alcoholism, disease concept of アルコール症の疾病概念、アルコホリズムの疾病概念

The belief that alcoholism is a condition of primary biological causation and predictable natural history, conforming to accepted definitions of a disease. They lay perspective of Alcoholics Anonymous (1939)—that alcoholism, characterized by the individual's loss of control over drinking and thus over his or her life, was a “sickness”—was carried into the scholarly literature in the 1950s in the form of the disease concept of alcoholism. The concept was rooted in 19th-century medical and lay conceptions of inebriety as a disease. In 1977, a WHO Group of Investigators* responding to the loose and varying usage of alcoholism, proposed substituting the term alcohol dependence syndrome in psychiatric nosology. By analogy with drug dependence, alcohol dependence has found general acceptance in current nosologies.


* Edwards, G. et al., ed. Alcohol-related disabilities, Geneva, World Health Organization, 1977 (WHO Offset Publication No. 32) WHO (1994)1), p.12
Lexicon of alcohol and drug terms (WHO)


WHOのLexicon of alcohol and drug termsの各項目で参照されたWHOのドキュメント類。


WHO委員会による報告書 Alcohol Related Disabilities(アルコール関連障害)の中の Report of a WHO Group of Investigators on Criteria for Identifying and Classifying Disabilities Related to Alcohol Consumptionアルコール消費に関連した障害の同定と分類に関する研究者グループ報告書)。



3. Alcohol dependence syndrome
3.1 Concepts
(1) Semantics
3. アルコール依存症候群
3.1 概念
(1) 語義

There can be little doubt that scientifically the most apt designation of the basic condition under discussion is alcohol dependence,1 and this term usefully emphasizes the fact that what is being dealt with is one of the family of dependence disorders. The term syndrome has the advantage of emphasizing the openness of the position that is being taken: it is implicit only that a number of phenomena tend to cluster with sufficient frequency to constitute a recognizable occurrence. The assertion is not made that all those elements will always be present with the same magnitude or relative magnitudes, nor indeed that all elements need invariably be present. No assumption need at this stage be made as to the causal nexus (the pathology), nor as to which elements are primary and which secondary. Despite the looseness of the syndrome concept as at present articulated, it nevertheless carries very considerable implications. There is the basic question of whether such a clustering does indeed naturally occur, and if that question is answered affirmatively there is a need then further to explore how the syndrome may be recognized and its dimensions measured, and what are the causal processes and the nature of the linkage between the syn- drome's different elements. The medical, social and administrative consequences of the syndrome's existence have to be investigated.

議論されている基本的な状態に対して、アルコール依存という名称を使うことが最も適切であるのは疑いない。1 そして、この用語は扱っている対象が(薬物)依存という疾患群の一つである事実を強調するのに役立つ。また症候群という用語には、様々な見解への許容力を強調できる利点があり、また、いくつかの徴候がその発生を十分に認識しうる頻度で群を成すことだけを暗黙に示している。それらの徴候が、常に同じ規模で、あるいは相関した規模で現れることも、またすべての徴候が例外なく現れることも断言していない。このステージに至る何らかの因果関係(病理)を想定する必要もないし、どちらの要素が一次的であるか二次的であるかを問わない。現段階で明らかにされている症候群の概念は不明瞭なものではあるが、にもかかわらずそれには多くの含意がある。こうした一群の徴候は生来的に起こるものなのか、という基本的な疑問がある。その疑問の答えが肯定だとすれば、この症候群をどのように認知し、規模を計測するべきか、それがどんな原因から生じるのか、またこの症候群のそれぞれ異なった要素の間の関連性につて、さらなる探求が必要になってくる。この症候群による、医学的、社会的、また施政への影響について調査が行われるべきである。

The simplest solution might be to use the word alcoholism as synonymous with alcohol dependence, as was done by the Criteria Committee of the National Council on Alcoholism (NCA) in the United States of America:

おそらく最も単純な解決は、National Council on Alcoholism (NCA) の診断基準委員会が行ったように、アルコホリズム(alcoholism)という用語をアルコール依存の同義語として使うことだろう。

“The committee was unanimous in defining the disease of alcoholism as a pathological dependence on ethanol, as it is classified under Section 303.2 in the Diagnostic and Statistical Manual of Mental Disorders, second edition, of the American Psychiatric Association.” 2

本委員会は、アメリカ精神医学会(APA)の『精神障害の診断と統計の手引き 第2版』の303.2項に分類されているように、アルコホリズム(alcoholism)がエタノールへの病的な依存であると定義することを全会一致で決定した。 2

It seems, however, that the term alcoholism has come to be used so loosely that an attempt to restrict its meaning once more to a specific syndrome is likely to be futile.


1 Eddy, N. B. et al., Drug dependence: its significance and characteristics. Bull. Wld Hlth Org., 32: 721 (1965). 2 National Council on Alcoholism, Criteria Committee, Criteria for the diagnosis of alcoholism. Amer. J. Psychiat., 129: 127 (1972). WHO Group of Investigators (1977)2), p.9,
WHO Offset Publication No.32 [pdf] (WHO)

WHO (1994), Lexicon of alcohol and drug terms. Geneva: World Health Organization →Lexicon of alcohol and drug terms (WHO)
WHO Group of Investigators (1977), Report of a WHO Group of Investigators on Criteria for Identifying and Classifying Disabilities Related to Alcohol Consumption, Geneva: World Health Organization →WHO Offset Publication No.32 [pdf] (WHO)
lexicon/alcoholism_disease_concept_of.txt · 最終更新: 2015/09/02 00:33 by ragi