INTRODUCTION: Alcoholism can affect anyone. It has enormous costs as it pertains to societies, families, and individuals. It is not prejudicial towards any race, color, sex, religion, or economic level. Although we do have ideas as to what alcoholism is, what we do not know is the exact cause(s) of this problem. Researchers are continually seeking answers to the long-standing nature versus nurture debate. Different views are split between a biological paradigm and a physchological paradigm. No one explanation seems to be better than another is. I will present views of the effects alcoholism has on society and an insight to the factors that serve to fuel the nature or nurture debate concerning alcohol abuse and alcoholism.
STATISTICS: The abuse of alcohol alone is estimated at $144.1 billion dollars annually. Every man, woman and child in America pays nearly $1,000 a year to cover the costs of unnecessary health care, auto accidents, crime and lost of productivity resulting from alcohol abuse. Alcohol deaths account for approximately five percent of all deaths occurring in the United States. Alcohol is considered to be one of the most widely used drugs as it attacks the central nervous system. Two-thirds of all adults drink alcohol; one-third of those are under the age of eighteen.
The term alcoholic is commonly used to refer to a person who is severely dependent on alcohol as a result of their drinking pattern. Not everyone with an alcohol problem becomes an alcoholic. If this is true then what differentiates the social drinker from the alcoholic? A novice explanation would be that social drinkers do not experience problems when they drink, however alcoholics develop a physical dependence on alcohol and lack control over how much they drink and what happens when they drink, resulting in social problems. Can it be this simple? Why doesn’t a person just stop drinking when they notice that their lives are in a downward spiral? It has taken society and the medical community a long time to consider alcoholism as a disease. This may be in part because alcohol is used primarily for recreational or social purposes and is not viewed as something that cannot be controlled.
CULTURAL: Styles of drinking and attitudes toward alcohol vary across cultures. In cultural groups such as the Chinese, Greeks and Italians, drinking are maintained by social customs. Children are introduced to alcohol at an early age, but are not associated with masculinity or social power. The abuse of alcohol is looked upon with strong disapproval. Conversely the American experience is just the opposite. In colonial America habitual drunkenness was not considered to be an uncontrollable disease. In those days drinking was a social activity that took place in a close-knit family environment. But during the early 1800s drinking moved into the male dominated saloons and alcohol became a symbol of masculine independence and violence. At this point, the rates of alcoholism began to increase dramatically. This was the first sign of what was to become 19th century America’s view that habitual drinkers were unable to control their drinking. These early warnings would eventually lead to alcoholism being recognized as a disease.
ABUSE OR ADDICTION? Several studies have confirmed that some chronic drinkers can still maintain control even when intoxicated. It is believed this is because when directed towards a goal such as job, family, etc. even the chronic drinker was able to regulate the amount of alcohol they drank. The problem with these studies is that while these chronic drinkers may be able to control their drinking, they are unable to guarantee when they can do so. They soon lose the ability to distinguish social drinking from drinking as a social crutch. As a result these chronic drinkers eventually break promises and commitments to their families and employers.
In order for alcohol to become a contributor to alcohol addiction, a person must first use the ‘drug’ and continue to use the drug. What constitutes use from abuse with alcohol cannot clearly be distinguished. This is because alcohol taken in various amounts affects individuals differently. Some people may be considered an alcohol abuser early in their drinking experiences because of the adverse consequences they go through. From the early days that alcoholism was discovered to be a problem there has been a long-standing debate as to how one becomes an alcoholic? There are two sides of the story?that being that people inherit the trait and the other that it is learned. I will discuss the social aspect of the disease and then move to the genetic factors that may attribute to the problem.
SOCIAL: Abraham Maslow describes a security need that is believed to exist in every person. We desire to be part of a group or community. We have a need to be loved, a part of a family, and the need for friends. We actually base our careers on this need as we tend to move places and take jobs based on friends, family, wives, children, social groups, and so on. That being said, people may participate in subgroups that encourage the use of alcohol. This cultural environment encourages, reinforces, maintains and increases the use of alcohol. Examples of this can be seem amongst teenagers who feel that it may be the ‘in thing’ to drink alcohol in order to be accepted. Alcohol use can also occur where no subgroup support exists. The orientation towards alcohol may have been acquired earlier on in life when the individual took part in subgroups that used alcohol. Some individuals continue their alcohol use long after ending their association with certain subgroups. This was the case for many that grew up in the 60s and 70s where experimenting with drugs and alcohol was the social norm. Some individuals drink alcohol by themselves. Interestingly these people associate themselves with groups who are opposed to excessive drinking. Professionals such as judges, nurses, doctors and lawyers have been documented as being ‘loners’ in their drinking patterns.
Studies have shown that alcohol and drug use can be a result of oppressed social conditions, that being a lack of money, decent schools and sub-standard housing in communities that lack social services. The lack of education directly relates to the attitude that many alcoholics possess the reality that they may be able to only find meaningless work. People who live in these conditions cannot see anything good happening in their environment, thus they drink. Oppressive social conditions and limited economic opportunities are a fact of life for the high concentrations of inner city minorities. I would also like to add that poverty within rural communities, while lacking much of the violence and crime of urban areas, is no less oppressive than the inner city. To define the problem of alcohol to the urban poor would indeed be unfair.
