Alcoholism: Pathophysiology of a Disease

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Editor’s introduction The first component of the patient-centered method distinguishes disease and illness. Effective care requires clinicians’ understanding and facility with both concepts. Dr Woodside explores the ‘body-as-machinef portion of the first component as he leads readers toward an appreciation of the illness experience. Exploring evidence and implications of the disease concept of alcoholism, this chapter begins with a review of the historical evolution of the concept of alcoholism as a disease: speeches by Abraham Lincoln and editorials from the JAMA in the 1890s, writings from the founders of Alcoholics Anonymous (AA), and the American Medical Association s (AMA) declaration of alcoholism as a disease in the 1950s. This is followed by a review of the scientific evidence supporting the disease concept. Investigations demonstrating genetic transmission including twin and adoption studies are presented along with research leading toward biochemical markers, and ‘valid’ biological bases for disease. Dr Woodside also reviews emergent literature describing the neurobiologic role of the mesolimbic dopamine system in craving and in the maintenance of drinking behavior. Case studies demonstrating patterns of inheritance facilitate his discussion, particularly as this relates to the perspective of an alcoholdependent person attempting to recover. The disease concept is described as playing a valuable role in mitigating shame and promoting acceptance of a recovery process. Taking this broader perspective, the disease concept has important implications for society’s approach to alcoholism, the responsibility of the healthcare industry, and third-party payers.