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The articles are written at a level accessible to the general public, making this a potentially useful starting point for research. Libraries Unlimited. Need Help? Try our Search Tips. Award Winner. Reviewed Content. Sale Title. Available for Course Adoption. Highlights Covers 20th-century American history as seen through its movers and shakers Shows how America led the 20th-century world in new ideas and inventions Presents individual biographies that give a unique perspective on how the right combination of personality, motivation, and time period can to produce major change in a culture Explains how the rise of media culture—the movies, television, the Internet—have changed America.


The role of the dopaminergic system may lie in the direction of attention towards reward-indicating stimuli, rather than in the induction of euphoria or positive mood states Schultz et al. Stimulus-dependent dopamine release may be specifically vulnerable to sensitization, thus mediating a stronger behavioural response upon re-exposure to the drug-associated cue Robinson and Berridge, The focus on cue-induced craving and the underlying learning mechanisms Glautier et al. What was not being denied are the organic consequences of chronic alcohol intake, such as brain atrophy Mann et al.

Rather, it is argued that cigarette smoking similarly causes physical dependence or neuroadaptation without therefore being considered a disease. A response to these concerns rests on several arguments. Secondly, it is argued that a state may be called a disease even in the absence of abnormalities of anatomic structure. A case in point may be essential hypertension, which is commonly understood as a disease, although the aetiology and pathogenesis are currently unknown. Keller suggested calling alcoholism a disease, because its behavioural manifestations represent a disablement.

This argument resembles the concept of a mental disorder given by the American Psychiatric Association , which argued that a mental disorder is characterized by present distress, disability, or a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. Applying this definition to cigarette smoking indicates that smoking should be considered a mental disorder, as it is associated with the increased risk of suffering death, and it would thus be considered a malady or disease by Culver and Gert This brings up the question of whether fast driving then must be called a disease, as it increases the risk of dying in a traffic accident.

It could be answered that the association between fast driving and traffic accidents is rather low and that the habit of driving fast might be terminated without experiencing the distress associated with drug withdrawal symptoms.

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As aloof as these discussions sometimes appear, they have important implications for the treatment of alcoholism. In , a Board of the American Medical Association AMA passed a resolution that urged hospitals to admit patients with alcoholism equally with patients treated for other diseases.

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This act is usually seen as the moment when alcoholism was formally recognized as a disease in the United States; however, alcoholism was already listed as a disease in in the Standard Classified Nomenclature of Diseases, which was approved by the AMA and the American Psychiatric Association Keller, Yet the resolution highlights the important legal issues that are associated with the disease status of alcoholism, not least being the question of whether treatment costs should be covered by health insurances Jurd, Research in the field of costs and benefits of alcoholism therapy supported the demand to treat alcoholism within the medical system Holder, The last decade of the 20th century witnessed substantial progress in treatment options and strategies.

Brief interventions in primary health care institutions are very often effective in reducing alcohol consumption Bien et al.

For those patients who need more extensive treatment, primary health care services have a gatekeeper function. Motivational enhancement in primary health care Miller and Rollnick, can effectively increase the participation in treatment programmes and was associated with reduced subsequent relapse rates Bien et al. Project MATCH examined three treatment options, cognitive behaviour therapy, twelve-step facilitation according to the AA programme and motivational enhancement therapy, and found them similarly effective Project Match Research Group, As disappointing as this result may be for the discovery of prospective indicators of treatment response, it shows that the major treatment options available to alcoholics worldwide work successfully and that the eclectic combination of behaviour therapy and the attendance of self-help groups may indeed combine two powerful treatment strategies.

With naltrexone and acamprosate, two pharmaceuticals are available that successfully reduce the relapse risk during early abstinence O'Malley et al. However, even with an accompanying medical treatment, most alcoholics relapse.


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The goal of the future will therefore be to describe subgroups of patients that may respond positively to specific medications. As acamprosate and naltrexone affect different neurotransmitter systems, neurobiological screening of alcoholics may help to discover predictors of treatment response. Preliminary results indicate that sleep disorders, EEG activity and delayed recovery of dopamine receptor sensitivity during early abstinence are associated with the relapse risk and may help to identify patients who require specific treatment strategies Bauer, ; Heinz et al.

Basic research has profoundly helped to understand alcohol effects at the level of signal transduction. We now know that drugs affect neurotransmitter release, receptor sensitivity, post-synaptic second-messenger mechanisms and, perhaps most importantly, gene expression Koob, ; Nestler, These observations indicate that human fate is not passively determined by the genetic constitution, but rather that biological and ultimately environmental stimuli regulate gene expression.

Increasing knowledge of the molecular mechanisms of dependence may enable us to target these pathological conditions more specifically than we are able today. That alcoholism had been considered a disease in Germany since Jellinek, did not prevent the dehumanizing treatment of patients with alcohol dependence during the Nazi era.

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It is an integral part of the professional mission to assist patients in their effort to be treated equally inside and outside of medical therapy. Our increasing knowledge about the disposition towards alcohol dependence and a high relapse risk can help to identify patients with demands for special therapeutic efforts, it should never be used to stigmatize these subjects. To monitor the consequences of our research is part of the professional duty. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

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Volume Article Contents. Oxford Academic. Google Scholar. Derik Hermann. Andreas Heinz. Cite Citation. Permissions Icon Permissions. Abstract The past years witnessed the formation of a disease concept of alcoholism and a rapid increase in the knowledge of its aetiopathology and treatment options. Abi-Dargham, A. Bauer, L. Berridge, K. Bien, T. Bleuler, M. Charles C. Thomas, Springfield, IL. Brower, K. John Broughton. Focus Groups. Professor Richard A. Famous Quotes on Trust. Henry M.

People Who Changed 20th Century America 2 Volumes Cross Mary

Charles L. Ponce de Leon. Media Analysis Techniques. Arthur A. Professor Jacqueline Collier. Pop Icons and Business Legends. Hank Moore. Hollywood's America.

Steven Mintz. Pennie Rockerfeller. Sidney Poitier.