Alcoholism or Alcohol Use Disorder (AUD) has a profound impact on individuals, families, and society as a whole. It is commonly defined as “A problematic pattern of alcohol use leading to clinically significant impairment or distress.”[1] In other words the person affected recognize that use of the substance has spiralled out of control and is causing harm to themselves and others, including negative consequences for personal health, safety, family and personal relationships, work or study environments. Despite being aware of these negative affects the strong cravings or impulses to continue using alcohol override these concerns, resulting in continued and often escalating drinking.
The impact of alcohol and other substance abuse is widespread. The latest statistics show that there is nearly 29 million people in the United States who met the criteria for Alcohol use disorder in 2021. Disturbingly, when we focus on adolescents, there were 894 000 individuals aged 12-17 who met the traditional criteria for alcohol dependance or abuse in 2021.[2][3] Over the past two decades alcohol abuse and dependence has steadily increased with the COVID pandemic exacerbating the issue.
This brings up the question of what puts us at risk for developing alcoholism or AUD:
Genetics or inheritability.
According to prominent authors, genetics play a significant role in 50-60% of people diagnosed with alcohol abuse[4]. The most convincing evidence comes from studies involving children of alcoholics who were adopted before the age of six weeks. They were removed from the environment wherein alcohol abuse occurred and they had no knowledge that their biological parents suffered from alcoholism. The study showed that they were four times as likely to develop an alcohol use disorder compared to adopted sons of non-alcoholics.[5] However the specific gene or genes that contribute to developing alcoholism has not been identified. This is likely due to the complex interplay of multiple genes and enzymes involved in alcohol metabolism that play a role in the development of alcohol dependance.
Nonetheless not everyone that has a family history of alcoholism or drug use becomes and addict, similarly many with Alcohol or drug use disorder have no family history of addiction. Clearly other factors and the environmental influences plays a significant role in the development (and treatment) of addiction.
One important factors is Adverse childhood experiences.
Adverse childhood experiences (ACEs)
ACEs refer to various traumatic events that can occur during a person's early years and have long-lasting negative effects on their well-being. Examples of ACEs include physical, emotional, or sexual abuse, neglect, witnessing domestic violence, parental substance abuse, parental incarceration, divorce or separation, and household dysfunction such as mental illness or parental separation. These experiences can significantly impact a child's physical and mental health, as well as their overall development.
The impact of ACEs on mental and even physical health has been widely studied. A review of these studied concluded that there is a higher prevalence of ACE’s in the population with addiction to either alcohol or other drugs compared to the general populations and that there is a positive association between ACEs and the development and severity of Substance use disorder (SUD) in adolescence and adulthood.[6]
At iRecover we understand the importance of exploring someones past in order to resolve past trauma including post traumatic stress disorder (PTSD) and ACEs to ensure success in treatment.
Marital status
It is interesting to note that marriage has a strong protective effect on alcohol use disorder. It appears the protective effect is stronger in women than in men. Furthermore the decline in risk for alcohol use disorder was significantly stronger for those with a positive family history of alcohol use disorder.[7] The authors hypothesis in this article was that the psychological and social aspects of marriage, and in particular health-monitoring spousal interaction was strongly protective against the development of alcohol use disorder.
Another study found that divorce and widowhood appear to increase the risk for alcoholism, while remarriage has a protective effect.[8]
It is however common to see that marriages suffer significantly due to addiction, but with the above common sense advise it is our strong belief that during treatment concerted efforts should be made to heal broken marriage and other relationships during alcohol or drug rehab.
Age
Alcoholism is generally less common as individuals grow older. Several factors contribute to this trend. Firstly, it is possible that individuals with Alcohol Use Disorder have either received treatment or succumbed to illness and passed away.Additionally, data collection methods for studying alcohol use may exclude elderly individuals residing in nursing homes. Moreover, older adults may be more hesitant to participate in questionnaires focusing on alcohol use.
One important factor related to age is that there is a strong correlation between the age of onset of first alcohol use and later development of problem drinking or alcoholism. Generally, the earlier an individual starts using alcohol, the higher the risk of developing an alcohol use disorder later in life.[9]
Religion
It has been stated that religiosity may be one of the more important familial-environmental factors that affect the risk for substance use and dependence.[10] The authors of this study showed a clear protective effect between religion and the lifetime risk of alcohol dependance.
This cannot be overstated, although we do not force religion on anyone participating in recovery or treatment for any substance use disorder, for those who believe in God as manifested in Christ, we do strongly emphasize that one of the key tenants in addressing any addiction is the restoration of our relationship with God as manifested in prayer, meditation on God’s word and the forgiveness of sin as well as maintaining our relationship with others that share our faith based values.
During recovery it is important to focus on the Biological, Psychological, Social and Spiritual model, addressing all of these components are key in resolving substance use.
Expectations and Motivation to drink
We all have a subconscious expectation of what the effect of alcohol may be. For many the belief is that alcohol will diminish negative emotions and increase positive emotion. This can be attained from peers, parents and marketing.
