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<div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Classification of problem drinking as a disease</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Alcohol dependence</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:1904_Claim_of_Alcoholism_Being_Disease4.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/49/1904_Claim_of_Alcoholism_Being_Disease4.jpg/220px-1904_Claim_of_Alcoholism_Being_Disease4.jpg" decoding="async" width="220" height="591" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/49/1904_Claim_of_Alcoholism_Being_Disease4.jpg/330px-1904_Claim_of_Alcoholism_Being_Disease4.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/49/1904_Claim_of_Alcoholism_Being_Disease4.jpg/440px-1904_Claim_of_Alcoholism_Being_Disease4.jpg 2x" data-file-width="560" data-file-height="1505" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">A 1904 advertisement labeling alcoholism a "disease"</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a></td></tr></tbody></table> <p>The modern <b>disease theory of alcoholism</b> states that problem drinking is sometimes caused by a <a href="/wiki/Neurological_disorder" title="Neurological disorder">disease of the brain</a>, characterized by altered brain structure and function. Today, alcohol use disorder (AUD) is used as a more scientific and suitable approach to <a href="/wiki/Alcohol_dependence" title="Alcohol dependence">alcohol dependence</a> and <a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">alcohol</a>-related problems.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>The largest association of physicians – the <a href="/wiki/American_Medical_Association" title="American Medical Association">American Medical Association</a> (AMA) – declared that alcoholism was an illness in 1956.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> In 1991, the AMA further endorsed the dual classification of alcoholism by the <a href="/wiki/International_Classification_of_Diseases" title="International Classification of Diseases">International Classification of Diseases</a> under both <a href="/wiki/Psychiatric" class="mw-redirect" title="Psychiatric">psychiatric</a> and <a href="/wiki/Medical" class="mw-redirect" title="Medical">medical</a> sections. </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Theory">Theory</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Disease_theory_of_alcoholism&action=edit&section=1" title="Edit section: Theory"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Under the model of <a href="/wiki/Alcoholism" title="Alcoholism">alcoholism</a>, alcohol use disorder is viewed as <a href="/wiki/Chronic_(medical)" class="mw-redirect" title="Chronic (medical)">chronic</a> problem for which abstinence is required.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> A brain disease model of addiction, based on the extent of neuroadaptation and impaired control, is main position advanced for proposing a disease model of alcohol use disorder.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> However, if managed properly, <a href="/wiki/Brain_damage" class="mw-redirect" title="Brain damage">damage to the brain</a> can be stopped and to some extent reversed.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup>  In addition to problem drinking, the disease is characterized by symptoms including an impaired control over alcohol, compulsive thoughts about alcohol, and <a href="/wiki/Distorted_thinking" class="mw-redirect" title="Distorted thinking">distorted thinking</a>.<sup id="cite_ref-MORSE1992_7-0" class="reference"><a href="#cite_note-MORSE1992-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Alcoholism can also lead indirectly, through excess consumption, to <a href="/wiki/Physical_dependence" title="Physical dependence">physical dependence</a> on alcohol, and diseases such as <a href="/wiki/Cirrhosis" title="Cirrhosis">cirrhosis</a> of the liver. </p><p>The risk of developing alcoholism depends on many factors, such as environment. Those with a family history of alcoholism are more likely to develop it themselves (Enoch & Goldman, 2001); however, many individuals have developed alcoholism without a family history of the disease. Since the consumption of alcohol is necessary to develop alcoholism, the availability of and attitudes towards alcohol in an individual's environment affect their likelihood of developing the disease. Current evidence indicates that in both men and women, alcoholism is 50–60% genetically determined, leaving 40-50% for environmental influences.<sup id="cite_ref-The_Genetics_of_Alcohol_Dependency_8-0" class="reference"><a href="#cite_note-The_Genetics_of_Alcohol_Dependency-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>In a review in 2001, McLellan et al. compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. They found that genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders, providing evidence that drug (including alcohol) dependence is a chronic medical illness.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Genetics_and_environment">Genetics and environment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Disease_theory_of_alcoholism&action=edit&section=2" title="Edit section: Genetics and environment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>According to the theory, genes play a strong role in the development of alcoholism. </p><p><a href="/wiki/Twin_studies" class="mw-redirect" title="Twin studies">Twin studies</a>, adoption studies, and artificial selection studies have shown that a person's genes can predispose them to developing alcoholism. Evidence from twin studies show that concordance rates for alcoholism are higher for <a href="/wiki/Monozygotic_twins" class="mw-redirect" title="Monozygotic twins">monozygotic twins</a> than <a href="/wiki/Dizygotic_twins" class="mw-redirect" title="Dizygotic twins">dizygotic twins</a>—76% for monozygotic twins and 61% for dizygotic twins.<sup id="cite_ref-Carlson_et_al._2005_75–76_10-0" class="reference"><a href="#cite_note-Carlson_et_al._2005_75–76-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> However, female twin studies demonstrate that females have much lower concordance rates than males.<sup id="cite_ref-Carlson_et_al._2005_75–76_10-1" class="reference"><a href="#cite_note-Carlson_et_al._2005_75–76-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Reasons for gender differences may include environmental factors, such as negative public attitudes towards female drinkers.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>Adoption studies also suggest a strong genetic tendency towards alcoholism. Studies on children separated from their biological parents demonstrates that sons of alcoholic biological fathers were more likely to become alcoholic, even though they have been separated and raised by non alcoholic parents.<sup id="cite_ref-Carlson_et_al._2005_75–76_10-2" class="reference"><a href="#cite_note-Carlson_et_al._2005_75–76-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>In artificial selection studies, specific strains of rats were bred to prefer alcohol. These rats preferred drinking alcohol over other liquids, resulting in a tolerance for alcohol and exhibited a physical dependency on alcohol.<sup id="cite_ref-Carlson_et_al._2005_75–76_10-3" class="reference"><a href="#cite_note-Carlson_et_al._2005_75–76-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Rats that were not bred for this preference did not have these traits.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Carlson_et_al._2005_75–76_10-4" class="reference"><a href="#cite_note-Carlson_et_al._2005_75–76-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Upon analyzing the brains of these two strains of rats, it was discovered that there were differences in chemical composition of certain areas of the brain. This study suggests that certain brain mechanisms are more genetically prone to alcoholism.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>The convergent evidence from these studies present a strong case for the genetic basis of alcoholism.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Disease_theory_of_alcoholism&action=edit&section=3" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Historians debate who has primacy in arguing that habitual drinking carried the characteristics of a disease. Some note that Scottish physician <a href="/wiki/Thomas_Trotter_(physician)" title="Thomas Trotter (physician)">Thomas Trotter</a> was the first to characterize excessive drinking as a mental disease or medical defect.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>Others point to American physician <a href="/wiki/Benjamin_Rush" title="Benjamin Rush">Benjamin Rush</a> (1745–1813), a signatory to the <a href="/wiki/United_States_Declaration_of_Independence" title="United States Declaration of Independence">United States Declaration of Independence</a>, who understood drunkenness to be what we would now call a "loss of control", as possibly the first to use the term <i>addiction</i> in this sort of meaning.<sup id="cite_ref-auto1_16-0" class="reference"><a href="#cite_note-auto1-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r1244412712">.