title: History of the Concept of Addiction.
abstract: Our distant forebears wrestled with concepts of alcohol addiction not unlike those of today: Is addiction a sin or a disease? Is addiction caused by the gods, the substance, the individual's vulnerability, or psychological or social factors? Luther, Calvin, and Catholic Church leaders viewed moderate alcohol use as God's gift; used intemperately, it was a moral transgression. The founders of modern scientific psychiatry rejected moral explanations for addiction in favor of an early biological model. The first two versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I and DSM-II) stigmatized addiction by listing it with other societally disapproved disorders stemming from personality disorder. DSM-III espoused atheoretical, descriptive diagnoses but required tolerance or withdrawal to diagnose dependence. Substance dependence in DSM-III-R included physiological and behavioral symptoms and reflected the substance dependence syndrome. DSM-IV's emphasis on biology in its concept of dependence was unchanged from its immediate predecessors. DSM-5 declared that all drugs taken in excess have in common the direct activation of the brain reward system. This article examines evolving concepts of alcohol addiction through 12,000 years of recorded human history, from the first mention of alcohol consumption in China more than 12,000 years ago to alcohol use and abuse in the DSM era, 1952 to the present.
authors.affiliation: Department of Psychology.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Nathan
authors.affiliation: National American Indian/Alaska Native ATTC (N-AIAN ATTC), College of Public Health, University of Iowa, Iowa City, Iowa 52242; email: peter-nathan@uiowa.edu , mandy-conrad@uiowa.edu , anne-skinstad@uiowa.edu.
authors.forename: Mandy
authors.initials: M
authors.lastname: Conrad
authors.affiliation: National American Indian/Alaska Native ATTC (N-AIAN ATTC), College of Public Health, University of Iowa, Iowa City, Iowa 52242; email: peter-nathan@uiowa.edu , mandy-conrad@uiowa.edu , anne-skinstad@uiowa.edu.
authors.forename: Anne Helene
authors.initials: AH
authors.lastname: Skinstad
mesh_terms: D000437:Alcoholism / Q000145:classification / Q000266:history*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D049668:History, 15th Century; D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D049691:History, Medieval; D006801:Humans
keywords: abuse; alcoholism; beer; dependence; distilled spirits; substance use disorder; tolerance; wine; withdrawal