Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Addiction. 2012 Jan;107(1):6-12. doi: 10.1111/j.1360-0443.2011.03583.x. Epub 2011 Oct 7.
This 'For Debate' paper starts by recognizing the growing trend towards considering alcohol dependence as a chronic relapsing disorder. We argue that the adoption of this model results from focusing on those in treatment for alcohol dependence rather than considering the larger number of people in the general population who meet criteria for alcohol dependence at some point in their lives. The majority of the general population who ever experience alcohol dependence do not behave as though they have a chronic relapsing disorder: they do not seek treatment, resolve their dependence themselves and do not relapse repeatedly. We suggest that caution is therefore needed in using the chronic relapsing disorder label. Our primary concerns are that this formulation privileges biological aspects of dependence to the detriment of psychological and social contributions, it inhibits much-needed developments in understanding alcohol dependence and leads to inefficient distributions of public health and clinical care resources for alcohol dependence. We invite debate on this issue.
这篇“争议”文章首先认识到,越来越倾向于将酒精依赖视为一种慢性复发性疾病。我们认为,这种模式的采用源于关注那些接受酒精依赖治疗的人群,而不是考虑到在其一生中的某个时候符合酒精依赖标准的更大数量的普通人群。大多数经历过酒精依赖的普通人群并不表现得好像他们患有慢性复发性疾病:他们不寻求治疗,自己解决依赖问题,也不会反复复发。因此,我们建议在使用慢性复发性疾病标签时要谨慎。我们主要关注的是,这种表述将依赖的生物学方面置于优先地位,而忽视了心理和社会方面的贡献,它抑制了对酒精依赖的理解所需的发展,并导致公共卫生和临床酒精依赖护理资源的分配效率低下。我们邀请对此问题进行辩论。