Alcohol abuse is a serious problem that leads or contributes to broken homes, various personal abuse situations, traffic accidents, traffic deaths and other undesirable consequences annually. According to a UCSF Family Alcoholism Report, an estimated 76 million or people in the US are alcoholic or are affected by the condition. (ref) The report also notes that about 100,000 deaths annually can be attributed to the condition. While excessive alcohol consumption is a habit, some have raised questions as to whether it is triggered by biological factors such as genes.
We know that alcoholic behavior runs in families, but we are not certain why. Is such behavior caused by genes, is it triggered by a person’s environment, is it a matter of personal choice or does it arise from a combination of factors. Efforts to address these questions have led to sociological, psychological and genetic studies that shed light on the condition without successfully answering the central questions. Although our knowledge about alcoholism is increasing, we are still a long way from determining what constitutes the term.
The following report will summarize research concerning genetic and environmental factors that contribute to alcoholic behavior and how they interact. We shall consider the chromosomes, genes on chromosomes, nurture versus nature, adoption studies, twin studies, personal choice and environment among the various factors that lead to the condition and seek to understand what is generally known about alcoholism today. Researchers are now integrating data from many fields of research in order to reach a better understanding of the alcoholic condition.
The concept that ‘alcoholism is a disease’ has not proven beneficial to furthering research on the condition since there is no consensus agreement as to what that phrase actually means. II. Excessive Drinking Excessive behaviors are not uncommon. Virtually any obsessive behavior can lead to sickness or disease. Although excessive behavior can be a sign of illness, most excessive behaviors are just habits with which people go overboard or become obsessed. In general, they become excessive because an individual gives in to their desires and over indulge past the point where the once pleasurable and benign behavior is still a pleasure.
While this can develop into a psychiatric condition and lead to a physical, medical pathology, for the most part, excessive behaviors do not result from any physical or mental defect or disease. Although alcoholism could be viewed as the excessive consumption of alcohol, our understanding of the condition is not as simple as that. Excessive alcohol consumption certainly is a component of the condition, but we do not have a sufficiently certain or clear understanding of the condition to allow us to determine exactly what actually constitutes ‘alcoholism’ and to what degree the excessive drinking contributes to it.
This uncertainty comes, in part, from our lack of agreement as to exactly what constitutes the condition of ‘alcoholism’. Some view that the habit of excessive drinking itself is the disease. III. Alcoholism Defined Some feel that alcohol abuse is a pattern problem drinking that causes personal harm, but that is not necessarily the agreed upon definition of ‘alcoholism’. The National Council on Alcoholism and Drug Dependence (NCADD) presents eight attributes as signs of problem drinking.
Each of these signs such as having guilt about drinking and lying about or hiding drinking habits are clearly a response to an undesirable habit rather than a disease, but Alcoholics Anonymous, the leading group involved with helping alcoholics overcome their condition, insists that alcoholism, whatever that term means, is a disease. Arguing with the entrenched Alcoholics Anonymous advocates and their view will not resolve anything.
People have the same responses to over indulging in eating, gambling or sex, but clearly, such over indulgences are habits and only rarely a sign of a disease. If problem drinking itself is a disease, a rather far-fetched idea, one must wonder if the over consumption of any beverage constitutes a disease. Alcoholics Anonymous labels ‘alcoholism’ as a disease without any clear reference as to whether the term refers to the habit of over drinking or to the subsequent clinical conditions that arise and with no clear reference as to what they refer when they use the term ‘disease’.
Although much of the initial behavior that leads to the condition of alcoholism is certainly a habit, we don’t understand why people become alcoholics, but often, part of the reason involves the inability to cope with life’s situations without some type of crutch. The concept of alcoholism is so poorly defined that we cannot attribute it to anything, including genetics, because we don’t have a well defined idea or grasp of what constitutes alcoholism. None of the other anonymous groups—smokers, gamblers, sex addicts, etc—label the condition they deal with as arising from a disease.
Clearly, excessive drinking is a habit rather than a disease, but elaborating that point is out of the scope of the present considerations. For now, all we can say is that alcoholism, whatever it is, involves habits and leads to diseases. The problem with assuming that excessive alcohol consumption is a disease can be made clearer by considering the relationship between smoking and cancer. Smokers are subject to a host of diseases, but excessive smoking (which is certainly a poorly defined concept since any smoking at all could be considered excessive) is not labeled as a disease.
Yet, diseases do arise from excessive smoking. Still, the habit of smoking and the subsequent diseases that arise from it, one of which is cancer, are clearly separated. This is not true for those who drink excessively. So, our first task is to define the term alcoholism, or at least to determine what most people mean when they use the term. This endeavor is futile because few people actually define the term when the use it and there is no place to turn to find an agreed upon definition.
So, we shall begin by defining alcoholism, for our purposes, as excessive drinking, and then add the note that the research to which we will refer generally deals with alcoholism as the medical and health conditions (diseases) that arise when people consume alcohol in excess. To summarize this, for our purposes, alcoholism is the habit of excessive drinking that, if continued, leads to diseases. Although throughout this report, we will refer to the notion that alcoholism is a disease, that notion, when presented, is the view of others rather than the view taken here.
Fortunately, researchers are going beyond the idea that alcoholism is a disease and examining the relationship between the transmission of serotonin and behaviors associated with the alcoholic condition. IV. Cotton’s Review There can be no doubt that there is a genetic component to alcoholism. The question is, ‘How critical is that component to the behavior of excessive drinking? ’ This question is crucial whether or not the behavior is also the disease. A number of studies have demonstrated a connection between genetics and problem drinking, but none have provided convincing evidence that the connection is the causative factor.
After reviewing the literature, Cotton (1979) concluded that alcoholics were six times more likely than non-alcoholics to have a family history of excessive alcohol consumption. This leads to the question as to whether there is a genetic link to problem drinking, but it also brings up the issue of environment. Since her report, many studies have uncovered genetic links to alcohol dependence. V. Alcoholism and Family History The idea that alcoholism might be caused by genetic factors came about in part because of the observation that many alcoholics have a history of alcohol abuse in the family.
Cotton’s review of the literature, briefly considered above, indicating that alcoholism runs in families was a major contributing factor to this view. Many studies appear to support her conclusion, and some studies have located genes that are more common in alcoholics than in non alcoholics (see below). Despite the observation that there is a connection between family history and the alcoholic condition, many children of alcoholics do not end up with drinking problems. Even though genetics is one obvious question to investigate when alcohol abuse is common to families, the family factor does not necessarily suggest a causative genetic link.
Environmental factors are family related and are plausible candidates. Moderate drinking behavior may be more difficult for people who come from families where there is a history of excessive drinking, but this can be caused either by the environment or genetics. Many aspects of family life influence drinking behavior. Some of these factors may increase the need to cope, and individuals may resort to drinking or other undesirable behaviors to deal with this need to cope. Genetics need not be the prime factor.