Classic texts revisited

THREE CLASSICS 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: provisional 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 suggests 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 produced statements that heroin would cause full-blown
addiction 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 Jaffes chapters in Goodman and
Gilmans The Pharmacological Basis of Therapeutics ( Jaffe
1965), Edward Brechers book Licit and Illicit Drugs
(Brecher 1972) and Griffith Edwardss & Milton Grosss
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 and
Drug Abuse for the Goodman and Gilman series from
1965 to 1990 (Dr Charles OBrien wrote the most recent
1996 chapter (OBrien 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 psychological and physical dependence, stating that tolerance and
withdrawal occur with some non-dependence producing
2002 Society for the Study of Addiction to Alcohol and Other Drugs

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 pharmacological and psychosocial factors and that both can be
talked about scientifically, influenced the thinking of
many future doctors and scientists.
Seven years after Dr Jaffes first chapter, Consumer
Reports published Edward Brechers book Licit and Illicit
Drugs (Brecher 1972). This book also slayed several drug
use myths but, in contrast to Jaffes 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 skepticism and empiricism. Mr Brechers book was written to
help parents and community leaders faced with drug
problems 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 interaction of science, sociology and medicine. This is also a
great book for those already on the front lines of prevention 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.
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Classic texts revisited

The US Army stockpiled LSD to use to disable an

enemy force.
The book is not perfect. It does become somewhat onesided 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 publication. However, to my mind, any book that had the intellectual 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) published a paper in the British Medical Journal of a provisional 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 the
field 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 drinkseeking, tolerance, withdrawal, relief/avoidance of withdrawal, 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 Organizations International Classifications of
Diseases (WHO 1992) and the American Psychiatric
Associations 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 concurrence of phenomena contrasts sharply with its many
excellent insights. For example, the authors make clear
the distinction between drug dependence and drug problems, as evidenced by their observation that harm can
occur in the absence of dependence and their prescient
statement that much of the controlled drinking contro-

2002 Society for the Study of Addiction to Alcohol and Other Drugs

versy arises around whether the clients who succeed at

this are actually alcohol dependent.
In summary, during a period of rampant misinformation about drugs, these three publications accomplished 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.
JOHN R. HUGHES

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: provisional description of a clinical syndrome. British Medical
Journal, 1, 10581061.
Jaffe, J. H. (1965) Drug addiction and drug abuse. In: Goodman,
L. S. & Gilman, A., eds. The Pharmacological Basis of
Therapeutics. New York: Macmillan.
OBrien, C. P. (1996) Drug addiction and drug abuse. In:
Hardman, J. G. & Limbird, L. L., eds. Goodman and Gilmans The
Pharmacological Basis of Therapeutics, pp. 557577. New York:
McGraw-Hill.
World Health Organization (WHO) (1992) The ICD-10
Classification of Mental and Behavioral Disorders. Geneva: World
Health Organization.

Addiction, 97, 111112