Alcoholism Health Article

Definition

Alcoholism is a chronic physical, psychological, and behavioral disorder characterized by excessive use of alcoholic beverages; emotional and physical dependence on them; increased tolerance over time of the effects of alcohol; and withdrawal symptoms if the person stops drinking.

Description

Alcoholism is a complex behavioral as well as medical disorder. It often involves the criminal justice system as well as medicine and other helping professions. Its emergence in an individual's life is affected by a number of variables ranging from age, weight, sex, and ethnic background to his or her family history, peer group, occupation, religious preference, and many other categories. Moreover, persons diagnosed with alcoholism may demonstrate considerable variety in their drinking patterns, age at onset of the disorder, and the speed of its progression.

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), distinguishes between Alcohol Dependence and Alcohol Abuse largely on the basis of a compulsive element in Alcohol Dependence that is not present in Alcohol Abuse. Some psychiatrists differentiate between so-called primary alcoholism, in which the patient has no other major psychiatric diagnosis; and secondary alcoholism, in which the problem drinking is the patient's preferred way of medicating symptoms of another psychiatric disorder, such as depression, schizophrenia, post-traumatic stress disorder, or one of the dissociative disorders. Experts in other branches of medicine tend to emphasize patterns of and attitudes toward drinking in order to distinguish between nonproblematic use of alcohol and alcohol abuse or dependence. Classification is typically based on the following five categories:

• Social drinkers. Individuals who use alcohol in minimal to moderate amounts to enhance meals or other social activities. They do not drink alone.
• Situational drinkers. These people rarely or never drink except during periods of stress. They are far more likely to drink alone than social drinkers.
• Problem drinkers. These individuals drink heavily, even when they are not under overwhelming stress. Their drinking causes some problems in their lives (e.g., DUI arrests), but they are capable of responding to warnings or advice from others.
• Binge drinkers. This type of drinker uses alcohol in an out-of-control fashion at regular intervals. The binges may be planned in advance. This pattern is a growing problem on many college campuses.
• Alcoholic drinkers. These are drinkers who have no control of any kind over their intake, and find that their lives are unmanageable.

Other factors have complicated definitions of alcoholism in the United States, including: 1) the increasing tendency to combine alcohol with other drugs of abuse, sometimes called cross-addiction; and 2) the rising rates of alcohol abuse and dependence among children under 12 years of age.

Genetic profile

Alcoholism was one of the first behavioral disorders tackled by genetic research, partly because it is a widespread problem and partly because the cost to society is so high. It has been known since the 1960s that alcoholism has a genetic component. A family history of alcoholism is presently considered the strongest risk factor for developing alcoholism. The risk increases with the number of alcoholic relatives in a person's family, the genetic closeness of the relationships, and the severity of the alcohol problems in the affected relatives. As of 2000, researchers estimate that 40%-60% of a person's vulnerability to alcoholism is genetically based. About 20% of the sons and 5% of the daughters of alcoholic parents develop the disorder, compared to 5% of men and 1% of women in the general North American population.x

Alcoholism is thought to be a polygenic disorder; that is, more than one gene appears to be involved in its transmission. The Collaborative Study on the Genetics of Alcoholism (COGA) has pinpointed several areas in the brain that may contain genes for alcoholism. Begun in 1989, COGA has compiled a database from over 300 alcoholic families at six research sites (SUNY-Downstate, University of Connecticut, Indiana University, Washington University, University of Iowa, and University of California at San Diego). The completed mapping of the human genome is also expected to help researchers identify the specific genes that affect an individual's vulnerability to alcohol abuse.

Recent COGA findings suggest that a gene or genes on human chromosome 1 may influence vulnerability to affective disorders as well as to alcoholism. The researchers found that first-degree relatives of subjects diagnosed with depression as well as alcoholism had a higher prevalence of both disorders than relatives of subjects diagnosed with alcoholism alone.