1. Lenes Chery

2. What is Alcoholism? What is Alcoholism? Quick facts Quick facts Causes Causes Symptoms Symptoms Detection Detection Treatment Treatment Prevention Prevention Research Research

3. Alcoholism is the popular term for two disorders: alcohol abuse and alcohol dependence. Alcoholism is the popular term for two disorders: alcohol abuse and alcohol dependence. – a chronic disorder marked by excessive and usually compulsive drinking of alcohol leading to psychological and physical dependence or addiction (Merriam-Webster Online Dictionary, 2008).

4. Nearly 14 million Americans--1 in every 13 adults--abuse alcohol or are alcoholics (NIAAA,2008). Nearly 14 million Americans--1 in every 13 adults--abuse alcohol or are alcoholics (NIAAA,2008). 10 million adults and 3 million children 10 million adults and 3 million children More men than women are alcohol dependent. More men than women are alcohol dependent. 53 % of people in the US report that one or more of their close relatives has a drinking problem (NIAAA,2008). 53 % of people in the US report that one or more of their close relatives has a drinking problem (NIAAA,2008). – The risk is 3 to 4 times higher for someone whose family has an alcoholism history. Highest among young adults ages 18-29. Highest among young adults ages 18-29. Underage drinkers at higher risk of becoming alcoholics. Underage drinkers at higher risk of becoming alcoholics. 50-60% of variance in alcohol dependence can be attributed to genetic factors (McGue, 1990). 50-60% of variance in alcohol dependence can be attributed to genetic factors (McGue, 1990).

5. Type 1-accounts for 75% of alcoholics. Type 1-accounts for 75% of alcoholics. Symptoms: Symptoms: – The onset of alcohol-related problems occurs after the age of 25. – A low degree of spontaneous alcohol- seeking behavior and alcohol-related fighting. Psychological dependence, coupled with guilt and fear about alcoholism. – A low degree of novelty-seeking and a high degree of harm avoidance. Type 2 – Antisocial and aggressive Type 2 – Antisocial and aggressive Symptoms: Symptoms: – The onset of alcohol-related problems occur before the age of 25. – There is a high degree of spontaneous alcohol-seeking behavior and fighting. – Infrequent feelings of guilt and fear about alcohol dependence. – A low degree of harm avoidance and a high degree of thrill seeking.

6. Environment Environment – Peers, location etc. Genetics Genetics Alcoholism and Genetics Alcoholism and Genetics – Polymorphism in the genes linked to Dopamine D2, γ -amino butyric acid-A receptor, opioid receptors and serotonin transporter function can dramatically affect an individual’s risk to develop alcoholism (Edenberg & Kranzler 2005). – Alcoholism linked to only 5 chromosomal regions (on chromosomes 1, 7, and possibly 2, 4 and 5) (Preuss, Schultz, Wong, Watzke, Barnow, & Zimmermann, 2004).

7. Craving: A strong need, or compulsion, to drink. Craving: A strong need, or compulsion, to drink. Loss of control: The frequent inability to stop drinking once a person has begun. Loss of control: The frequent inability to stop drinking once a person has begun. Physical dependence: The occurrence of withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a period of heavy drinking. These symptoms are usually relieved by drinking alcohol or by taking another sedative drug. Physical dependence: The occurrence of withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a period of heavy drinking. These symptoms are usually relieved by drinking alcohol or by taking another sedative drug. Tolerance: The need for increasing amounts of alcohol in order to get "high." Tolerance: The need for increasing amounts of alcohol in order to get "high."

8. Diagnostic criteria for alcohol dependence (DSM-IV) A maladaptive pattern of drinking leading to significant impairment or distress, demonstrated by three or more of seven criteria (occurring at any time during a single year). A maladaptive pattern of drinking leading to significant impairment or distress, demonstrated by three or more of seven criteria (occurring at any time during a single year). 1. Tolerance 2. Withdrawal symptoms or use of alcohol to avoid or relieve withdrawal 3. Drinking more than intended 4. Unsuccessful attempts to cut down on use 5. Excessive time related to alcohol (obtaining, hangover) 6. Impaired social or work activities due to alcohol 7. Continued use despite physical or psychological consequences