Drinking usually falls under one of four categories: 1) to obtain social reward, or enhance social interaction; 2) drinking to enhance a positive mood; 3) drinking to reduce negative emotion and 4) drinking to avoid social rejection and conform to social norms.
It has been shown that of these four factors drinking to enhance positive affect (ie elation, happiness, relief from stress, boost in self assurance) and perhaps most important drinking to reduce negative emotion (Feelings of worry, unease, anxiety, feeling of sadness or hopelessness) has a higher risk for future development of alcohol.
It is thus important to examine why we drink, and to remember that alcohol or for that any matter any substance may provide temporary relief of negative emotions that in the end it will worsen the problem.
Summary
Although there is a clear and strong relation between a family history of alcoholism and subsequent risk for descendants, it does not guarantee that everyone that has a family history of substance abuse will develop addiction. The positive aspect is that there are effective strategies to prevent alcohol or substance abuse. These include having open and non-judgmental conversations with our children to educate them regarding alcohol, marijuana and other drugs of abuse, delaying the start of drinking, engaging in meaningful and lasting relationships with positive influence, understanding that we do not drink to remove pain, maintaining religion and addressing the marketing tactics used by the alcohol industry. By implementing these measures we can significantly reduce the risk of addiction.
[1] DSM-5: American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; ICD-10-CM: International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification [2] SAMHSA, Center for Behavioral Health Statistics and Quality. 2021 National Survey on Drug Use and Health. Table 5.6A—Alcohol use disorder in past year: among people aged 12 or older; by age group and demographic characteristics, numbers in thousands, 2021. Available from: https://www.samhsa.gov/data/sites/default/files/reports/rpt39441/NSDUHDetailedTabs2021/NSDUHDetailedTabs2021/NSDUHDetTabsSect5pe2021.htm#tab5.6a(link is external) [3] SAMHSA, Center for Behavioral Health Statistics and Quality. 2021 National Survey on Drug Use and Health. Table 5.6B—Alcohol use disorder in past year: among people aged 12 or older; by age group and demographic characteristics, percentages, 2021. Available from: https://www.samhsa.gov/data/sites/default/files/reports/rpt39441/NSDUHDetailedTabs2021/NSDUHDetailedTabs2021/NSDUHDetTabsSect5pe2021.htm#tab5.6b [4] Reilly MT, Noronha A, Goldman D, Koob GF. Genetic studies of alcohol dependence in the context of the addiction cycle. Neuropharmacology. 2017 Aug 1;122:3-21. doi: 10.1016/j.neuropharm.2017.01.017. Epub 2017 Jan 22. PMID: 28118990; PMCID: PMC6233301. [5] Goodwin DW, Schulsinger F, Hermansen L, Guze SB, Winokur G, 1973 Alcohol problems in adoptees raised apart from alcoholic biological parents. Arch. Gen. Psychiatry 28, 238–243. [PubMed: 4684290] Goodwin DW, Schulsinger F, Knop J, Mednick S, Guze SB, 1977 Psychopathology in adopted and nonadopted daughters of alcoholics. Arch. Gen. Psychiatry 34, 1005–1009. [PubMed: 901132] Goodwin DW, Schulsinger F, Moller N, Hermansen L, Winokur G, Guze SB, 1974 Drinking problems in adopted and nonadopted sons of alcoholics. Arch. Gen. Psychiatry 31, 164–169. [PubMed: 4851437] [6] Leza L, Siria S, López-Goñi JJ, Fernández-Montalvo J. Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review. Drug Alcohol Depend. 2021 Apr 1;221:108563 [7] Kendler KS, Lönn SL, Salvatore J, Sundquist J, Sundquist K. Effect of Marriage on Risk for Onset of Alcohol Use Disorder: A Longitudinal and Co-Relative Analysis in a Swedish National Sample. Am J Psychiatry. 2016 Sep 1;173(9):911-8. [8] Kendler KS, Lönn SL, Salvatore J, Sundquist J, Sundquist K. Divorce and the Onset of Alcohol Use Disorder: A Swedish Population-Based Longitudinal Cohort and Co-Relative Study. Am J Psychiatry. 2017 May 1;174(5):451-458. [9] Chen YC, Prescott CA, Walsh D, Patterson DG, Riley BP, Kendler KS, Kuo PH. Different phenotypic and genotypic presentations in alcohol dependence: age at onset matters. J Stud Alcohol Drugs. 2011 Sep;72(5):752-62 [10] Kendler KS, Gardner CO, Prescott CA. Religion, psychopathology, and substance use and abuse; a multimeasure, genetic-epidemiologic study. Am J Psychiatry. 1997 Mar;154(3):322-9.
iRecover US is considered by many to be the top alcohol rehab and drug rehab in South Dakota. iRecover US employs evidence based treatment programs to provide the best alcohol addiction treatment and drug addiction treatment to all residents of South Dakota and the Mid-West. We accept insurance and self-pay options are available.
Comments