WHERE ARE WE GOING? A FURTHER QUESTION FOR THE ADDICTION FIELD
Notice bibliographique
Résumé
It is a pleasure to reply to such well-considered and well-articulated commentaries. All were in general agreement that the chronic relapsing disorder construct limits understanding of both the nature of alcohol problems and the development of effective means of help. Tucker 1 and Moskalewicz 2 also focus on related but different issues. Tucker takes issue with the conceptualization of dependence itself, while Moskalewicz interrogates wider biomedicalization and examines more distal historical influences 3. We are in full awareness that we have taken the concept of dependence as a given in ways which these two commentators critique. We chose this focus for debate carefully, however, being concerned by the apparent recent influence of the chronic relapsing disorder construct on research, clinical service provision and public health initiatives. Andreasson 4 adds a new element that was missing from our original account by incorporating public understanding of the nature of addiction into his persuasive depiction of a vicious circle. We agree strongly. While we were more concerned by what leaders in the addiction field were communicating to generic professionals, we omitted consideration of what the field as a whole does to engender greater public understanding of the nature of dependence and related problems 5. Indeed, it may not be excessive to consider this the greatest failure of the field, as such promotion of cultural change might be expected to contribute to greater numbers avoiding dependence or resolving it more quickly 6. ‘For Debate’ papers inevitably call into question what is known in the area concerned. It is tempting to be pessimistic about the limited development of the epidemiology of alcohol dependence. This should be resisted. Ours is not a systematic review, and may be useful for hypothesis generation for both primary and secondary research concerned with the onset and persistence of dependence, patterns of relapse and the contributions of other problems and social contexts. The heart of our invitation to debate is about the how the chronic relapsing disorder construct is used, and whether this is useful for research, policy and practice. It remains our view that this is a useful focus for debate and therefore it is somewhat disappointing that we have not yet succeeded in eliciting perspectives opposed to our own. Looking at, for example, the latest statement by the American Society of Addiction Medicine on the nature of addiction 7, it is obvious that there are many addiction researchers who would disagree with our perspective. We also encourage debates on variations of similar themes such as those suggested in these commentaries, as well as research studies that address novel ways of understanding the causes and course of alcohol dependence (e.g. 8). Support to CAMH for salary of scientists and infrastructure has been provided by the Ontario Ministry of Health and Long Term Care. The views expressed here do not necessarily reflect those of the Ministry of Health and Long Term Care. John Cunningham is also supported as the Canada Research Chair on Brief Interventions for Addictive Behaviours. Jim McCambridge is supported by a Wellcome Trust Research Career Development fellowship in Basic Biomedical Science (WT086516MA).
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».