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 32px}.mw-parser-output .templatequotecite{line-height:1.5em;text-align:left;margin-top:0}@media(min-width:500px){.mw-parser-output .templatequotecite{padding-left:1.6em}}</style><blockquote class="templatequote"><p>My observations authorize me to say, that persons who have been addicted to them, should abstain from them suddenly and entirely. 'Taste not, handle not, touch not' should be inscribed upon every vessel that contains spirits in the house of a man, who wishes to be cured of habits of intemperance.</p><div class="templatequotecite">— <cite>Levine, H.G., The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America<sup id="cite_ref-auto1_16-1" class="reference"><a href="#cite_note-auto1-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup></cite></div></blockquote> <p>Rush argued that "habitual drunkenness should be regarded not as a bad habit but as a disease", describing it as "a palsy of the will".<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Rush expounded his views in a book published in 1808.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> His views are described by Valverde,<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Levine<sup id="cite_ref-auto1_16-2" class="reference"><a href="#cite_note-auto1-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Spode,<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> and Perkins-McVey.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Already in 1802 the prominent German physician <a href="/wiki/Christoph_Wilhelm_Hufeland" title="Christoph Wilhelm Hufeland">Christoph Wilhelm Hufeland</a> had published a book on the “brandy plague” stating that the “infection” with spirits makes it “inevitably necessary to drink ever more.”<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Later he wrote an enthusiastic preface to the book <i>On the addiction to drink and a rational cure of it</i> by German-Russian physician C. von Brühl-Cramer.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> As Spode points out, this study marked the birth of a consistent "paradigm" of addiction as a mental illness, although it took many decades until this view was accepted.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Perkins-McVey argues that Rush, Trotter, and Brühl-Cramer each independently developed their own disease theories of alcoholism as a result of their shared interest in the <a href="/wiki/Brunonian_system_of_medicine" title="Brunonian system of medicine">Brunonian system of medicine</a>, which classified alcohol as a stimulant of the vital force.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> As Perkins-McVey argues, this "understanding of the disease of habitual drunkenness as a phenomena  [<i><a href="/wiki/Sic" title="Sic">sic</a></i>] of stimulus dependence is arguably the primary vehicle driving the disease model in the works of Rush, Trotter, and Brühl-Cramer."<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> This shifts the discussion away from the question of historical priority, instead identifying a common conceptual influence on early disease theorists. </p><p>In 1849, Swedish physician <a href="/wiki/Magnus_Huss" title="Magnus Huss">Magnus Huss</a> coined the term <i>alcoholism</i> in his book <i>Alcoholismus chronicus</i>. Some argue he was the first to systematically describe the physical characteristics of habitual drinking and claim that it was a mental disease. However, Huss regarded heavy drinking still as a vice (that causes a destruction of the nervous system).<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Moreover, this came decades after Trotter, Rush, Hufeland and Brühl-Cramer wrote their works, and some historians argue that the idea that habitual drinking was a mental disease emerged even earlier.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p><p>Given this controversy, the best one can say is that the idea that habitual alcohol drinking was a disease had become more acceptable by the second half of the nineteenth century, although many writers still argued it was a vice, a sin, and not the purview of medicine but of religion.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p><p> Between 1980 and 1991, medical organizations, including the AMA, worked together to establish policies regarding their positions on the disease theory. These policies were developed in 1987 in part because third-party reimbursement for treatment was difficult or impossible unless alcoholism were categorized as a disease. The policies of the AMA, formed through consensus of the federation of state and specialty medical societies within their House of Delegates, state, in part: </p><blockquote><p>"The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice."</p></blockquote> <p>In 1991, the AMA further endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections. </p> <div class="mw-heading mw-heading2"><h2 id="Controlled_drinking">Controlled drinking</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Disease_theory_of_alcoholism&action=edit&section=4" title="Edit section: Controlled drinking"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The disease theory is often interpreted as implying that problem drinkers are incapable of returning to 'normal' problem free drinking, and therefore that treatment should focus on total abstinence. Some critics have used evidence of controlled drinking in formerly dependent drinkers to dispute the disease theory of alcoholism.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p><p>The first major empirical challenge to this interpretation of the disease theory followed a 1962 study by Dr. D. L. Davies.<sup id="cite_ref-davies_31-0" class="reference"><a href="#cite_note-davies-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Davies' follow-up of ninety-three problem drinkers found that seven of them were able to return to "controlled drinking" (less than seven drinks per day for at least seven years). Davies concluded that "the accepted view that no alcohol addict can ever again drink normally should be modified, although all patients should be advised to aim at total abstinence"; After the Davies study, several other researchers reported cases of problem drinkers returning to controlled drinking.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p><p>In 1976, a major study commonly referred to as the RAND report, published evidence of problem drinkers learning to consume alcohol in moderation.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> The publication of the study renewed controversy over how people with a disease which reputedly leads to uncontrollable drinking could manage to drink controllably. Subsequent studies also reported evidence of return to controlled drinking.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> Similarly, according to a 2002 <a href="/wiki/National_Institute_on_Alcohol_Abuse_and_Alcoholism" title="National Institute on Alcohol Abuse and Alcoholism">National Institute on Alcohol Abuse and Alcoholism</a> (NIAAA) study,<sup id="cite_ref-niaaa20050118_46-0" class="reference"><a href="#cite_note-niaaa20050118-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> about one of every six (18%) of alcohol dependent adults in the U.S. whose dependence began over one year previously had become "low-risk drinkers" (less than fourteen drinks per week and five drinks per day for men, or less than seven per week and four per day for women). This modern longitudinal study surveyed more than 43,000 individuals representative of the U.S. adult population, rather than focusing solely on those seeking or receiving treatment for alcohol dependence.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> "Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence."<sup id="cite_ref-niaaa20050118_46-1" class="reference"><a href="#cite_note-niaaa20050118-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-auto_48-0" class="reference"><a href="#cite_note-auto-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p><p>However, many researchers have debated the results of the smaller studies. A 1994 followup of the original seven cases studied by Davies suggested that he "had been substantially misled, and the paradox exists that a widely influential paper which did much to stimulate new thinking was based on faulty data."<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> The most recent study, a long-term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."<sup id="cite_ref-pmid12873238_50-0" class="reference"><a href="#cite_note-pmid12873238-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage." </p><p>The second RAND study, in 1980, found that alcohol dependence represents a factor of central importance in the process of relapse.<sup id="cite_ref-rand_51-0" class="reference"><a href="#cite_note-rand-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> Among people with low dependence levels at admission, the risk of relapse appears relatively low for those who later drank without problems. But the greater the initial level of dependence, the higher the likelihood of relapse for nonproblem drinkers.