Chapter Five: Etiology of Alcohol Dependence

public health model Agent: alcohol Host: individual’s genetic endowment and psychological make-up Environment: family, community, and culture

the agent: alcohol Effects inviting use depressant drug diminution of inhibition  relaxation speed of action Socially accepted and widely available

the host Multiple theories advanced Nature versus nurture Nature = genetic make-up Nurture = individual’s circumstances Dilemma: separating these factors

the host research models Twin and adoption studies Studies of nonalcoholic blood relatives Genetic marker studies

the host (cont.) findings on role of heredity Epidemiological studies: alcoholism runs in families If one twin alcoholic, more common in an identical twin than a fraternal twin Studies of step-siblings alcoholic “home” vs. alcoholic parent Animal studies: such as “drinking rats”

the host: what is inherited ? Less sensitivity to acute effects, handle alcohol “too well” Greater sense of relaxation with alcohol Neuropsychological differences Differences in metabolism Differences in brain chemistry neurotransmitters

the individual Early psychological approaches application of personality theories “alcoholic personality” not supported Current approaches basic psychological needs role of learning expectations role of temperament stressful events

the individual: temperament Traits exist on continuum Traits can predispose or be protective Personality traits related to alcohol problems Cognitive structure Harm avoidance Impulsivity Playfulness Sensation seeking

the environment Cultural orientation significant defines acceptable and unacceptable drinking level of problems in a country tied to cultural view Orientation View Rate abstinence drinking not accepted lowest ritual use clear rules for drinking  convivial use drinking within social life  utilitarian use personal discretion highest

the environment: international comparisons 2002, per capita consumption absolute alcohol Rank Country Total (liters) 1. Luxembourg 11.9 2. Hungry 11.1 3. Ireland 10.2 4. Czech Republic 10.8 5. Germany 10.4 6. France 10.3 7. Portugal 9.7 8. Spain 9.6 9. United Kingdom 9.6 10. Denmark 9.5 >25 United States 6.6

the environment: international comparisons — some caveats Total consumption based on tax revenues Per capita consumption based on population 15 and over a high proportion of children leads to under estimates Untaxed alcohol includes home-brewed beverages alcohol smuggled into a country

the environment: Alcohol use in developing countries Social change  changes in drinking patterns In traditional cultures — beverages have lower alcohol content higher rates of non-drinkers alcohol not a “commodity” but tied to ceremonies and special events alcohol production a cottage industry

the environment: Alcohol use in developing countries (cont.) Traditional drinking patterns persist after social change Traditional practices may be dysfunctional in new social context

the environment: drinking styles & problems Norms influence rates of problems Rates of problems associated with — solitary drinking over-permissive norms tolerating drunkenness tolerating negative consequences absence of ritualized use

environment: drinking styles & problems (cont) Rates of problems associated with — tolerating negative consequences drinking separate from meals absence of child socialization to drinking drinking with strangers drinking pursued as recreation drinking concentrated in young males culture stressing individualism, self- reliance, achievement

the environment: legal approaches Major determinant of rate of alcohol problems Examples of legal approaches laws to limit access hours of sales, drinking age tax structure restrictions on advertising DWI

the environment: legal approaches cross-cultural comparisons Countries vary in legal drinking age In other countries, variations tied to type of beverage location served with or apart from meals Europe: legal age ranges from 15-20 yrs.

the environment: current social issues in U.S. Health insurance coverage Host liability Role of harm reduction Drinking as recreational activity (college campus, among young adults) Limitations on advertising