ONE hUNDRED YEARS oF ALCOHOLISM: tHE TWENTIETH CENTURY

Question

The past 100 years witnessed the formation of a disease concept of alcoholism and a rapid increase in the knowledge of its aetiopathology and treatment options. In the first half of the century, public sanctions aimed at the abolition of alcoholism. In the United States, alcohol prohibition was revoked in the economic turmoil of the Great Depression. In Germany, proposed medical procedures to reduce the fertility of alcoholics had catastrophic consequences during the fascist dictatorship. A revived focus on alcoholics as patients with a right to medical treatment came out of self-organized groups, such as Alcoholics Anonymous. The current disease concept includes the psychosocial and neurobiological foundations and consequences of alcoholism. Neurobiological research points to the dispositional factor of monoaminergic dysfunction and indicates that neuroadaptation and sensitization may play a role in the maintenance of addictive behaviour. New treatment options include pharmacological approaches and indicate that behaviour and motivational therapy and the attendance of patient groups may equally reduce the relapse risk.  Th᠎is ​post w as c​reat᠎ed  wi᠎th　the he​lp of　G᠎SA Content​ Gen erat or  DEMO!

The task of the future will be to apply scientific discoveries in the best interest of the patients and AI Art to support their efforts to be respected like subjects suffering from other diseases. Alcoholism research and treatment underwent significant changes in the 20th century. Within the last 100 years, a disease concept was formed, which is now widely accepted, the psychosocial and neurobiological consequences of alcoholism have been characterized and treatment programmes have been established and continuously refined. First attempts were made to formulate models of the disposition and development of alcohol dependence that integrate both neurobiological and psychosocial findings. In this essay, we will highlight some of the cornerstones of our present understanding of alcoholism and reflect on some of the organizations and research traditions whose activities were crucial in the development of current concepts. Given the scope of the subject, this review will be both incomplete and subjective, and we will be unable to mention many subjects and institutions whose contributions to current alcoholism concepts were as important and fundamental as the ones we are able to discuss. Da ta h​as be en created ᠎by GSA  C onte​nt Gen᠎erat or Demover sion.

Degenerationism thus offered a medical explanation for the social problems which were so visible at the end of the 19th century, and excessive alcohol consumption played a crucial role in the concept, as it was seen as a vice which also affects the next generation. In the early 20th century, AI Art the degeneration theory suffered from an increasing knowledge about modes of transmission of heritable traits, which pointed to the separate inheritance of different mental and physical diseases, and distinguished between heritable traits and toxic effects on the germ plasm or embryo, thus fundamentally questioning the postulate of the inheritance of acquired traits (Hermle, 1986). However, degenerationism substantially contributed to the concerns about the specific alcohol-related problems of certain individuals. In the first 30 years of the 20th century, degenerationism and the successors of the temperance movement sparked widespread political activities in the field of alcohol addiction. In the United States, the Anti-Saloon League followed the approach of the temperance movement and focused on the general problems of alcohol consumption.

In Germany, the focus on the individual and their heritable vulnerability to alcohol addiction was imbued with alarmist concerns about the proliferation of the mentally ill, which was supposed to threaten the survival of the nation or ‘race.' Consequently, compulsory sterilization of ‘severe alcoholics' was already advocated by some medical doctors before it was legalized during the Nazi dictatorship. It was in the wake of the failure of prohibition that the current concept of alcoholism was formed, and the worldwide shock about the cruelty and inhumanity of Nazi politics may have promoted the modern disease concept with its focus on individual therapy and its emphasis that alcohol addiction is a disease just like any other physical or mental malady (Levine, AI Art 1984; Henkel, 1998). A decisive point was the foundation of Alcoholics Anonymous (AA) in the late 1930s. Similar to previous temperance movements, Alcoholics Anonymous displayed a sympathetic and supporting attitude towards the addicted person, but unlike previous groups, AA was only for alcoholics and was not concerned with the general level of alcohol consumption in the population.

In fact, the view that all it would take to create an alcohol addict would be his excessive alcohol consumption was no longer persuasive after the end of prohibition (Levine, 1984). Likewise, the existence of alcohol tolerance and withdrawal was widely neglected in the 1930s and early 1940s, although delirium tremens due to alcohol withdrawal had clearly been described by Hare 1910 in the British Journal of Inebriety (Edwards, 1990). Jellinek (1942) and the Yale Summer School on Alcohol Studies agreed with AA that alcoholism would be a disease with a progressive character and not a moral failing. The 1954 report of the World Health Organization (WHO) reflected this new focus on the individual and stated that ‘the personal make-up is the determining factor, but the pharmacological action (of alcohol) plays a significant role’ (Edwards, 1990). However, it was not until the mid-1950s that convulsions and delirium tremens regained public attention as symptoms of alcohol withdrawal, AI Art largely due to the detailed reports of Victor and Adams (1953) and Isbell et al.