<sup id="cite_ref-rand_51-1" class="reference"><a href="#cite_note-rand-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> The second RAND study findings have been strengthened by subsequent research by Dawson <i>et al.</i> in 2005 which found that severity was associated positively with the likelihood of abstinent recovery and associated negatively with the likelihood of non-abstinent recovery or controlled drinking.<sup id="cite_ref-auto_48-1" class="reference"><a href="#cite_note-auto-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> Other factors such as a significant period of abstinence or changes in life circumstances were also identified as strong influences for success in a book on Controlled Drinking published in 1981.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Managed_drinking">Managed drinking</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Disease_theory_of_alcoholism&action=edit&section=5" title="Edit section: Managed drinking"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As part of a <a href="/wiki/Harm_reduction" title="Harm reduction">harm reduction</a> strategy, provision of small amounts of alcoholic beverages to homeless alcoholics at homeless shelters in <a href="/wiki/Toronto" title="Toronto">Toronto</a> and <a href="/wiki/Ottawa" title="Ottawa">Ottawa</a> reduced government costs and improved health outcomes.<sup id="cite_ref-pmid16389236_53-0" class="reference"><a href="#cite_note-pmid16389236-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Guardian42616_54-0" class="reference"><a href="#cite_note-Guardian42616-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Legal_considerations">Legal considerations</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Disease_theory_of_alcoholism&action=edit&section=6" title="Edit section: Legal considerations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 1988, the <a href="/wiki/US_Supreme_Court" class="mw-redirect" title="US Supreme Court">US Supreme Court</a> upheld a regulation whereby the <a href="/wiki/Veterans%27_Administration" class="mw-redirect" title="Veterans' Administration">Veterans' Administration</a> was able to avoid paying benefits by presuming that primary alcoholism is always the result of the veteran's "own willful misconduct." The majority opinion written by Justice Byron R. White echoed the District of Columbia Circuit's finding that there exists "a substantial body of medical literature that even contests the proposition that alcoholism is a disease, much less that it is a disease for which the victim bears no responsibility".<sup id="cite_ref-TraynorTurnage_55-0" class="reference"><a href="#cite_note-TraynorTurnage-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> He also wrote: "Indeed, even among many who consider alcoholism a 'disease' to which its victims are genetically predisposed, the consumption of alcohol is not regarded as wholly involuntary." However, the majority opinion stated in conclusion that "this litigation does not require the Court to decide whether alcoholism is a disease whose course its victims cannot control. It is not our role to resolve this medical issue on which the authorities remain sharply divided." The dissenting opinion noted that "despite much comment in the popular press, these cases are not concerned with whether alcoholism, simplistically, is or is not a 'disease.'"<sup id="cite_ref-56" class="reference"><a href="#cite_note-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> </p><p>The <a href="/wiki/American_Bar_Association" title="American Bar Association">American Bar Association</a> "affirms the principle that dependence on alcohol or other drugs is a disease."<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Current_acceptance">Current acceptance</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Disease_theory_of_alcoholism&action=edit&section=7" title="Edit section: Current acceptance"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Alcoholism is a disease with a known <a href="/wiki/Pathology" title="Pathology">pathology</a> and an established biomolecular <a href="/wiki/Signal_transduction" title="Signal transduction">signal transduction</a> pathway<sup id="cite_ref-Alcoholism_ΔFosB_58-0" class="reference"><a href="#cite_note-Alcoholism_ΔFosB-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> which culminates in <a href="/wiki/%CE%94FosB" class="mw-redirect" title="ΔFosB">ΔFosB</a> overexpression within the <a href="/wiki/D1-type" class="mw-redirect" title="D1-type">D1-type</a> <a href="/wiki/Medium_spiny_neurons" class="mw-redirect" title="Medium spiny neurons">medium spiny neurons</a> of the <a href="/wiki/Nucleus_accumbens" title="Nucleus accumbens">nucleus accumbens</a>;<sup id="cite_ref-Alcoholism_ΔFosB_58-1" class="reference"><a href="#cite_note-Alcoholism_ΔFosB-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-What_the_ΔFosB?_59-0" class="reference"><a href="#cite_note-What_the_ΔFosB?-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Cellular_basis_60-0" class="reference"><a href="#cite_note-Cellular_basis-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> when this overexpression occurs, ΔFosB induces the addictive state.<sup id="cite_ref-Alcoholism_ΔFosB_58-2" class="reference"><a href="#cite_note-Alcoholism_ΔFosB-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-What_the_ΔFosB?_59-1" class="reference"><a href="#cite_note-What_the_ΔFosB?-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Cellular_basis_60-1" class="reference"><a href="#cite_note-Cellular_basis-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> </p><p>In 2004, the <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> published a detailed report on alcohol and other psychoactive substances entitled "Neuroscience of psychoactive substance use and dependence".<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> It stated that this was the "first attempt by WHO to provide a comprehensive overview of the biological factors related to substance use and dependence by summarizing the vast amount of knowledge gained in the last 20-30 years. The report highlights the current state of knowledge of the mechanisms of action of different types of psychoactive substances, and explains how the use of these substances can lead to the development of dependence syndrome." The report states that "dependence has not previously been recognized as a disorder of the brain, in the same way that psychiatric and mental illnesses were not previously viewed as being a result of a disorder of the brain. However, with recent advances in neuroscience, it is clear that dependence is as much a disorder of the brain as any other neurological or psychiatric illness." </p><p>The <a href="/wiki/American_Society_of_Addiction_Medicine" title="American Society of Addiction Medicine">American Society of Addiction Medicine</a> and the <a href="/wiki/American_Medical_Association" title="American Medical Association">American Medical Association</a> both maintain extensive policy regarding alcoholism. The <a href="/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a> recognizes the existence of alcoholism as the equivalent of alcohol dependence. The <a href="/wiki/American_Hospital_Association" title="American Hospital Association">American Hospital Association</a>, the <a href="/wiki/American_Public_Health_Association" title="American Public Health Association">American Public Health Association</a>, the <a href="/wiki/National_Association_of_Social_Workers" title="National Association of Social Workers">National Association of Social Workers</a>, and the <a href="/wiki/American_College_of_Physicians" title="American College of Physicians">American College of Physicians</a> classify alcoholism as a <a href="/wiki/Disease" title="Disease">disease</a>. </p><p>In the US, the <a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">National Institutes of Health</a> has a specific institute, the <a href="/wiki/National_Institute_on_Alcohol_Abuse_and_Alcoholism" title="National Institute on Alcohol Abuse and Alcoholism">National Institute on Alcohol Abuse and Alcoholism</a> (NIAAA), concerned with the support and conduct of biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. It funds approximately 90 percent of all such research in the United States. The official NIAAA position is that "alcoholism is a disease. The craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems. Like many other diseases, alcoholism is chronic, meaning that it lasts a person's lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing alcoholism is influenced both by a person's genes and by his or her lifestyle."<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> </p><p>Certain medications including opioid antagonists such as <a href="/wiki/Naltrexone" title="Naltrexone">naltrexone</a> have been shown to be effective in the treatment of alcoholism.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Criticism">Criticism</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Disease_theory_of_alcoholism&action=edit&section=8" title="Edit section: Criticism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Some physicians, scientists and others have rejected the disease theory of alcoholism on logical, empirical and other grounds.<sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-66" class="reference"><a href="#cite_note-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-67" class="reference"><a href="#cite_note-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-VAILLANT1990_69-0" class="reference"><a href="#cite_note-VAILLANT1990-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup> Indeed, some addiction experts such as <a href="/wiki/Stanton_Peele" title="Stanton Peele">Stanton Peele</a> are outspoken in their rejection of the disease model, and other prominent alcohol researchers such as <a href="/wiki/Nick_Heather" title="Nick Heather">Nick Heather</a> have authored books intending to disprove the disease model.<sup id="cite_ref-70" class="reference"><a href="#cite_note-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup> </p><p>These critics hold that by removing some of the stigma and personal responsibility the disease concept actually increases alcoholism and drug abuse and thus the need for treatment.<sup id="cite_ref-baldwinresearch_71-0" class="reference"><a href="#cite_note-baldwinresearch-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup> This is somewhat supported by a study which found that a greater belief in the disease theory of alcoholism and higher commitment to total abstinence to be factors correlated with increased likelihood that an alcoholic would have a full-blown relapse (substantial continued use) following an initial lapse (single use).<sup id="cite_ref-72" class="reference"><a href="#cite_note-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> However, the authors noted that "the direction of causality cannot be determined from these data. It is possible that belief in alcoholism as a loss-of-control disease predisposes clients to relapse, or that repeated relapses reinforce clients' beliefs in the disease model." </p><p>One study published in 1996 found that only 25 percent of physicians believed that alcoholism is a disease. The majority believed alcoholism to be a social or psychological problem instead of a disease.<sup id="cite_ref-73" class="reference"><a href="#cite_note-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> </p><p>Thomas R. Hobbs says that "Based on my experiences working in the addiction field for the past 10 years, I believe many, if not most, health care professionals still view alcohol addiction as a willpower or conduct problem and are resistant to look at it as a disease."<sup id="cite_ref-74" class="reference"><a href="#cite_note-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> </p><p>The <a href="/wiki/Sociology" title="Sociology">sociologist</a> Lynn M. Appleton noted that "Despite all public pronouncements about alcoholism as a disease, medical practice rejects treating it as such. Not only does alcoholism not follow the model of a 'disease,' it is not amenable to standard medical treatment." She says that "Medical doctors' rejection of the disease theory of alcoholism has a strong basis in the biomedical model underpinning most of their training" and that "medical research on alcoholism does not support the disease model."<sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 65 and 69">: 65 and 69 </span></sup> </p><p>"Many doctors have been loath to prescribe drugs to treat alcoholism, sometimes because of the belief that alcoholism is a moral disorder rather than a disease," according to Dr. <a href="/wiki/Bankole_Johnson" title="Bankole Johnson">Bankole Johnson</a>, Chairman of the Department of Psychiatry at the <a href="/wiki/University_of_Virginia" title="University of Virginia">University of Virginia</a>.<sup id="cite_ref-76" class="reference"><a href="#cite_note-76"><span class="cite-bracket">[</span>76<span class="cite-bracket">]</span></a></sup> Dr Johnson's own pioneering work has made important contributions to the understanding of alcoholism as a disease.<sup id="cite_ref-77" class="reference"><a href="#cite_note-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup> </p><p>Frequency and quantity of alcohol use are not related to the presence of the condition; that is, people can drink a great deal without necessarily being alcoholic, and alcoholics may drink minimally or infrequently.<sup id="cite_ref-MORSE1992_7-1" class="reference"><a href="#cite_note-MORSE1992-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Esser2014_78-0" class="reference"><a href="#cite_note-Esser2014-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Disease_theory_of_alcoholism&action=edit&section=9" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Disease_model_of_addiction" title="Disease model of addiction">Disease model of addiction</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Disease_theory_of_alcoholism&action=edit&section=10" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFMorrisBonessBurton2023" class="citation journal cs1">Morris, James; 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"The Genetics of Alcohol Dependency". <i>Current Psychiatry Reports</i>. <b>8</b> (2): <span class="nowrap">151–</span>7. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs11920-006-0015-1">10.1007/s11920-006-0015-1</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16539893">16539893</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:10535003">10535003</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Psychiatry+Reports&rft.atitle=The+Genetics+of+Alcohol+Dependency&rft.volume=8&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E151-%3C%2Fspan%3E7&rft.date=2006&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A10535003%23id-name%3DS2CID&rft_id=info%3Apmid%2F16539893&rft_id=info%3Adoi%2F10.1007%2Fs11920-006-0015-1&rft.aulast=Dick&rft.aufirst=DM&rft.au=Bierut%2C+LJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADisease+theory+of+alcoholism" class="Z3988"></span></span> </li> <li id="cite_note-9"><span class="mw-cite-backlink"><b><a href="#cite_ref-9">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMcLellanLewisO'BrienKleber2000" class="citation journal cs1">McLellan, AT; Lewis, DC; O'Brien, CP; Kleber, HD (2000). "Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation". <i>JAMA: The Journal of the American Medical Association</i>. <b>284</b> (13): <span class="nowrap">1689–</span>95. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1001%2Fjama.284.13.1689">10.1001/jama.284.13.1689</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11015800">11015800</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JAMA%3A+The+Journal+of+the+American+Medical+Association&rft.atitle=Drug+dependence%2C+a+chronic+medical+illness%3A+implications+for+treatment%2C+insurance%2C+and+outcomes+evaluation&rft.volume=284&rft.issue=13&rft.pages=%3Cspan+class%3D%22nowrap%22%3E1689-%3C%2Fspan%3E95&rft.date=2000&rft_id=info%3Adoi%2F10.1001%2Fjama.284.13.1689&rft_id=info%3Apmid%2F11015800&rft.aulast=McLellan&rft.aufirst=AT&rft.au=Lewis%2C+DC&rft.au=O%27Brien%2C+CP&rft.au=Kleber%2C+HD&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADisease+theory+of+alcoholism" class="Z3988"></span></span> </li> <li id="cite_note-Carlson_et_al._2005_75–76-10"><span class="mw-cite-backlink">^ <a href="#cite_ref-Carlson_et_al._2005_75–76_10-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Carlson_et_al._2005_75–76_10-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Carlson_et_al._2005_75–76_10-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Carlson_et_al._2005_75–76_10-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Carlson_et_al._2005_75–76_10-4"><sup><i><b>e</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCarlsonBuskistEnzleHeth2005" class="citation book cs1">Carlson, Neil R.; Buskist, William; Enzle, Michael E.; Heth, C. 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Pearson. pp. <a rel="nofollow" class="external text" href="https://archive.org/details/psychologyscienc0000unse/page/75">75–76</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-205-45769-4" title="Special:BookSources/978-0-205-45769-4"><bdi>978-0-205-45769-4</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Psychology%3A+The+Science+of+Behaviour+3rd+Canadian+Edition&rft.pages=75-76&rft.pub=Pearson&rft.date=2005&rft.isbn=978-0-205-45769-4&rft.aulast=Carlson&rft.aufirst=Neil+R.&rft.au=Buskist%2C+William&rft.au=Enzle%2C+Michael+E.&rft.au=Heth%2C+C.+Donald&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fpsychologyscienc0000unse%2Fpage%2F75&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADisease+theory+of+alcoholism" class="Z3988"></span></span> </li> <li id="cite_note-11"><span class="mw-cite-backlink"><b><a href="#cite_ref-11">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20120626041314/http://www.indiana.edu/~engs/articles/gender90.htm">"Differences in drinking among male and female students: Dr. Engs"</a>. Indiana.edu. Archived from <a rel="nofollow" class="external text" href="http://www.indiana.edu/~engs/articles/gender90.htm">the original</a> on 2012-06-26<span class="reference-accessdate">. Retrieved <span class="nowrap">2012-05-30</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Differences+in+drinking+among+male+and+female+students%3A+Dr.+Engs&rft.pub=Indiana.edu&rft_id=http%3A%2F%2Fwww.indiana.edu%2F~engs%2Farticles%2Fgender90.