History of the CINP. Brentwood; JM Productions; 1996. p. 339-43.
Isbell H, White WM. Clinical characteristics of addiction. Am J Med 1953; 14: 558-65.
Kaplan HI, Sadock BJ. Synopsis of Psychiatry. Behavioral Sciences Clinical Psychiatry. Fifth Edition. Baltimore: Williams & Wilkins; 1988. p. 218-28.
Kleber HD, editor. Addiction. Volume Six. (In Ban TA, editor. An Oral History of Neuropsychopharmacology. The First Fifty Years Peer Interviews). Brentwood: American College of Neuropsychopharmacology; 2011.
Levine J, editor. Psychopharmacology. Volume Four. (In Ban TA, editor. An Oral History of Neuropsychopharmacology. The First Fifty Years Peer Interviews). Brentwood: American College of Neuropsychopharmacology; 2011.
Mayer-Gross W, Slater E, Roth M. Clinical Psychiatry. Second edition. London: Cassell; 1960.
Sulser F, editor. Neuropharmacology. Volume Three. (In Ban TA, editor. An Oral History of Neuropsychopharmacology. The First Fifty Years Peer Interviews). Brentwood: American College of Neuropsychopharmacology; 2011.
Wikler A. The Relation of Psychiatry to Pharmacology. Baltimore; American Society for Pharmacology andExperimental Therapeutics. Williams & Wilkins Company; 1957.
World Health Organization. Expert Committee on Drugs Liable to Produce Addiction. Report on the second session. Technical Report Series 21. Geneva: WHO; 1950.
World Health Organization. Expert Committee on Mental Health. Report on the first session of the alcoholism subcommittee. Technical Report Series 42. Geneva: WHO; 1951.
World Health Organization. Expert Committee on Mental Health, Alcoholism Subcommittee. Second report. Technical Report Series 48. Geneva: WHO; 1952a.
World Health Organization. Expert Committee on Drugs Liable to Produce Addiction. Third report. Technical Report Series 57. Geneva: WHO; 1952b.
World Health Organization. Expert Committee on Drugs Liable to Produce Drug Addiction. Technical Report Series 76. Geneva: WHO; 1964.
World Health Organization. Alcohol and Alcoholism Report of an Expert Committee. Technical Report Series 94. Geneva: World Health Organization; 1965).
World Health Organization. Expert Committee on Addiction Producing Drugs. Seventh Report. Technical Report Series 116. Geneva: World Health Organization; 1965).