Addictive Behaviors. Vol. I, pp. I-2, PergamonPress 1975. Printed in Great Britain
EDITORIAL RESEARCH
ON ADDICTIVE
BEHAVIORS:
CURRENT
NEEDS
Social and clinical concerns over tlSe abuse of substances that are potentially addicting (either psychologically or physically) have a long and rather cyclical tradition. Widespread experimental studies investigating the etiology and treatment of alcoholism, drug abuse, obesity, and excessive cigarette smoking, however, represent a more recent phenomenon. While current research findings are gradually increasing our understanding of the addictions, the fulfilment of several needs appears essential for significant inroads to be made in modifying these problems on a large scale. First, while well designed experimentation utilizing objective assessment procedures would appear to be an obvious necessity for any serious research endeavor, adequate controls are frequently lacking in studies on the addictions. A survey of the literature reveals an abundance of quasi-theoretical articles with premises based on minimal scientific information. Even more typical is the espousal by an "expert" of the widespread and immediate implementation of a new treatment approach that, unfortunately, has not as yet been fully evaluated. These articles have led to periodic treatment fads that are especially characteristic in the area of addictive behaviors. Possibly the most prominent example of this consists of the numerous new "miracle diets" that have been proposed as the solution to obesity. Perhaps the eagerness of both laymen and professionals alike to accept these unproven treatments relates to their own legitimate frustration with the continuing disparity between immediate clinical needs of a vast number of individuals and the relative lack of scientific information on the nature of addictions. It would appear that the most significant recent advancement in narrowing this disparity involves the development of more objective assessment procedures. These procedures allow for a more careful evaluation of: (1) social, emotional, attitudinal, cognitive, environmental, and physiological factors associated with the maintenance of addictive behaviors, and (2) the long term efficacy of various treatment modalities. Such assessments have consisted of quantitative measures accumulated on a periodic basis through urine analysis in the case of drug abuse and breathalyzer analysis in alcoholism research. More recently, direct observations of consummatory behavior--eating, smoking, drinking alcohol--both in the natural environment (e.g., ratings of the components of alcohol drinking in a barroom setting), and via laboratory analogue tasks (e.g., a taste-rating procedure in which the amount of a substance consumed is assessed surreptitiously)'have been.used. While these procedures are occasionally challenged on ethical grounds, their use has not only added significantly to basic conceptions of addictive behaviors but also has-helped to dispel various myths regarding the nature of specific addictions that have been perpetuated by post hoc anecdotal data. Specifically, these new data have seriously questicmed the traditionally held notions that: (1) alcoholism constitutes a disease process whereby the individual exhibits total loss of control over his drinking such that the consumption of even one drink will inevitably lead to a drinking binge, and (2) marijuana is an addicting drug that inevitably leads to the use of potent narcotics. Resistance to the use of these direct measurement techniques has in part constituted an emotional reaction to the issues raised by the results of these studies and partly due to a misconception that providing an abused substance to an addict in a free choice situation will necessarily exacerbate his/her problem. Second, While some research on addictive behaviors is well designed experimentally, its relevance to applied preventive or clinical use is unclear. For example, there are perhaps hundreds of studies demonstrating that alcoholics, drug addicts, the obese, and chronic cigarette smokers significantly differ from other groups on various psychological, sociological, and physiological variables. Such research has invariably added little to our knowledge of either etiology or treatment effectiveness. While basic research is extremely important, its relevance to broader clinical issues must be established. A.B. VoL I. No. I--A
l
2
Editorial
Third, an unfortunate phenomenon relates to the fact that the four major addictions being discussed here are typically studied separately with little attempt to compile and share knowledge or to formulate general theories on addictions. Indeed, certain clinical procedures found effective in modifying obesity may also prove beneficial in decreasing cigarette consumption. Clinicians and researchers, particularly in the drug and alcohol abuse fields, tend to isolate themselves and their work from the more general research on addictions as a whole. Such a closed systems approach can hardly lead to significant advances in the field. Related to this issue is the paucity of research on the interrelationships among addictive behaviors. That is, what are the etiological similarities between the development of obesity and the development of excessive cigarette smoking? Clinically, such relationships may be extremely important as characterized by the vast numbers of methadone maintained ex-heroin users who develop a new addiction (namely alcohol abuse). Fourth, perhaps one of the most essential needs involves a further sharing of research ideas and findings among the diverse disciplines conducting research in the addictions field. Each of the addictive behaviors may have various components that are sociological, physiological, and psychological in nature. While most researchers in these fields would agree with this contention, in practice they frequently stress their own orientation to the exclusion of others. This attitude fosters an extreme oversimplification of the nature of addictions and severely limits the scope of our understanding. Addictive Behaviors, as a newly established journal encompassing alcoholism, drug abuse, smoking, and obesity, will hopefully provide a format within which solutions to these many needs may be articulated. While the journal will be rigorously empirical, no one theoretical orientation or disciplinary endeavor will be stressed. The objective is to publish experimental studies within a forum that is open to diverse conceptions of the nature of addictive behaviors. Department of Psychiatry and Human Behavior University of Mississippi Medical Center Department of Psychiatry Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine
PETER M. MILLER
MICHEL HERSEN
EDITORIAL RESEARCH
ON ADDICTIVE
BEHAVIORS:
CURRENT
NEEDS
Social and clinical concerns over tlSe abuse of substances that are potentially addicting (either psychologically or physically) have a long and rather cyclical tradition. Widespread experimental studies investigating the etiology and treatment of alcoholism, drug abuse, obesity, and excessive cigarette smoking, however, represent a more recent phenomenon. While current research findings are gradually increasing our understanding of the addictions, the fulfilment of several needs appears essential for significant inroads to be made in modifying these problems on a large scale. First, while well designed experimentation utilizing objective assessment procedures would appear to be an obvious necessity for any serious research endeavor, adequate controls are frequently lacking in studies on the addictions. A survey of the literature reveals an abundance of quasi-theoretical articles with premises based on minimal scientific information. Even more typical is the espousal by an "expert" of the widespread and immediate implementation of a new treatment approach that, unfortunately, has not as yet been fully evaluated. These articles have led to periodic treatment fads that are especially characteristic in the area of addictive behaviors. Possibly the most prominent example of this consists of the numerous new "miracle diets" that have been proposed as the solution to obesity. Perhaps the eagerness of both laymen and professionals alike to accept these unproven treatments relates to their own legitimate frustration with the continuing disparity between immediate clinical needs of a vast number of individuals and the relative lack of scientific information on the nature of addictions. It would appear that the most significant recent advancement in narrowing this disparity involves the development of more objective assessment procedures. These procedures allow for a more careful evaluation of: (1) social, emotional, attitudinal, cognitive, environmental, and physiological factors associated with the maintenance of addictive behaviors, and (2) the long term efficacy of various treatment modalities. Such assessments have consisted of quantitative measures accumulated on a periodic basis through urine analysis in the case of drug abuse and breathalyzer analysis in alcoholism research. More recently, direct observations of consummatory behavior--eating, smoking, drinking alcohol--both in the natural environment (e.g., ratings of the components of alcohol drinking in a barroom setting), and via laboratory analogue tasks (e.g., a taste-rating procedure in which the amount of a substance consumed is assessed surreptitiously)'have been.used. While these procedures are occasionally challenged on ethical grounds, their use has not only added significantly to basic conceptions of addictive behaviors but also has-helped to dispel various myths regarding the nature of specific addictions that have been perpetuated by post hoc anecdotal data. Specifically, these new data have seriously questicmed the traditionally held notions that: (1) alcoholism constitutes a disease process whereby the individual exhibits total loss of control over his drinking such that the consumption of even one drink will inevitably lead to a drinking binge, and (2) marijuana is an addicting drug that inevitably leads to the use of potent narcotics. Resistance to the use of these direct measurement techniques has in part constituted an emotional reaction to the issues raised by the results of these studies and partly due to a misconception that providing an abused substance to an addict in a free choice situation will necessarily exacerbate his/her problem. Second, While some research on addictive behaviors is well designed experimentally, its relevance to applied preventive or clinical use is unclear. For example, there are perhaps hundreds of studies demonstrating that alcoholics, drug addicts, the obese, and chronic cigarette smokers significantly differ from other groups on various psychological, sociological, and physiological variables. Such research has invariably added little to our knowledge of either etiology or treatment effectiveness. While basic research is extremely important, its relevance to broader clinical issues must be established. A.B. VoL I. No. I--A
l
2
Editorial
Third, an unfortunate phenomenon relates to the fact that the four major addictions being discussed here are typically studied separately with little attempt to compile and share knowledge or to formulate general theories on addictions. Indeed, certain clinical procedures found effective in modifying obesity may also prove beneficial in decreasing cigarette consumption. Clinicians and researchers, particularly in the drug and alcohol abuse fields, tend to isolate themselves and their work from the more general research on addictions as a whole. Such a closed systems approach can hardly lead to significant advances in the field. Related to this issue is the paucity of research on the interrelationships among addictive behaviors. That is, what are the etiological similarities between the development of obesity and the development of excessive cigarette smoking? Clinically, such relationships may be extremely important as characterized by the vast numbers of methadone maintained ex-heroin users who develop a new addiction (namely alcohol abuse). Fourth, perhaps one of the most essential needs involves a further sharing of research ideas and findings among the diverse disciplines conducting research in the addictions field. Each of the addictive behaviors may have various components that are sociological, physiological, and psychological in nature. While most researchers in these fields would agree with this contention, in practice they frequently stress their own orientation to the exclusion of others. This attitude fosters an extreme oversimplification of the nature of addictions and severely limits the scope of our understanding. Addictive Behaviors, as a newly established journal encompassing alcoholism, drug abuse, smoking, and obesity, will hopefully provide a format within which solutions to these many needs may be articulated. While the journal will be rigorously empirical, no one theoretical orientation or disciplinary endeavor will be stressed. The objective is to publish experimental studies within a forum that is open to diverse conceptions of the nature of addictive behaviors. Department of Psychiatry and Human Behavior University of Mississippi Medical Center Department of Psychiatry Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine
PETER M. MILLER
MICHEL HERSEN