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADisease+theory+of+alcoholism" class="Z3988"></span></span> </li> <li id="cite_note-12"><span class="mw-cite-backlink"><b><a href="#cite_ref-12">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLumengMurphyMcBrideLi1995" class="citation book cs1">Lumeng, Lawrence; Murphy, James M.; McBride, William J.; Li, Ting-Kai (1995). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=7sLOolRhovkC&pg=PA165">"Genetic Influences on Alcohol Preference in Animals"</a>. In Begleiter, Henri; Kissin, Benjamin (eds.). <a rel="nofollow" class="external text" href="https://archive.org/details/geneticsofalcoho00begl/page/165"><i>The Genetics of Alcoholism</i></a>. Oxford University Press. pp. <a rel="nofollow" class="external text" href="https://archive.org/details/geneticsofalcoho00begl/page/165">165–201</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-19-508877-9" title="Special:BookSources/978-0-19-508877-9"><bdi>978-0-19-508877-9</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Genetic+Influences+on+Alcohol+Preference+in+Animals&rft.btitle=The+Genetics+of+Alcoholism&rft.pages=165-201&rft.pub=Oxford+University+Press&rft.date=1995&rft.isbn=978-0-19-508877-9&rft.aulast=Lumeng&rft.aufirst=Lawrence&rft.au=Murphy%2C+James+M.&rft.au=McBride%2C+William+J.&rft.au=Li%2C+Ting-Kai&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D7sLOolRhovkC%26pg%3DPA165&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADisease+theory+of+alcoholism" class="Z3988"></span></span> </li> <li id="cite_note-13"><span class="mw-cite-backlink"><b><a href="#cite_ref-13">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMayfieldHarrisSchuckit2008" class="citation journal cs1">Mayfield, R D; Harris, R A; Schuckit, M A (May 2008). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442454">"Genetic factors influencing alcohol dependence"</a>. <i>British Journal of Pharmacology</i>. <b>154</b> (2): <span class="nowrap">275–</span>287. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fbjp.2008.88">10.1038/bjp.2008.88</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442454">2442454</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/18362899">18362899</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=British+Journal+of+Pharmacology&rft.atitle=Genetic+factors+influencing+alcohol+dependence&rft.volume=154&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E275-%3C%2Fspan%3E287&rft.date=2008-05&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2442454%23id-name%3DPMC&rft_id=info%3Apmid%2F18362899&rft_id=info%3Adoi%2F10.1038%2Fbjp.2008.88&rft.aulast=Mayfield&rft.aufirst=R+D&rft.au=Harris%2C+R+A&rft.au=Schuckit%2C+M+A&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2442454&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADisease+theory+of+alcoholism" class="Z3988"></span></span> </li> <li id="cite_note-14"><span class="mw-cite-backlink"><b><a href="#cite_ref-14">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFElkins2016" class="citation news cs1">Elkins, Chris (2016-06-22). <a rel="nofollow" class="external text" href="https://www.drugrehab.com/born-to-do-drugs/">"Born To Do Drugs: Overcoming A Family History Of Addiction"</a>. <i>DrugRehab.com</i><span class="reference-accessdate">. Retrieved <span class="nowrap">2016-07-11</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=DrugRehab.com&rft.atitle=Born+To+Do+Drugs%3A+Overcoming+A+Family+History+Of+Addiction&rft.date=2016-06-22&rft.aulast=Elkins&rft.aufirst=Chris&rft_id=https%3A%2F%2Fwww.drugrehab.com%2Fborn-to-do-drugs%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADisease+theory+of+alcoholism" class="Z3988"></span></span> </li> <li id="cite_note-15"><span class="mw-cite-backlink"><b><a href="#cite_ref-15">^</a></b></span> <span class="reference-text">Trotter, T. (Porter, R., ed.), <i>An Essay, Medical, Philosophical, and Chemical, on Drunkenness and Its Effects on the Human Body</i>, Routledge, (London), 1988. (This a facsimile of the first (1804) London edition. The book itself was based on the thesis "<i>De ebrietate, ejusque effectibus in corpus humanum</i>" that Trotter had presented to <a href="/wiki/Edinburgh_University" class="mw-redirect" title="Edinburgh University">Edinburgh University</a> in 1788.)</span> </li> <li id="cite_note-auto1-16"><span class="mw-cite-backlink">^ <a href="#cite_ref-auto1_16-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-auto1_16-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-auto1_16-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text">Levine, H.G., "The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America", <i>Journal of Studies on Alcohol</i>, Vol.39, No.1, (January 1978), pp.143-174. (Reprint: <i>Journal of Substance Abuse Treatment</i>, Vol.2, No.1, (1985), pp.43-57.) Available at <a rel="nofollow" class="external autonumber" href="http://soc.qc.cuny.edu/Staff/levine/doa.htm">[1]</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20080415000151/http://soc.qc.cuny.edu/Staff/levine/doa.htm">Archived</a> April 15, 2008, at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a></span> </li> <li id="cite_note-17"><span class="mw-cite-backlink"><b><a href="#cite_ref-17">^</a></b></span> <span class="reference-text">Valverde (1998, p.2) <sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citing_sources#What_information_to_include" title="Wikipedia:Citing sources"><span title="A complete citation is needed. (September 2018)">full citation needed</span></a></i>]</sup></span> </li> <li id="cite_note-18"><span class="mw-cite-backlink"><b><a href="#cite_ref-18">^</a></b></span> <span class="reference-text">Rush, B., <i>An Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind: With an Account of the Means of Preventing, and of the Remedies for Curing Them</i>, Thomas Dobson, (Philadelphia), 1808.</span> </li> <li id="cite_note-19"><span class="mw-cite-backlink"><b><a href="#cite_ref-19">^</a></b></span> <span class="reference-text">Valverde, M., <i>Diseases of the Will: Alcohol and the Dilemmas of Freedom</i>, Cambridge University Press, (Cambridge), 1998.</span> </li> <li id="cite_note-20"><span class="mw-cite-backlink"><b><a href="#cite_ref-20">^</a></b></span> <span class="reference-text">Hasso Spode, <i>Die Macht der Trunkenheit</i>, Opladen 1993, pp. 124ff.</span> </li> <li id="cite_note-21"><span class="mw-cite-backlink"><b><a href="#cite_ref-21">^</a></b></span> <span class="reference-text">Matthew Perkins-McVey, "Were the scale of excitability a circle: Tracing the roots of the disease theory of alcoholism through Brunonian stimulus dependence", <i>Studies in History and Philosophy of Science</i>, Vol. 99 (2023): 48 (<a rel="nofollow" class="external free" href="https://doi.org/10.1016/j.shpsa.2023.03.001">https://doi.org/10.1016/j.shpsa.2023.03.001</a>)</span> </li> <li id="cite_note-22"><span class="mw-cite-backlink"><b><a href="#cite_ref-22">^</a></b></span> <span class="reference-text"><a href="/wiki/Hasso_Spode" title="Hasso Spode">Hasso Spode</a>, "Transsubstantiations of the Mystery: Two Remarks on the Shifts in the Knowledge about Addiction." <i>Social History of Alcohol and Drugs</i>, Vol. 20 (2005): 126 (<a rel="nofollow" class="external free" href="http://hist-soz.de/publika/SPODE-SHAD20-05.pdf">http://hist-soz.de/publika/SPODE-SHAD20-05.pdf</a>)</span> </li> <li id="cite_note-23"><span class="mw-cite-backlink"><b><a href="#cite_ref-23">^</a></b></span> <span class="reference-text">C. von Brühl-Cramer, Ueber die Trunksucht und eine rationelle Heilmethode derselben, Berlin 1819 (also publ. in Moscow).</span> </li> <li id="cite_note-24"><span class="mw-cite-backlink"><b><a href="#cite_ref-24">^</a></b></span> <span class="reference-text">Hasso Spode, <i>Die Macht der Trunkenheit</i>, Opladen 1993, pp. 127ff.</span> </li> <li id="cite_note-25"><span class="mw-cite-backlink"><b><a href="#cite_ref-25">^</a></b></span> <span class="reference-text">Matthew Perkins-McVey, "Were the scale of excitability a circle: Tracing the roots of the disease theory of alcoholism through Brunonian stimulus dependence", <i>Studies in History and Philosophy of Science</i>, Vol. 99 (2023): 52 (<a rel="nofollow" class="external free" href="https://doi.org/10.1016/j.shpsa.2023.03.001">https://doi.org/10.1016/j.shpsa.2023.03.001</a>)</span> </li> <li id="cite_note-26"><span class="mw-cite-backlink"><b><a href="#cite_ref-26">^</a></b></span> <span class="reference-text">Matthew Perkins-McVey, "Were the scale of excitability a circle: Tracing the roots of the disease theory of alcoholism through Brunonian stimulus dependence", <i>Studies in History and Philosophy of Science</i>, Vol. 99 (2023): 52 (<a rel="nofollow" class="external free" href="https://doi.org/10.1016/j.shpsa.2023.03.001">https://doi.org/10.1016/j.shpsa.2023.03.001</a>)</span> </li> <li id="cite_note-27"><span class="mw-cite-backlink"><b><a href="#cite_ref-27">^</a></b></span> <span class="reference-text">Hasso Spode, <i>Die Macht der Trunkenheit</i>, Opladen 1993, pp. 127ff.