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drinking over days but not to the levels of intoxication witnessed in loss of control. This condition was thought to be characteristic of drinking in France and Mediterranean countries. He further hypothesised that loss of control drinking may be a consequence of acquired increased tissue tolerance resulting in the need for greater amounts of alcohol in order to achieve the desired effect, while inability to abstain was maintained by the avoidance or relief of withdrawal symptoms. Later, Jellinek proposed that the term craving was not a sufficiently specific one as it was used to denote both the circumstances of continuing drinking to avoid or relieve withdrawal symptoms as well as the psychological need to drink after a period of abstinence. He proposed, in line with the World Health Organisation’s Committee on Alcohol and Alcoholism (World Health Organisation 1955), that these different phenomena be referred to as physical and psychological dependence respectively (Jellinek 1960 pp.143-144).
Here then was described a condition where the presence of a physical, or ‘physiopathological’ state results in specific sorts of behaviour. Jellinek referred to the manifestations of these behaviours as being variable but characteristic; his claim was that the origin of the state was the result of a long history of excessive alcohol consumption, a behaviour that could have many causes. He referred to the progression from the non-disease forms of alcoholism to the disease states but also asserted that such progression was by no means inevitable. Heavy drinking was manifest without the resultant development of alcoholism. He equated the disease forms of alcoholism with drug addiction, specifically heroin, morphine and barbiturate addiction, highlighting differences in the course of development of addiction compared to alcoholism which he attributed to the pharmacological properties and hence the different addiction forming potential of the drugs. The development of addiction to heroin, for example, was inevitable due to the pharmacological properties of the drug, whereas alcohol had much lower addiction forming potential and the role of predisposing behavioural, cultural, psychological and a host of other factors in the individual played an important role.
Jellinek stated the World Health Organisation’s position of the time (World Health Organisation 1955) wherein the term alcoholism embraced both physical and psychological dependence; physical dependence referred to the neuroadapted state and the consequent withdrawal symptoms that result from cessation or reduction in consumption and psychological dependence referred to the ‘pathological desire’ for alcohol (Jellinek 1960 p. 144), both resulting in drink seeking behaviour. This pathological desire, it was claimed, could also pre-date the onset of the disease and be the cause of its development. On the question of the permanence or otherwise of the disease, he proposed that the underlying acquired tissue tolerance may be extinguished by a
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