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disease model” of alcoholism. These were i) the unitary nature of the disease, qualitatively distinct and discontinuous from normality, ii) having biological origins rooted in physiology and heredity, iii) the definitive symptom is inability to control consumption after the first drink and iv) the condition is irreversible. However, as we have seen in the previous discussion, only one of these assumptions was contained in the writing of Jellinek. Many disease formulations of dependence have tended to see the condition as a categorical state that follows a predictable pattern in the light of which the individual is a passive agent able only to decide that abstinence will arrest further deterioration rather than cure the condition because once acquired, the disease is irreversible.
With reference to etiology, views differ. Embraced under the general heading of disease theories are those theories claiming the etiology of the condition to be attributable to the pharmacological properties of the substance, the condition therefore resulting from the ingestion of the substance and those attributing the cause to the predisposing genetic make-up of the individual suggesting that certain metabolic abnormalities or allergic reactions pre-determine a pathological response to ingestion of the substance. Genetic studies contain compelling evidence for a genetic contribution which may account for a small amount of the variance in drinking patterns (Marshall and Murray 1991) and to a far lesser extent in some sorts of drug use; a short review of the evidence for genetic factors in opiate, caffeine and nicotine use is presented by Cook and Gurling (1990). More accessible and of possibly greater relevance to the concerns of the present study is the contribution of the pharmacological properties of the substance, but rather than seeing these as predetermining drinking and drug taking outcomes, their possible contribution to these outcomes will be addressed.
While characteristic of disease formulations, the suggestion of the permanence of the condition is not supported solely in these formulations, but, as will be discussed below, is also supported in some of the behavioural research including animal studies. One might be tempted to ask at this point why it is the case that the question of permanence or reversibility is not resolved; perhaps it is the quest for categorical answers which is the problem. In other words, it is the question itself which should be changed. People with problems of dependence and those who study them report both sorts of outcomes: for some the condition or state is experienced as permanent and, in the experience of others, decline in dependence is possible. One of the aims of the present study is to elucidate the nature and conditions for such decline and to explore the question of whether or not it is the case that dependence, where it does decline, does so in the same way in all individuals.
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