</span> </li> <li id="cite_note-28"><span class="mw-cite-backlink"><b><a href="#cite_ref-28">^</a></b></span> <span class="reference-text">Along with Levine, see Roy Porter ("Drinking Man's Disease: the 'Pre-History' of Alcoholism in Georgian Britain," <i>British Journal of Addiction</i> 80 (1985): 385-96) who places the idea to emerge with Trotter, Jessica Warner ["'Resolved to Drink No More': Addiction as a preindustrial construct" <i>Journal of Studies on Alcohol</i> 55 (1994): 685-91] who uses a narrow reading of 17th century sermons to place it in the 1600s, Peter Ferentzy ["From Sin to Disease: Differences and similarities between past and current conceptions on 'chronic drunkenness'" <i>Contemporary Drug Problems</i> 28 (2001): 362-90] who successfully challenges Warner's argument by showing that the term "disease" was applied to many conditions that had little to do with physical debility, and James Nicholls ["Vinum Britannicum: The 'Drink Question' in Early Modern England" <i>Social History of Alcohol and Drugs: An interdisciplinary Journal</i> 22 (2008): 6-25] who draws it together and argues that the idea emerged at different times in different places.</span> </li> <li id="cite_note-29"><span class="mw-cite-backlink"><b><a href="#cite_ref-29">^</a></b></span> <span class="reference-text">See, for example, books with such telling titles as John Edwards Todd, <i>Drunkenness, a Vice--not a Disease</i> (1882).</span> </li> <li id="cite_note-30"><span class="mw-cite-backlink"><b><a href="#cite_ref-30">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://findings.org.uk/PHP/dl.php?file=cont_drink.hot">"<span class="cs1-kern-left"></span>'Dangerous data': drinking after dependence"</a>. <i>findings.org.uk</i>. 2021-03-26<span class="reference-accessdate">. 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August 8, 2019. Archived from <a rel="nofollow" class="external text" href="https://www.americanbar.org/content/dam/aba/migrated/subabuse/07report_with_recommendation.pdf">the original</a> <span class="cs1-format">(PDF)</span> on 2019-08-08.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=RECOMMENDATION&rft.date=2019-08-08&rft_id=https%3A%2F%2Fwww.americanbar.org%2Fcontent%2Fdam%2Faba%2Fmigrated%2Fsubabuse%2F07report_with_recommendation.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADisease+theory+of+alcoholism" class="Z3988"></span></span> </li> <li id="cite_note-Alcoholism_ΔFosB-58"><span class="mw-cite-backlink">^ <a href="#cite_ref-Alcoholism_ΔFosB_58-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Alcoholism_ΔFosB_58-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Alcoholism_ΔFosB_58-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKanehisa_Laboratories2014" class="citation web cs1">Kanehisa Laboratories (29 October 2014). <a rel="nofollow" class="external text" href="http://www.genome.jp/kegg-bin/show_pathway?org_name=hsadd&mapno=05034&mapscale=&show_description=y">"Alcoholism – Homo sapiens (human) + Disease/drug"</a>. <i>KEGG Pathway</i><span class="reference-accessdate">. Retrieved <span class="nowrap">6 April</span> 2015</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=KEGG+Pathway&rft.atitle=Alcoholism+%E2%80%93+Homo+sapiens+%28human%29+%2B+Disease%2Fdrug&rft.date=2014-10-29&rft.au=Kanehisa+Laboratories&rft_id=http%3A%2F%2Fwww.genome.jp%2Fkegg-bin%2Fshow_pathway%3Forg_name%3Dhsadd%26mapno%3D05034%26mapscale%3D%26show_description%3Dy&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADisease+theory+of+alcoholism" class="Z3988"></span></span> </li> <li id="cite_note-What_the_ΔFosB?-59"><span class="mw-cite-backlink">^ <a href="#cite_ref-What_the_ΔFosB?_59-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-What_the_ΔFosB?_59-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRuffle_JK2014" class="citation journal cs1">Ruffle JK (November 2014). "Molecular neurobiology of addiction: what's all the (Δ)FosB about?". <i>Am J Drug Alcohol Abuse</i>. <b>40</b> (6): <span class="nowrap">428–</span>437. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.3109%2F00952990.2014.933840">10.3109/00952990.2014.933840</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25083822">25083822</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:19157711">19157711</a>. <q>Using control drugs implicated in both ΔFosB induction and addiction (ethanol and nicotine), similar ΔFosB expression was apparent when propofol was given ...<br />ΔFosB as a therapeutic biomarker<br />The strong correlation between chronic drug exposure and ΔFosB provides novel opportunities for targeted therapies in addiction (118), and suggests methods to analyze their efficacy (119). Over the past two decades, research has progressed from identifying ΔFosB induction to investigating its subsequent action (38). It is likely that ΔFosB research will now progress into a new era – the use of ΔFosB as a biomarker. If ΔFosB detection is indicative of chronic drug exposure (and is at least partly responsible for dependence of the substance), then its monitoring for therapeutic efficacy in interventional studies is a suitable biomarker (Figure 2). Examples of therapeutic avenues are discussed herein. ...<br /><br />Conclusions<br />ΔFosB is an essential transcription factor implicated in the molecular and behavioral pathways of addiction following repeated drug exposure. The formation of ΔFosB in multiple brain regions, and the molecular pathway leading to the formation of AP-1 complexes is well understood. The establishment of a functional purpose for ΔFosB has allowed further determination as to some of the key aspects of its molecular cascades, involving effectors such as GluR2 (87,88), Cdk5 (93) and NFkB (100). Moreover, many of these molecular changes identified are now directly linked to the structural, physiological and behavioral changes observed following chronic drug exposure (60,95,97,102). New frontiers of research investigating the molecular roles of ΔFosB have been opened by epigenetic studies, and recent advances have illustrated the role of ΔFosB acting on DNA and histones, truly as a <i>molecular switch</i> (34). As a consequence of our improved understanding of ΔFosB in addiction, it is possible to evaluate the addictive potential of current medications (119), as well as use it as a biomarker for assessing the efficacy of therapeutic interventions (121,122,124). Some of these proposed interventions have limitations (125) or are in their infancy (75). However, it is hoped that some of these preliminary findings may lead to innovative treatments, which are much needed in addiction.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Am+J+Drug+Alcohol+Abuse&rft.atitle=Molecular+neurobiology+of+addiction%3A+what%27s+all+the+%28%CE%94%29FosB+about%3F&rft.volume=40&rft.issue=6&rft.pages=%3Cspan+class%3D%22nowrap%22%3E428-%3C%2Fspan%3E437&rft.date=2014-11&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A19157711%23id-name%3DS2CID&rft_id=info%3Apmid%2F25083822&rft_id=info%3Adoi%2F10.3109%2F00952990.2014.933840&rft.au=Ruffle+JK&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADisease+theory+of+alcoholism" class="Z3988"></span></span> </li> <li id="cite_note-Cellular_basis-60"><span class="mw-cite-backlink">^ <a href="#cite_ref-Cellular_basis_60-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Cellular_basis_60-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNestler_EJ2013" class="citation journal cs1">Nestler EJ (December 2013). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898681">"Cellular basis of memory for addiction"</a>. <i>Dialogues Clin. Neurosci</i>. <b>15</b> (4): <span class="nowrap">431–</span>443. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.31887%2FDCNS.2013.15.4%2Fenestler">10.31887/DCNS.2013.15.4/enestler</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898681">3898681</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24459410">24459410</a>. <q>DESPITE THE IMPORTANCE OF NUMEROUS PSYCHOSOCIAL FACTORS, AT ITS CORE, DRUG ADDICTION INVOLVES A BIOLOGICAL PROCESS: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type NAc neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... A large body of literature has demonstrated that such ΔFosB induction in D1-type NAc neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... 