Alcoholism And The Family

Saturo Saitoh, Peter Steinglass, Marc A. Schuckit

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9781138004856
• eBook ISBN:
  9781134852819
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

The science of the etiology and treatment of alcohol has made notable progress in recent years. Since the early 1970s there have been growing in-roads made concerning the relevance of hereditary factors in alcoholism. This has led to the presentation of various innovative hypotheses in this field. In conjunction with this there has been much discussion and study of the "alcoholic personality" and its possible characteristics. These may be considered the "longitudinal aspects" linked to the transmission of alcoholism.

PART I

GENETIC FACTORS OF ALCOHOLISM

In both this section and the next, the authors review the ways in which genetic and environmental factors contribute to the cause and/or development of alcoholism. We must pose the question: To what extent—and at what stage—may genetics interact with environmental influences?

Professor Marc Schuckit, Associate Professor Michihiko Nakamura, and Professor Asaka all address this challenging question in somewhat different ways.

Professor Schuckit and his team use biochemical and electrophysiological investigations. Professor Nakamura's group concentrates upon CNV (Contingent Negative Variation) paradigms within the electrophysiological field. Professor Asaka's methodology was the comparison of the life histories of monozygotic twins.

From these three reports, readers can gather information on a wide variety of approaches to this problem, and the extent to which answers have been uncovered, to date, regarding this question.

PART I: GENETIC FACTORS OF ALCOHOLISM

1

Alcoholism, A Familial Disorder: Genetic Aspects^*

Marc A. Schuckit, M.D.

This paper discusses how genetic factors contribute to the familial nature of alcoholism. The importance of a genetic component to this disorder is supported by the fourfold increased risk for severe alcohol problems in close relatives of alcoholics, the high risk for identical twins of alcoholics, and the documentation of a high level of vulnerability among adopted-out children of alcoholics. Studies are now underway attempting to identify biologic factors that interact with the environment to produce the alcoholism risk. Among the leads is the documentation that sons and daughters of alcohol-dependent parents show a decreased intensity of reaction to modest doses of alcohol. The implications of these findings to the prevention and treatment of alcoholism are discussed.

I. INTRODUCTION

A) General Issues

Alcoholism is a familial disorder in many ways. First, the course of alcohol-related life problems affects mood, productivity, and episodes of violence, and, thus, impacts on the lives of most friends and relatives.⁽²¹⁾ As a result, few alcoholics suffer their disorder alone. A second familial aspect of alcoholism rests with the theory that optimum treatment of the alcoholic cannot occur unless the entire immediate support system, including the family unit, joins in therapy.

The present paper focuses on a third way in which alcoholism is familial. For many years, alcoholism has been demonstrated to cluster in certain family groups,⁽³⁾ a finding which could be the result of genetic and/or environmental factors. The strong familial component has contributed to the development of studies evaluating if the patterns might reflect underlying genetic factors. This search has proceeded through several steps of increasing complexity as is described in the next section.

B) The Search for Genetic Factors in Alcoholism

Alcoholism indeed runs strongly within families.^(3),(19) The risk for developing this serious disorder is increased at least fourfold in close family members of alcoholics. Most data also indicate that if the original identified alcoholic has no obvious major preexisting psychiatric disorders (i.e., he has primary alcoholism), the illness most likely to be observed in that family is alcoholism itself.^{(17),(18),(24)} Also consistent with the importance of a genetic predisposition is the probability that the risk for developing alcoholism increases with the number of alcoholic relatives, even if those alcoholics had never lived with the individual while he or she was growing up. For example, alcoholism in a grandfather appears to add significantly to the alcoholism risk.⁽⁸⁾ Finally, the more severely alcoholic the individual is (e.g., whether he or she has been hospitalized or not), the greater the likelihood a close family member will develop alcoholism.

This constellation of findings has justified the next type of investigation, twin studies,⁽¹⁴⁾ with results that have generally supported the importance of genetic factors. Partanen and colleagues⁽¹²⁾ in Finland documented a greater similarity for many drinking characteristics for identical twins when compared to fraternal pairs. The classical twin study focusing on severe and pervasive alcohol-related life problems (i.e., alcoholism) reported that the risk for alcoholism was twice as high in the identical twin of an alcoholic than in a fraternal twin, with the latter demonstrating a level of similarity that was equivalent to that of same-sexed full siblings.⁽⁷⁾ Those results were similar to several earlier investigations and have been supported by later studies (e.g., 2,14). However, one recent investigation began with individuals who fulfilled criteria for alcoholism but who were selected from a general psychiatric hospital population, and generated data inconsistent with a genetic influence.⁽¹⁰⁾

The preponderance of data from the family and twin investigations justifies making the efforts needed in adoption studies. If alcoholism is genetically influenced, then the sons and daughters of alcoholics should be at exceptionally high risk for this disorder, even if they were adopted out and raised by nonalcoholics.^(19),(20) All modern adoption studies have documented that alcoholism in the biological parent predicts the likelihood of alcoholism in the children, even in individuals who were raised by nonalcoholics; ^{(2),(6), (2)} An interesting sidelight has been the lack of evidence that being reared by an alcoholic increases the risk at all beyond what would be predicted from the illness in the biological parent alone.

In summary, one familial attribute of alcoholism is the manner in which it clusters within families. There is evidence from family, twin, and adoption studies to support the contention that this familial aspect of alcoholism includes a genetic component. The next section briefly ...

Table of contents

• Cover Page
• Half Title page
• Series page
• Title Page
• Copyright Page
• Contents
• Preface
• Contributors
• Introduction
• I Genetic Factors of Alcoholism
• II Genetic Factors Of Alcoholism: Clinical Aspects
• III Alcoholic Families And Mental Health
• IV Alcoholism And Family Models
• V Therapeutic Approaches to the Alcoholic Family
• Name Index
• Subject Index