RISK FACTORS FOR ALCOHOL ADDICTION
Anyone can become dependent on alcohol. Continued exposure to alcohol changes brain in ways that produce
dependence. Although there are large
differences in individuals' risk for dependency and addiction, any person who puts enough alcohol into his brain
over a long enough time will become
physically dependent on the drug. Putting aside for a moment the risk factors that have been identified
for alcohol dependence, the numbers
generally show that the chances of a man becoming addicted to alcohol increase markedly if he drinks more than about three to four drinks per day. For women, the number of drinks is
about three. Another consistent
finding is that people who become addicted to alcohol are often those who report that they drink to relieve their
emotional or social difficulties. In
other words, if someone drinks to self-medicate—to block out emotional or social problems—he is especially
likely to become addicted. But self-medication simply cannot account for all of
the alcohol addiction in the world, and the big question remains: Why do
some people choose to drink enough to
get addicted?
GENETIC FACTORS
Much of the evidence that genetic factors may lead
to alcohol dependence has come from
studies on twins and children of alcoholics who were adopted at birth and raised by nonalcoholic
adoptive parents. Studies like these
allow researchers to begin to tease apart the separate influences of nature and
nurture in the development of alcohol addiction. At present it seems clear that the basis of alcoholism is partly
genetic but that genetic factors alone
cannot account for the development of the disease. The real value of the nature versus nurture studies so far
is that they have identified certain traits, or markers, that run in families
and predispose people to alcohol
dependence. Thus, they help to identify individuals who may be at risk for developing alcohol problems. If a
person knows that he is at more risk
than normal for this disease, then he can make better decisions about drinking.
It is very clear that alcoholism, like diabetes,
runs in families. With no family
history of alcoholism, the risk of developing alcohol abuse problems is about 10 percent for men and 5 percent
for women. However, the risk nearly
doubles if there is a family history of alcohol problems. For example, for women who have a
first-degree relative (child, sibling,
or parent) who is an alcoholic, the chances rise from 5 percent to 10 percent.
For men with a first-degree relative who is an alcoholic, the risk goes from 10 percent to 20 percent. So,
for both men and women, the risk is
doubled. The risk goes to 30 percent for men and 15 percent for women who have both a first-degree relative
and a second- (e.g., uncle, aunt,
grandparent) or third-degree relative (e.g., cousin, great-grandparent) who is an alcoholic. So, being
the child of an alcoholic increases the risk of developing alcohol abuse
problems, but boys are at considerably more risk than girls.
It is important to
know that these family studies do not conclusively demonstrate a genetic basis
for alcoholism. It is likely that factors other than biological ones, such as being raised by an alcoholic parent, also contribute to drinking behavior. A number of
studies show that being raised in a
family in which alcohol is abused increases a child's chances of becoming alcohol dependent.
flealtfficare practitioners use several simple screening tests to assess
whether an individual may have an alcohol problem. Before describing them,
though, we must make two cautionary notes. First, a diagnosis of alcohol abuse, alcohol
dependency, or alcoholism can only truly be made by a health professional
trained specifically in addiction. These are very complex medical and
psychological states, and no simple screening tool is adequate to make a foolproof
assessment. Second, it sometimes does considerably more harm than good
to confront a friend or relative with the impression that she may have a
drinking problem. Although a concerned person may have the best of
intentions and may be acting out of true concern, the other person may simply feel
accused and withdraw from the very help being offered. The screening
tests we describe in what follows are often used in doctors' offices and
clinics as a first indication that there might be a problem.
A
SPECIAL RISK FOR MEN
Although genetic influences significantly affect
the risk of alcoholism in both men
and women, these influences appear to be particularly powerful in men. A number of studies compare the sons of
alcoholic fathers with sons of
nonalcoholic fathers. In general, it appears that the sons of alcoholic fathers are less impaired by alcohol than
those of nonalcoholic fathers.
However, early in the drinking session (when the pleasurable effects of alcohol prevail), the sons of alcoholics
appear to be more affected by alcohol
than others. This difference suggests that sons of alcoholic fathers may have a more powerful experience of the
pleasurable effects of alcohol and a
less powerful experience of the impairing effects of alcohol than other men, creating a setup for these men to
continue drinking over time and making
them more susceptible to addiction.
In addition, a specific type of alcoholism seems to
occur mostly in men. This is called
Type II alcoholism and is characterized by an onset of drinking problems in adolescence, aggressive
behavior, trouble with the law, and
the use of other drugs. Type II alcoholism is considered to be very strongly influenced by genetics. Type 1
alcoholism is more common and less
severe than Type II alcoholism, occurs in both men and women, and begins in adulthood. Men with fathers or
brothers who show signs of Type IT
alcoholism should be particularly careful about alcohol use.
HOW TO
SPOT A PROBLEM DRINKER
The
most widely used screening test is called the CAGE:
· Have you ever felt the
need to Cut
down on your drinking?
·
Have you ever felt Annoyed by someone criticizing
your drinking?
·
Have you ever felt Guilty about your drinking?
· Have you ever felt the need for an
Eye-opener (a drink at the beginning
of the day)?
If the person gives two
or more positive responses to these questions, there is a good chance that she has some degree of an alcohol problem. But remember that screening tests are, by their
nature, imperfect. For example, it is
easy to imagine that a person with a history of heavy drink‑
ing might answer yes to
all of the questions, even if she hadn't had a drink for years.
Another screening test, which has proven
particularly useful with women, is
called the TWEAK:
·
Tolerance: How many drinks does it take to make
you high?
·
Worried: Have close friends or relatives worried or
complained about your drinking?
· Eye-opener: Do you
sometimes take a drink in the morning to wake up?
·
Amnesia (memory loss): Has a friend or family
member ever told you
things you said or did while you were drinking
that you could not remember?
·
(K)Cut: Do you sometimes feel the need to cut down
on your drinking?
This test is scored differently from the CAGE, but
a positive score of
three or more is considered to indicate that the
person likely has a drinking problem.
One final word of caution regarding these
screening techniques: they all rely
on one critical component (which is not always so reliable)--the person's own responses. There are any number of
reasons why a person might not
respond fully accurately. Therefore, while these screening tools may be useful
as a first-pass indicator of a possible problem, they must not be used in isolation to form impressions about a
person.