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style="width:1%"><a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">Alcohol</a><br /> use</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alcohol-related_crime" title="Alcohol-related crime">Alcohol-related<br /> crimes</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Drunk_driving" title="Drunk driving">Drunk driving</a> <ul><li><a href="/wiki/Alcohol-related_traffic_crashes_in_the_United_States" title="Alcohol-related traffic crashes in the United States">Alcohol-related traffic crashes in the United States</a></li> <li><a href="/wiki/Drunk_driving_in_the_United_States" title="Drunk driving in the United States">Drunk driving in the United States</a></li></ul></li> <li><a href="/wiki/Moonshine" title="Moonshine">Moonshine</a> <ul><li><a href="/wiki/Bathtub_gin" title="Bathtub gin">Bathtub gin</a></li></ul></li> <li>Prison alcohol <ul><li><a href="/wiki/P%C3%A1jaro_verde" title="Pájaro verde">Pájaro verde</a></li> <li><a href="/wiki/Pruno" title="Pruno">Pruno</a></li></ul></li> <li><a href="/wiki/Public_intoxication" title="Public intoxication">Public intoxication</a></li> <li><a href="/wiki/Rum-running" title="Rum-running">Rum-running</a></li> <li><a href="/wiki/Sly-grog_shop" title="Sly-grog shop">Sly-grog shop</a></li> <li><a href="/wiki/Wine_fraud" title="Wine fraud">Wine fraud</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alcoholism" title="Alcoholism">Alcoholism</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcohol_and_Native_Americans" title="Alcohol and Native Americans">Alcohol and Native Americans</a></li> <li><a href="/wiki/Alcoholism_in_adolescence" title="Alcoholism in adolescence">Alcoholism in adolescence</a></li> <li><a href="/wiki/Alcoholism_in_family_systems" title="Alcoholism in family systems">Alcoholism in family systems</a></li> <li><a href="/wiki/Alcoholism_in_rural_Australia" title="Alcoholism in rural Australia">Alcoholism in rural Australia</a></li> <li><a href="/wiki/Collaborative_Study_on_the_Genetics_of_Alcoholism" title="Collaborative Study on the Genetics of Alcoholism">Collaborative Study on the Genetics of Alcoholism</a></li> <li><a class="mw-selflink selflink">Disease theory of alcoholism</a></li> <li><a href="/wiki/High-functioning_alcoholic" title="High-functioning alcoholic">High-functioning alcoholic</a> (HFA)</li> <li><a href="/wiki/Seeing_pink_elephants" title="Seeing pink elephants">Seeing pink elephants</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Chemistry</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Beverage-specific <ul><li><a href="/wiki/Beer_chemistry" title="Beer chemistry">Beer chemistry</a></li> <li><a href="/wiki/Wine_chemistry" title="Wine chemistry">Wine chemistry</a></li></ul></li> <li><a href="/wiki/Comparison_of_psychoactive_alcohols_in_alcoholic_drinks" title="Comparison of psychoactive alcohols in alcoholic drinks">Comparison of psychoactive alcohols in alcoholic drinks</a></li> <li><a href="/wiki/Congener_(beverages)" title="Congener (beverages)">Congener</a> <ul><li><a href="/wiki/Alcohol_congener_analysis" title="Alcohol congener analysis">Alcohol congener analysis</a></li></ul></li> <li><a href="/wiki/Ethanol" title="Ethanol">Ethanol</a> <ul><li><a href="/wiki/Blood_alcohol_content" title="Blood alcohol content">Blood alcohol content</a></li></ul></li> <li><a href="/wiki/Fusel_alcohol" title="Fusel alcohol">Fusel alcohol</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Effects</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Short-term_effects_of_alcohol_consumption" title="Short-term effects of alcohol consumption">Short-term effects of alcohol consumption</a></li> <li><a href="/wiki/Long-term_effects_of_alcohol" title="Long-term effects of alcohol">Long-term effects of alcohol</a></li> <li><a href="/wiki/Pharmacology_of_ethanol" title="Pharmacology of ethanol">Pharmacology of ethanol</a></li> <li><a href="/wiki/Subjective_response_to_alcohol" title="Subjective response to alcohol">Subjective response to alcohol</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Adverse effects</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hangxiety" title="Hangxiety">Anxiety</a></li> <li><a href="/wiki/Impact_of_alcohol_on_aging" title="Impact of alcohol on aging">Aging</a></li> <li><a href="/wiki/Long-term_impact_of_alcohol_on_the_brain" title="Long-term impact of alcohol on the brain">Brain</a></li> <li><a href="/wiki/Alcohol_and_cancer" title="Alcohol and cancer">Cancer</a> <ul><li><a href="/wiki/Alcohol_and_breast_cancer" title="Alcohol and breast cancer">breast cancer</a></li></ul></li> <li><a href="/wiki/Alcohol_and_cortisol" title="Alcohol and cortisol">Cortisol</a></li> <li><a href="/wiki/Effects_of_alcohol_on_memory" title="Effects of alcohol on memory">Memory</a></li> <li><a href="/wiki/Alcohol_and_pregnancy" class="mw-redirect" title="Alcohol and pregnancy">Pregnancy</a></li> <li><a href="/wiki/Alcohol_use_and_sleep" title="Alcohol use and sleep">Sleep</a></li> <li><a href="/wiki/Alcohol_tolerance" title="Alcohol tolerance">Tolerance</a>/<a href="/wiki/Alcohol_intolerance" title="Alcohol intolerance">intolerance</a></li> <li><a href="/wiki/Alcohol_and_weight" title="Alcohol and weight">Weight</a></li> <li>Beverage-specific <ul><li>Beer: <a href="/wiki/Potomania" title="Potomania">Potomania</a></li> <li>Wine: <a href="/wiki/Red_wine_headache" title="Red wine headache">Red wine headache</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Social_issues" class="mw-redirect" title="Social issues">Social issues</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Adulterated alcohol <ul><li><a href="/wiki/Moonshine#Adulterated_moonshine" title="Moonshine">Adulterated moonshine</a></li> <li><a href="/wiki/Denatured_alcohol" title="Denatured alcohol">Denatured alcohol</a> (<a href="/wiki/List_of_methanol_poisoning_incidents" title="List of methanol poisoning incidents">List of methanol poisoning incidents</a>)</li> <li><a href="/wiki/Surrogate_alcohol" title="Surrogate alcohol">Surrogate alcohol</a></li></ul></li> <li><a href="/wiki/Alcohol_abuse" title="Alcohol abuse">Alcohol abuse</a></li> <li><a href="/wiki/Alcohol_advertising" title="Alcohol advertising">Alcohol advertising</a> <ul><li><a href="/wiki/Alcohol_advertising_on_college_campuses" title="Alcohol advertising on college campuses">on college campuses</a></li></ul></li> <li><a href="/wiki/Alcohol_and_sex" title="Alcohol and sex">Sex</a> <ul><li><a href="/wiki/Beer_goggles" title="Beer goggles">Beer goggles</a></li></ul></li> <li><a href="/wiki/Alcohol_myopia" title="Alcohol myopia">Alcohol myopia</a></li> <li><a href="/wiki/Alcohol_in_association_football" title="Alcohol in association football">Alcohol in association football</a></li> <li><a href="/wiki/Alcohol_use_among_college_students" title="Alcohol use among college students">Alcohol use among college students</a></li> <li><a href="/wiki/Binge_drinking" title="Binge drinking">Binge drinking</a> <ul><li><a href="/wiki/Austrian_syndrome" title="Austrian syndrome">Austrian syndrome</a></li> <li><a href="/wiki/Alcohol_intoxication" title="Alcohol intoxication">Alcohol intoxication</a></li> <li><a href="/wiki/Epidemiology_of_binge_drinking" title="Epidemiology of binge drinking">Epidemiology of binge drinking</a></li> <li><a href="/wiki/Holiday_heart_syndrome" title="Holiday heart syndrome">Holiday heart syndrome</a></li> <li>Problematic alcoholic products <ul><li><a href="/wiki/Alcohol_powder" title="Alcohol powder">Alcohol powder</a></li> <li><a href="/wiki/Alcopop" title="Alcopop">Alcopop</a></li> <li><a href="/wiki/Borg_(drink)" title="Borg (drink)">Borg</a></li> <li>Low-cost alcohol <ul><li><a href="/wiki/Flavored_fortified_wine" title="Flavored fortified wine">Flavored fortified wine</a></li></ul></li> <li><a href="/wiki/Alcohol_(drug)#Stimulants" title="Alcohol (drug)">Polysubstance alcoholic drinks</a> <ul><li><a href="/wiki/Caffeinated_alcoholic_drink" title="Caffeinated alcoholic drink">Caffeinated alcoholic drink</a></li> <li><a href="/wiki/Coca_wine" title="Coca wine">Coca wine</a></li> <li><a href="/wiki/Nicotini" title="Nicotini">Nicotini</a></li></ul></li></ul></li> <li><a href="/wiki/Zapoy" title="Zapoy">Zapoy</a></li></ul></li> <li><a href="/wiki/Blackout_(drug-related_amnesia)" title="Blackout (drug-related amnesia)">Blackout</a></li> <li><a href="/wiki/Blackout_Wednesday" title="Blackout Wednesday">Blackout Wednesday</a></li> <li><a href="/wiki/Drinking_game" title="Drinking game">Drinking game</a> <ul><li><a href="/wiki/List_of_drinking_games" title="List of drinking games">list</a></li> <li><a href="/wiki/Pregaming" title="Pregaming">Pregaming</a></li></ul></li> <li><a href="/wiki/Drinking_in_public" title="Drinking in public">Drinking in public</a></li> <li><a href="/wiki/Drunk_walking" title="Drunk walking">Drunk walking</a></li> <li><a href="/wiki/Drunkorexia" title="Drunkorexia">Drunkorexia</a></li> <li><a href="/wiki/Dry_drunk" title="Dry drunk">Dry drunk</a></li> <li><a href="/wiki/Dutch_courage" title="Dutch courage">Dutch courage</a></li> <li><a href="/wiki/Flaming_drink" title="Flaming drink">Flaming drink</a></li> <li><a href="/wiki/Hair_of_the_dog" title="Hair of the dog">Hair of the dog</a></li> <li><a href="/wiki/Hurtful_communication#Alcohol" title="Hurtful communication">Hurtful communication</a> <ul><li><a href="/wiki/Drunk_dialing" title="Drunk dialing">Drunk dialing</a></li> <li><a href="/wiki/In_vino_veritas" title="In vino veritas"><i>In vino veritas</i></a></li></ul></li> <li><a href="/wiki/Nightcap_(drink)" title="Nightcap (drink)">Nightcap</a></li> <li><a href="/wiki/Pantsdrunk" title="Pantsdrunk">Pantsdrunk</a></li> <li><a href="/wiki/Passive_drinking" title="Passive drinking">Passive drinking</a></li> <li>Binge drinking devices <ul><li><a href="/wiki/Beer_bong" title="Beer bong">Beer bong</a></li> <li><a href="/wiki/Yard_of_ale" title="Yard of ale">Yard of ale</a></li></ul></li> <li>Routes of administration <ul><li><a href="/wiki/Alcohol_enema" title="Alcohol enema">Alcohol enema</a></li> <li><a href="/wiki/Alcohol_inhalation" title="Alcohol inhalation">Alcohol inhalation</a></li> <li><a href="/wiki/Vodka_eyeballing" title="Vodka eyeballing">Vodka eyeballing</a></li></ul></li> <li><a href="/wiki/Sconcing" title="Sconcing">Sconcing</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">History</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Andrew_Johnson_alcoholism_debate" title="Andrew Johnson alcoholism