8/16/2019 adicção s

1/2

© 2002 Society for the Study of Addiction to Alcohol and Other Drugs Addiction, 97, 111–112

THREE C LASSIC S THAT PROMOTED

THE SCIENTIFIC STUDY OF DRUG

DEPENDENCE

 J. H. Jaffe, ‘Drug addiction and drug abuse’ in The

Pharmacological Basis of Therapeutics. New York,

Macmillan, 1965

E. M. Brecher, Licit and Illicit Drugs. Boston, MA, Little

& Brown, 1972

G. Edwards & M. M. Gross, Alcohol dependence: provi-sional description of a clinical syndrome, British Medical

 Journal, 1976

Reviewed by JOHN R. HUGHES

In the United States and many western countries, the

major paradigm for dealing with drug problems has been

based on a ‘war on drugs’ metaphor. This metaphor sug-

gests drug problems are not scientific or public health

problems but rather are problems of morals and of good

versus evil (Bickel & DeGrandpre 1996). From 1960 to

1990, drug problems and the ‘war on drugs’ rhetoric pro-

duced statements that heroin would cause full-blownaddiction with three injections, that marijuana almost

always led to brain damage, etc. It was difficult to find a

sane and rational voice. However, during this time, three

publications argued for a more rational, scientific and

humane approach: Jerry Jaffe’s chapters in Goodman and 

Gilman’s The Pharmacological Basis of Therapeutics (Jaffe

1965), Edward Brecher’s book Licit and Illicit Drugs

(Brecher 1972) and Griffith Edwards’s & Milton Gross’s

paper ‘Alcohol dependence: provisional description of a

clinical syndrome’ in the British Medical Journal (Edwards

& Gross 1976).

Dr Jaffe wrote the chapters on ‘Drug Addiction andDrug Abuse’ for the Goodman and Gilman series from

1965 to 1990 (Dr Charles O’Brien wrote the most recent

1996 chapter (O’Brien 1996). The 1965 and subsequent

chapters were the perfect mix of hard science, clinical

observation and ‘common sense’ needed to combat the

many myths being perpetuated. These chapters reveal

how much was already known yet how much was

unknown about drug use in the 1960s. In 1965, the

chapter already makes a distinction between psychologi-

cal and physical dependence, stating that tolerance and

withdrawal occur with some non-dependence producing

drugs, physical dependence starts with the first dose

and euphoria is not essential for drug abuse. On the

other hand, the chapter does not mention receptors or

dopamine, genetics of alcohol dependence or animal

self-administration. Also striking is that in a traditional

pharmacology textbook published in 1965, sections on

‘psychological factors’, ‘sociological factors’, and ‘impact

of legislation and social attitudes on the patterns of 

treatment of drug abuse’ occur. This explicit recognition

that drug dependence is influenced by both pharmaco-logical and psychosocial factors and that both can be

talked about scientifically, influenced the thinking of 

many future doctors and scientists.

Seven years after Dr Jaffe’s first chapter, Consumer 

Reports published Edward Brecher’s book Licit and Illicit

Drugs (Brecher 1972). This book also slayed several drug

use myths but, in contrast to Jaffe’s tightly reasoned and

well-documented arguments, did so in a hard-hitting

 journalistic style. Mr Brecher had no formal medical or

scientific training but he did have a healthy dose of skepti-

cism and empiricism. Mr Brecher’s book was written to

‘help parents and community leaders faced with drugproblems’ and hoped that ‘young people will find here

information they can trust’. It quickly became known

across college campuses as one of the few voices of reason.

This is a great first book to read on drug abuse.

It has little jargon and just the right balance of fun facts

to keep readers interested plus an education in the inter-

action of science, sociology and medicine. This is also a

great book for those already on the front lines of preven-

tion and treatment. They will enjoy taking a broad look

at what our drug problems have involved, how these

problems have and have not changed, and their role in

drug abuse prevention and treatment.Although the book covers the US experience only, it

does provide some intriguing, often unknown facts; e.g.

• In the 1920s many physicians converted those with

alcohol dependence to opioid dependence as the

latter was thought less likely to lead to violence and

intoxication.

• In the 19th century, medical treatment was the most

common cause of opioid dependence.

• Freud promoted cocaine use in his ‘Song of Praise’

and ended up dying from a complication of nicotine

dependence.