A person doesn’t have to be a member of a racial or ethnic minority to use alcohol. But race and ethnicity does figure into the equation of causes of increased alcohol use. Race isn’t used in the genetic or biological sense but it has shaped the opportunity structure for many minorities. Based on my experiences, minorities do not feel that they fit into a ‘white man’s’ society and it is rare to find many white people in the poor inner-city communities, except the likes of policeman, teachers and social workers. In the case of the American Indian they have had a long history of alcoholism even to this day. For them it began during the 1600s when they traded alcohol with the European settlers. During this period the ‘Indians’ had never drank alcohol before, thus they had no examples of how to drink alcohol in moderation. They quickly adopted a behavior of consistently drinking to the point of intoxication. For whatever reason, the Indian youth place a great emphasis on the peer pressure to drink. Studies have shown that Indian youths are three times more likely to get into an alcohol related incident than their white counterparts. A 1982 study indicated that alcohol was involved in as many as 58 percent of Indian juvenile arrests. The age group with the highest rate of use was 11 to 13 years olds. Coincidentally the usage of alcohol at a young age is one of the most contributing predicting factors of later problems with alcohol abuse.
PSYCHOLOGICAL: Alcohol use may contribute to further use and abuse through psychological means as well. An initial successful experience of use may reduce an individual’s fear about using alcohol. This in turn leads the way to continued use that can lead to the increasing of tolerance and dependence. People who were once social drinkers have transitioned to abusive drinking because the effects of alcohol on them are better than the experiences of other activities going on in their life. An example of this is one who experiences the painful reality of a death in their family may find the experience too difficult to deal with, and the feeling produced by alcohol assists in the coping process. Some drinkers report that alcohol helps them reduce anxiety allowing them to face things that they may fear such as meeting people to flying in an airplane. Stressful life events such as divorce and job loss have led to increased use of alcohol. The stress is relieved through increased drinking. But experimental studies fail to show that increased tension leads to increased drinking. If people drink alcohol to reduce stress and tension then one would expect that drinking alcohol would increase during tension/stress arousing situations.
Yet another study suggests that people do not drink alcohol to reduce tensions. They drink once the tense situation is over or has stopped and relief has set in. It is the removal of stress that leads to drinking not the actual stressful situation.
PHYSCHOSOCIAL: When people drink to the point of intoxication they exhibit feelings of superiority and fearless behavior. Experiments have shown those males exhibit higher levels of aggression than do females. The aggressive behavior starts in the adolescent stages of life and may continue into adulthood. Where does the aggressiveness originate? Part of the explanation is that children who are sociable and spontaneous exhibit more aggressive behavior than those who do not. Surprisingly, common traits amongst these children are being first born, having a stable family life and a shy temperament. More current, up to date explanation state that aggression is learned response to frustration and by observing others who exhibit the same aggressive behavior.
Males also are at greater risk for developing criminal behavior. Criminal behavior has been linked to alcohol abuse. Studies have concluded that alcohol abuse precedes criminal behavior. Criminal behavior for most youths appears to peak between the ages of 15 to 17, about the same time that their usage of alcohol is on the rise. However only a small percentage (2 to 6) of these people engage in criminal activity into adulthood.
Clinicians have addressed the possibility that physical and sexual abuse may be associated with incidents of later alcohol abuse. Sixty to eighty percent of individuals in substance abuse treatment programs reported having been sexually abused. Abused women were about 10 times more likely than non-abused women were to report a history of drug abuse and more than twice as likely to report a history of alcoholism. Uncovering the memories of early childhood experiences is thought to be a contributing factor in alcohol use. The question should not be whether physical and sexual abuse causes the later use of alcohol. Many factors contribute, especially in the home, school, and peer settings of children as they grow up. However, the consistent finding of higher levels of physical and sexual abuse among alcohol abusers should warrant further research.
PHYSIOLOGICAL: Underlying all alcohol abuse and addiction are the actions that alcohol abuse exerts. A question that is important in understanding alcohol abuse is how alcohol affects the brain, and why alcohol has a potential for being abused. The two biological factors that contribute to alcohol abuse are the effects that alcohol abuse has on a person and the biological status of the individual using alcohol. The first relates to the action of alcohol has on the brain and the latter relates to the inherited characteristics that affect a person’s response to alcohol.
In order for alcohol to affect a person it first must reach the brain. This is accomplished by alcohol entering the circulatory system, then on to the brain. The amount of alcohol that enters the bloodstream affects how quickly the alcohol will penetrate to the brain. Alcohol is taken in orally; therefore the stomach, which results in a delay before the affects become apparent, absorbs it. This is exhibited if you have ever seen someone ingest alcohol while sitting down he or she seems to be okay. Yet when they stand up, they all of a sudden become dizzy and experience high levels of intoxication. Alcohol produces feelings of pleasure to the brain. There is increasing evidence that the ‘pleasure feelings’ are linked to the brain’s reward system. In the absence of any goal-seeking behavior, stimulation to the brain’s reward system produces extreme pleasure, which is reinforced more as alcohol consumption increases. Such strong reinforcement may explain why people will forego food, instead of alcoholic drinks if presented the choice. Increasing activity in the brain reward system is related to increased reinforcement, which supports the continued use and abuse of alcohol.