debate">Andrew Johnson alcoholism debate</a></li> <li><a href="/wiki/Dionysian_Mysteries" title="Dionysian Mysteries">Dionysian Mysteries</a></li> <li><a href="/wiki/Dipsomania" title="Dipsomania">Dipsomania</a></li> <li><a href="/wiki/Gilbert_Paul_Jordan" title="Gilbert Paul Jordan">Gilbert Paul Jordan</a></li> <li><a href="/wiki/Gin_Craze" title="Gin Craze">Gin Craze</a></li> <li><a href="/wiki/List_of_deaths_through_alcohol" title="List of deaths through alcohol">List of deaths through alcohol</a></li> <li><a href="/wiki/Rum_ration" title="Rum ration">Rum ration</a></li> <li><a href="/wiki/Rum_Rebellion" title="Rum Rebellion">Rum Rebellion</a></li> <li><a href="/wiki/Shebeen" title="Shebeen">Shebeen</a></li> <li><a href="/wiki/Six_o%27clock_swill" title="Six o'clock swill">Six o'clock swill</a></li> <li>Illegal drinking establishments <ul><li><a href="/wiki/Nip_joint" title="Nip joint">Nip joint</a></li> <li><a href="/wiki/Speakeasy" title="Speakeasy">Speakeasy</a></li></ul></li> <li><a href="/wiki/Whiskey_Rebellion" title="Whiskey Rebellion">Whiskey Rebellion</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">General</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcoholic_beverage" title="Alcoholic beverage">Alcoholic beverage</a></li> <li>Beer <ul><li><a href="/wiki/Beer_mile" title="Beer mile">Beer mile</a></li> <li><a href="/wiki/International_Beer_Day" title="International Beer Day">International Beer Day</a></li> <li><a href="/wiki/International_Women%27s_Collaboration_Brew_Day" title="International Women's Collaboration Brew Day">International Women's Collaboration Brew Day</a></li> <li><a href="/wiki/Women_in_brewing" title="Women in brewing">Women in brewing</a></li></ul></li> <li><a href="/wiki/Drinking_culture" title="Drinking culture">Drinking culture</a> <ul><li><a href="/wiki/Ap%C3%A9ritif_and_digestif" title="Apéritif and digestif">Apéritif and digestif</a></li> <li><a href="/wiki/Hangover_remedies" title="Hangover remedies">Hangover remedies</a></li> <li><a href="/wiki/Health_effects_of_wine" title="Health effects of wine">Health effects of wine</a> <ul><li><a href="/wiki/Wine_and_food_pairing" title="Wine and food pairing">Wine and food pairing</a></li></ul></li></ul></li> <li><a href="/wiki/Drunken_monkey_hypothesis" title="Drunken monkey hypothesis">Drunken monkey hypothesis</a></li> <li><a href="/wiki/Ladies%27_night" title="Ladies' night">Ladies' night</a></li> <li><a href="/wiki/List_of_countries_by_alcohol_consumption_per_capita" title="List of countries by alcohol consumption per capita">List of countries by alcohol consumption per capita</a> <ul><li><a href="/wiki/Alcohol_consumption_by_youth_in_the_United_States" title="Alcohol consumption by youth in the United States">Alcohol consumption by youth in the United States</a></li></ul></li> <li><a href="/wiki/List_of_substances_used_in_rituals#Alcohol" title="List of substances used in rituals">Ritual use of alcohol</a></li> <li>Whiskey <ul><li><a href="/wiki/International_whisk(e)y_day" title="International whisk(e)y day">International whisk(e)y day</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Alcohol <br />control</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alcohol_law" title="Alcohol law">Alcohol law</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Administrative_License_Suspension" title="Administrative License Suspension">Administrative License Suspension</a> (ALS)</li> <li><a href="/wiki/Alcohol_(Minimum_Pricing)_(Scotland)_Act_2012" title="Alcohol (Minimum Pricing) (Scotland) Act 2012">Alcohol (Minimum Pricing) (Scotland) Act 2012</a></li> <li><a href="/wiki/Alcohol_exclusion_laws" title="Alcohol exclusion laws">Alcohol exclusion laws</a></li> <li><a href="/wiki/Alcohol_monopoly" title="Alcohol monopoly">Alcohol monopoly</a> <ul><li><a href="/wiki/Alcoholic_beverage_control_state" title="Alcoholic beverage control state">Alcoholic beverage control state</a></li></ul></li> <li><a href="/wiki/Alcohol_packaging_warning_messages" title="Alcohol packaging warning messages">Alcohol packaging warning messages</a></li> <li><a href="/wiki/Ban_on_caffeinated_alcoholic_drinks_in_the_United_States" title="Ban on caffeinated alcoholic drinks in the United States">Ban on caffeinated alcoholic drinks in the United States</a></li> <li><a href="/wiki/Drunk_driving_law_by_country" title="Drunk driving law by country">Drunk driving law by country</a> <ul><li><a href="/wiki/DWI_court" title="DWI court">DWI court</a></li> <li><a href="/wiki/Field_sobriety_testing" title="Field sobriety testing">Field sobriety testing</a></li> <li><a href="/wiki/Hip_flask_defence" title="Hip flask defence">Hip flask defence</a></li> <li><a href="/wiki/Ignition_interlock_device" title="Ignition interlock device">Ignition interlock device</a></li></ul></li> <li><a href="/wiki/Dry_county" title="Dry county">Dry county</a> <ul><li><a href="/wiki/List_of_dry_communities_by_U.S._state" title="List of dry communities by U.S. state">List of dry communities by U.S. state</a></li></ul></li> <li><a href="/wiki/Last_call" title="Last call">Last call</a></li> <li><a href="/wiki/Legal_drinking_age" title="Legal drinking age">Legal drinking age</a> <ul><li><a href="/wiki/Legal_drinking_age_in_the_United_States" title="Legal drinking age in the United States">Legal drinking age in the United States</a></li> <li><a href="/wiki/Shoulder_tap_(alcohol)" title="Shoulder tap (alcohol)">Shoulder tap</a></li></ul></li> <li><a href="/wiki/List_of_alcohol_laws_of_the_United_States" title="List of alcohol laws of the United States">List of alcohol laws of US</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Prohibition" title="Prohibition">Alcohol prohibition</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/List_of_countries_with_alcohol_prohibition" title="List of countries with alcohol prohibition">List of countries with alcohol prohibition</a></li> <li><a href="/wiki/Neo-prohibitionism" title="Neo-prohibitionism">Neo-prohibitionism</a></li> <li><a href="/wiki/Temperance_movement" title="Temperance movement">Temperance movement</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sobriety" title="Sobriety">Sobriety</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcohol_detoxification" title="Alcohol detoxification">Alcohol detoxification</a></li> <li><a href="/wiki/Alcohol-free_zone" title="Alcohol-free zone">Alcohol-free zone</a> <ul><li><a href="/wiki/Dry_campus" title="Dry campus">Dry campus</a></li> <li><a href="/wiki/Open-container_law" title="Open-container law">Open-container law</a></li></ul></li> <li><a href="/wiki/Brief_intervention" title="Brief intervention">Brief intervention</a></li> <li><a href="/wiki/Designated_driver" title="Designated driver">Designated driver</a></li> <li><a href="/wiki/Drug_rehabilitation" title="Drug rehabilitation">Alcohol rehabilitation</a></li> <li><a href="/wiki/Drunk_tank" title="Drunk tank">Drunk tank</a></li> <li><a href="/wiki/Managed_alcohol_program" title="Managed alcohol program">Managed alcohol program</a></li> <li><a href="/wiki/Non-alcoholic_drink" title="Non-alcoholic drink">Non-alcoholic drink</a> <ul><li><a href="/wiki/List_of_non-alcoholic_cocktails" class="mw-redirect" title="List of non-alcoholic cocktails">List of cocktails</a></li> <li><a href="/wiki/List_of_non-alcoholic_mixed_drinks" title="List of non-alcoholic mixed drinks">List of mixed drinks</a></li> <li><a href="/wiki/Spritzer#Non-alcoholic_spritzer" title="Spritzer">Spritzer</a></li> <li><a href="/wiki/Malt_drink#Non-alcoholic_malt_drinks" title="Malt drink">Malt drinks</a></li></ul></li> <li><a href="/wiki/Teetotalism" title="Teetotalism">Teetotalism</a></li> <li><a href="/wiki/Temperance_bar" title="Temperance bar">Temperance bar</a></li> <li><a href="/wiki/Temperance_and_Good_Citizenship_Day" title="Temperance and Good Citizenship Day">Temperance and Good Citizenship Day</a></li> <li><a href="/wiki/List_of_twelve-step_groups" title="List of twelve-step groups">Twelve-step groups</a> <ul><li><a href="/wiki/Al-Anon/Alateen" title="Al-Anon/Alateen">Al-Anon/Alateen</a></li> <li><a href="/wiki/Alcoholics_Anonymous" title="Alcoholics Anonymous">Alcoholics Anonymous</a> (AA):</li> <li><a href="/wiki/Adult_Children_of_Alcoholics" class="mw-redirect" title="Adult Children of Alcoholics">Adult Children of Alcoholics</a> (ACA)</li></ul></li> <li><a href="/wiki/Sober_companion" title="Sober companion">Sober companion</a></li> <li><a href="/wiki/Sober_curious" title="Sober curious">Sober curious</a></li> <li><a href="/wiki/Sober_living_house" title="Sober living house">Sober living house</a></li> <li><a href="/wiki/Sobering_center" title="Sobering center">Sobering center</a></li> <li><a href="/wiki/Sobrietol" title="Sobrietol">Sobrietol</a></li> <li><a href="/wiki/Quit_lit_(alcohol_cessation)" title="Quit lit (alcohol cessation)">Quit lit</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Alcohol limitation</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/0-0-1-3" title="0-0-1-3">0-0-1-3</a></li> <li><a href="/wiki/Alcohol_consumption_recommendations" title="Alcohol consumption recommendations">Alcohol consumption recommendations</a></li> <li><a href="/wiki/Alcohol_education" title="Alcohol 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