Classic texts revisited

8/16/2019 adicção s

2/2

112 Classic texts revisited 

© 2002 Society for the Study of Addiction to Alcohol and Other Drugs Addiction, 97, 111–112

• The US Army stockpiled LSD to use to ‘disable’ an

enemy force.

The book is not perfect. It does become somewhat one-

sided in promoting decriminalization, harm reduction

and legalization. This, I think, is due to the classic error

of implying causality from association. However, all

classic books make errors. If they did not, think what that

would mean about scientific progress since their publica-

tion. However, to my mind, any book that had the intel-

lectual courage to explore whether caffeine and nicotine

are drugs of dependence in 1972 is worthy of a read.

Four years after the Brecher book, Griffith Edwards &

Milton Gross (with the help of WHO consultants) pub-

lished a paper in the British Medical Journal of a provi-

sional description of the alcohol dependence syndrome

(Edwards & Gross 1976). This paper is widely credited as

the genesis of our current conceptualization of drug

dependence. To my mind, this paper should be required

reading for every clinician and scientist working in thefield of drug dependence. The paper states that impaired

control over drug use is the essential feature of drug

dependence and outlines seven ‘essential elements of the

syndrome’: narrowing of the repertoire, salient drink-

seeking, tolerance, withdrawal, relief/avoidance of with-

drawal, compulsion and rapid reinstatement. Through

descriptions and examples, each of these phenomena is

clearly described.

The best evidence of the impact of this paper is that

subsequent drug use disorders sections of the World

Health Organization’s International Classifications of 

Diseases (WHO 1992) and the American PsychiatricAssociation’s Diagnostic and Statistical Manuals (APA

1994) were tied closely to the paper. Although current

versions of these nomenclatures differ somewhat from

this 1976 paper, both still endorse impaired control over

drug use as the central feature of drug dependence.

The modest prose of the paper, e.g. ‘Furthermore, we

take the term syndrome to mean no more than the con-

currence of phenomena’ contrasts sharply with its many

excellent insights. For example, the authors make clear

the distinction between drug dependence and drug prob-

lems, as evidenced by their observation that harm can

occur in the absence of dependence and their prescientstatement that much of the controlled drinking contro-

versy arises around whether the clients who succeed at

this are actually alcohol dependent.

In summary, during a period of rampant misinfor-

mation about drugs, these three publications accom-

plished the major tasks necessary to set the stage for

scientific study of drug problems: i.e. they described drug

phenomena in a clear, factual basis; they emphasized the

interplay of medical/pharmacological and psychosocial

factors; and they set a tone of reasoned discourse based

on factual information.

ACKNOWLEDGEMENTS

Preparation of this article was funded by Senior Research

Scientist Award DA-00450 from the US National

Institute on Drug Abuse.

 JOH N R. HU GH ES

University of Vermont

38 Fletcher Place

Burlington, VT 05401-1419

USA

E-mail: john.hughes@uvm.edu

REFERENCES

American Psychiatric Association (APA) (1994) Diagnostic and 

Statistical Manual of Mental Disorders, 4th edn. Washington,

DC: American Psychiatric Association.

Bickel, W. K. & DeGrandpre, R. J. (1996) Drug Policy and Human

Nature: Psychological Perspectives on the Control, Prevention and 

Treatment of Illicit Drug Use. New York: Plenum.

Brecher, E. M. (1972) Licit and Illicit Drugs. Boston, MA: Little &

Brown.

Edwards, G. & Gross, M. M. (1976) Alcohol dependence: provi-

sional description of a clinical syndrome. British Medical

 Journal, 1, 1058–1061.

 Jaffe, J. H. (1965) Drug addiction and drug abuse. In: Goodman,

L. S. & Gilman, A., eds. The Pharmacological Basis of 

Therapeutics. New York: Macmillan.

O’Brien, C. P. (1996) Drug addiction and drug abuse. In:

Hardman, J. G. & Limbird, L. L., eds. Goodman and Gilman’s The

Pharmacological Basis of Therapeutics, pp. 557–577. New York:

McGraw-Hill.

World Health Organization (WHO) (1992) The ICD-10

Classification of Mental and Behavioral Disorders. Geneva: WorldHealth Organization.