Tolerance of alcohol develops differently in people but one thing remains consistent. That being increased activity in the nervous system or shaking occurs on cessation after prolonged use. Tolerance is developed when following a prolonged period of use, more alcohol is required to produce a wanted or given effect. The development of tolerance can contribute to the progression from use to abuse and addiction. As alcohol dependency develops, a person must continue to drink more alcohol to avoid the unpleasant experience of withdrawal. Sensitization, the opposite of tolerance, plays a significant role in supporting alcoholism. With prolonged use of alcohol, cells in the brain adapt to its presence such that the alcohol is required to maintain normal cell function. On withdrawal of alcohol, the cell behaves abnormally and a withdrawal syndrome ensues. Generally, the withdrawal syndrome is characterized by a series of signs and symptoms, such as tremors. No matter the severity of the physical withdrawal syndrome, its existence can create a craving or desire for alcohol and dependence can play a very strong role in recurrent patterns of relapse and maintaining alcohol-seeking behavior. With repeated cycles of abstinence and re-use of alcohol, the time required to elicit alcohol dependence grows shorter. The quantity of alcohol rather than the frequency of use have been studied to be a powerful predictor of problematic use. The two are not the same. A person who occasionally drinks but when they do does so in large quantities, can be greatly harming himself or herself. Conversely a person who drinks in moderation every day may not experience any problems in the short term, but may encounter health problems later on. The type of alcohol used also has an effect on later alcohol problems. By this I mean drinking beer or wine instead of ‘hard’ liquor such as rum and whiskey.
BIOLOGICAL: Alcoholism is considered to derive from genetic causes. Family studies have repeatedly confirmed that the risk of alcoholism is higher among parents, siblings and children. While genetics may play an important role, there are other factors that can influence individual biological susceptibility to the effects of alcoholism. Because alcohol abuse is linked to behavioral and environmental factors leads to the point that genetics act together along with other non-genetic factors. Some diseases are caused by the alteration of a single gene such as cystic fibrosis, but alcoholism is not on of these. Alcohol abuse is very likely to involve multiple genes that control various aspects of the biological response to alcohol.
Research studies have not been able to explain what precisely is inherited that causes people to become problem drinkers although it may be possible to do so. First, one way would be to identify a ‘risk marker’ or biological trait associated with alcoholism, but to date no ‘risk markers’ have been clearly identified. Second, the genetic technique of linkage analysis can narrow the area on a chromosome where a gene may be located. It can lead to the identification of the gene, which in turn can improve the understanding of the molecular events that underlie the expression of the gene. There have been few genetic linkage studies related to alcohol abuse. Third, an association between alcoholism and a gene that regulates the number of a type of dopamine receptors in the brain has been studied. One study revealed a relationship between the presence of the gene not only in alcoholics, but also in other disorders such as autism and Tourette’s syndrome. The presence of this particular gene, while not uniquely specific for alcoholism, may cause an alteration in the brain’s dopamine system that somehow contributes to alcohol abuse.
Studies in this biological field began using selective breeding amongst animals. The results do show that alcohol tolerance, the actions of alcohol, alcohol preference and alcohol physical dependence can be affected by genetics. One study found a high rate of alcohol abuse between identical twins over fraternal twins. Interestingly studies found that identical male twins are more frequent in cases of alcohol abuse and dependence than that of fraternal male twins. The same results were found in identical female twins as well.
Adoption studies have also supported the role of inheritable factors concerning alcoholism. Researchers studied male and females that were adopted, comparing them with non-adopted siblings. Both males and females of alcoholic and non-alcoholic parents were also studied. The children of alcoholic parents is four times as likely to become alcoholic than one with non-alcoholic parents, even if the children were adopted and raised in non-alcoholic families. Furthermore being raised by a biological alcoholic parent did not increase the likelihood of developing alcoholism. This is substantiated by several cases that I personally know of where the person experienced problems with alcohol despite being raised by parents who never drank and provided love and support towards the person.
Another source of biological existence suggests that high risks candidates for alcoholism have instability in their nervous system that can be calmed by drinking alcohol. Studies proved that sons of alcoholic fathers are less able to hold their body still when asked to stand at attention, compared to sons of non-alcoholic fathers. People who come from non-alcoholic parents tend to sway more than those from alcoholic parents do. Medical studies suggest that patients who have an inherited disorder, ‘familial essential tremor’, in which their hands shake, are more likely to abuse alcohol. When they drink alcohol their tremors vanish.
SUMMARY: Alcohol abuses and alcoholism is as much as a problem today as it has ever been in the past. Alcoholism effects each individual differently. Therefore, everyone who abuses alcohol doesn’t become an alcoholic, but it is still important to understand the factors that are involved. Factors derive from biological, psychological, physiological, social and cultural fields of exploration. Alcoholism is a leach that sucks the life from an individual, families, and society. It turns people’s lives into a world of depression and loneliness.