Our distant forebears wrestled with concepts of alcohol addiction not unlike those of today: Is addiction a sin or a disease? Is addiction caused by the gods, the substance, the individual's vulnerability, or psychological or social factors? Luther, Calvin, and Catholic Church leaders viewed moderate alcohol use as God's gift; used intemperately, it was a moral transgression. The founders of modern scientific psychiatry rejected moral explanations for addiction in favor of an early biological model. The first two versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I and DSM-II) stigmatized addiction by listing it with other societally disapproved disorders stemming from personality disorder. DSM-III espoused atheoretical, descriptive diagnoses but required tolerance or withdrawal to diagnose dependence. Substance dependence in DSM-III-R included physiological and behavioral symptoms and reflected the substance dependence syndrome. DSM-IV's emphasis on biology in its concept of dependence was unchanged from its immediate predecessors. DSM-5 declared that all drugs taken in excess have in common the direct activation of the brain reward system. This article examines evolving concepts of alcohol addiction through 12,000 years of recorded human history, from the first mention of alcohol consumption in China more than 12,000 years ago to alcohol use and abuse in the DSM era, 1952 to the present.

This chapter undertakes a detailed examination of two of the most significant issues raised by critics of DSM-5. The first recognizes the continued absence of viable biomarkers of specific diagnoses, despite intense efforts by neuroscientists to identify such markers. The second question concerns what many critics view as the inordinate influence of the pharmaceutical industry-“Big Pharma”-on the highly troubling problem of overdiagnosis that began with DSM-III.

Bill Stiles wants to enhance the reliability and the utility of theory-building case studies. To do so, he proposes a systematic, replicable approach to clinical case materials that to date has been difficult to use systematically. At the core of his proposal is what he calls “logical operations,” which include some familiar elements of logic: deduction, induction, and abduction. While not without problems in concept and execution, Stiles’ proposal offers those who want to use theory-building case studies in their own work the prospect of an empirically-based analytic tool in a field that has not to this time had one.

The relationships between family history of substance use, executive functions, impaired decision making, and current substance dependence are the focus of this study. Thirty-eight substance-dependent inpatients were compared with 30 community controls on performance on the Wisconsin Card Sorting Test, Trail-Making Test-B, the Stroop Color Word Test, the Wais-II Digit Span, and the Iowa Gambling Task. Recent alcohol use, depressive symptoms, and impulsivity were also assessed. As hypothesized, individuals with substance dependence exhibited poorer executive functioning. Family history status was modestly related to impaired performance on tests designed to measure the integrity of the dorsolateral prefrontal cortex. In particular, substance-dependent, family history positive individuals performed less well on the Wisconsin Card Sorting Test than substance-dependent individuals without a family history. Digit Span performances were worse among family history positive controls when compared with family history negative controls. Impulsive personality traits--specifically, difficulty thinking before acting (Urgency)--were related, as hypothesized, to executive functioning. Results indicate that family history status confers an increased risk of impairment beyond that conferred by recent substance abuse, and that impulsive personality traits are related to performance on tests of executive functions. Implications for criminality are discussed.

The case report by Cigrang, Peterson, and Schobitz (2005) serves two functions. It describes serious combat-induced psychopathology in a sample of three veterans of the Iraq war, and it tests the efficacy of a method for preventing chronic PTSD that might be more efficient than current methods. Thus, exposure therapy in these three cases appears to have alleviated the intense early symptoms of PTSD, perhaps thereby heading off a chronic debilitating condition. While the Cigrang et al. report does not constitute a definitive demonstration of the efficacy of exposure to abort chronic PTSD, it does convey with great immediacy the Iraq battlefield context as well as the demanding decisions front-line mental health professionals must make about combat-induced psychopathology. Of course, additional research is needed to establish the efficacy and effectiveness of this approach to psychopathology generated by battlefield conditions.

These common methodological problems affect the usefulness of pathological gambling (PG) treatment research: (1) Most PG etiological models derive from substance abuse; (2) Most PGs recover on their own and few seek treatment, so PGs in treatment studies may not be representative; (3) Data on treatment-seeking PG women, older adults, and minority group members, or on group, marital, and psychodynamic approaches to PG, are sparse; (4) Little research has examined the impact of comorbidity on PG treatment response; (5) Design deficiencies burden many PG treatment studies.

The case report by Cigrang, Peterson, and Schobitz (2005) serves two functions. It describes serious combat-induced psychopathology in a sample of three veterans of the Iraq war, and it tests the efficacy of a method for preventing chronic PTSD that might be more efficient than current methods. Thus, exposure therapy in these three cases appears to have alleviated the intense early symptoms of PTSD, perhaps thereby heading off a chronic debilitating condition. While the Cigrang et al. report does not constitute a definitive demonstration of the efficacy of exposure to abort chronic PTSD, it does convey with great immediacy the Iraq battlefield context as well as the demanding decisions front-line mental health professionals must make about combat-induced psychopathology. Of course, additional research is needed to establish the efficacy and effectiveness of this approach to psychopathology generated by battlefield conditions.

Substantial disagreement continues to divide mental health professionals on the evidence base that underlies evidence-based practices. This article considers four of the most hotly debated unresolved issues underlying this controversy; suggests the nature of evidence that might permit their resolution; and speculates on the consequences that might follow a failure in efforts at resolution. Resolution of these issues is crucial to the future of evidence-based practices. [Brief Treatment and Crisis Intervention 4:243–254 (2004)]

Abstract Fundamental to the science and practice of clinical psychology is a valid diagnostic nomenclature. Clinicians and researchers need a common language with which to describe and discuss what they are treating and studying. This chapter begins with an overview of the nature of diagnosis and classification. The history of the diagnosis of psychopathology is then briefly described, including the editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Emphasis is given to issues of reliability, diagnostic stability, utility, cultural biases, and validity. Major controversies of the current diagnostic nomenclature are then discussed, including comorbidity, bias, the preference for categories or dimensions, and the definition of mental disorder. The chapter concludes with a presentation of new methods for diagnostic research.