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use). Learning theories are often based in an understanding of the interaction of these with the psychological attributes of the individuals.
During the eighteenth, nineteenth and twentieth centuries reference is made to both the ‘disease’ and the ‘habit’ (Rush 1785; Trotter 1804; De Quincey 1822; Macnish 1859; Jellinek 1960) when describing the nature of the condition, thus establishing both a biological and a behavioural understanding of dependence. The observation that alcohol or opiate use could be driven both by a physical state (withdrawal symptoms) and a state of mind (usually referred to as craving but observed to occur also in the absence of overt withdrawal symptoms and at a time when these would be unlikely to be present) provided the background for the study of psychological as well as physical processes.
1.4 Dependence as a disease state
The disease concept of alcoholism was most famously described by Jellinek (1960) in his book of that name. In his typology he identified different ‘species’ of alcoholism, some of which were disease states, namely ‘gamma’ and ‘delta’, and some of which were not, namely ‘alpha’, ‘beta’ and one of which he was unsure, namely ‘epsilon’. The disease states were characterised by loss of control and inability to abstain, while the non-disease species of alcoholism were characterised by drinking with problems but without loss of control or inability to abstain. Definitive of the disease state in Jellinek’s view were:-
“the adaptation of cell metabolism, and acquired increased tissue tolerance and withdrawal symptoms, which bring about ‘craving’ and loss of control or inability to abstain” (Jellinek 1960 p. 40)
He described these as physiopathological changes which are analogous to those changes which occur when drug addiction is present. He listed other species of alcoholism which may constitute problems but did not constitute a disease and that, in the state of knowledge of the time, it was not possible to decide whether a third species, namely ‘epsilon’ alcoholism, or episodic or binge drinking could also be classified as a disease. ‘Gamma’ alcoholism was characterised by loss of control, or ‘the inability to stop after one or two glasses’, a pattern found more often in North America and the Anglo-Saxon countries; his description is elaborated in Chapter 5 of the present study. ‘Delta’ alcoholism was characterised by an inability to abstain resulting in continuous
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