9. There is NO cure There is NO cure Counseling Counseling – Alcoholics Anonymous (AA) Medication Mayo Clinic, (2008) Medication Mayo Clinic, (2008) – Oral: Disulfiram (Antabuse®) – causes nausea Disulfiram (Antabuse®) – causes nausea Naltrexone (Depade®, ReVia®) – reduces craving Naltrexone (Depade®, ReVia®) – reduces craving Acamprosate (Campral®) – reduces possible symptoms - anxiety Acamprosate (Campral®) – reduces possible symptoms - anxiety – Injection: Naltrexone (Vivitrol®)

10. Do not drink alcohol Do not drink alcohol Avoid underage drinking Avoid underage drinking Drink moderately as an adult Drink moderately as an adult – Especially true with a family history of alcoholism, as have a higher risk for becoming dependent on alcohol. Talk to a health care professional Talk to a health care professional

11. Twin studies - compare the risk of alcoholism in identical and fraternal pairs of twins reared in the same environment Twin studies - compare the risk of alcoholism in identical and fraternal pairs of twins reared in the same environment – Koskenvuo & colleagues (1984) found a significantly higher risk ratio for male monozygotic than for male dizygotic twins of males hospitalized for alcoholism: 11.8 versus 5.5. – Kendler et al. (1992) included female same-sex pairs. Rates of alcoholism were significantly elevated in both MZ and DZ twins of alcoholics: risk ratios of 3.9 and 2.4, respectively. Adoptions studies - compares the risk of alcoholism in biological relatives with the risk in adoptive relatives of alcoholics Adoptions studies - compares the risk of alcoholism in biological relatives with the risk in adoptive relatives of alcoholics – Goodwin and colleagues (1977) reported an estimated risk ratio of 3.6 for adopted-away sons of alcoholics and 3.4 for nonadopted sons of alcoholics, compared with an assigned risk value of 1.0 for control adoptees.

12. Animal and Molecular Animal and Molecular – Fruit fly – North Carolina State University identified a number of genes in the fruit fly that appear to be associated with alcohol sensitivity. 23 of these genes have human equivalents (BioMed Central, 2007). Linkage studies – Linkage strategies rely on the fact that genes located close to one another on the same chromosome are inherited together. Linkage studies – Linkage strategies rely on the fact that genes located close to one another on the same chromosome are inherited together. – reported alcoholism to be linked to only 5 chromosomal regions (on chromosomes 1, 7, and possibly 2, 4 & 5) (Uhl, Lui and Naiman, 2002) Human Genetics studies Human Genetics studies – The Collaborative Study on the Genetics of Alcoholism - detected association with GABRA2, CHRM2 and ADH4 replicated by other researchers. Also detected GABRG3, TAS2R16, SNCA, OPRK1 and PDYN.

13. Alcohol is a disease which impacts millions of lives. Alcohol is a disease which impacts millions of lives. Type 1 & 2 alcoholics. Type 1 & 2 alcoholics. Many identifiable symptoms and disease criteria. Many identifiable symptoms and disease criteria. No cure – medication and counseling can help. No cure – medication and counseling can help. Great deal of research with various types of studies conducted. Great deal of research with various types of studies conducted. Evidence that alcoholism is a complex disorder in which variability in many different genes may affect the individual vulnerability risk. Evidence that alcoholism is a complex disorder in which variability in many different genes may affect the individual vulnerability risk. Human genetics and data obtained from laboratory animals have confirmed the important role of genetic factors in various behavioral and neurochemical actions of alcohol. Human genetics and data obtained from laboratory animals have confirmed the important role of genetic factors in various behavioral and neurochemical actions of alcohol.

14. Alcoholism, (2008). In Merriam-Webster Online Dictionary. Retrieved July 26, 2008, from http://www.merriamwebster.com/dictionary/alcoholism Alcoholism, (2008). In Merriam-Webster Online Dictionary. Retrieved July 26, 2008, from http://www.merriamwebster.com/dictionary/alcoholism Alcoholism-Statistics, (2004). Signs of alcoholism. Retrieved July, 22 2008 from, http://www.alcoholism-statistics.com/signs.php Alcoholism-Statistics, (2004). Signs of alcoholism. Retrieved July, 22 2008 from, http://www.alcoholism-statistics.com/signs.php Bergen, A.W., Yang, X. R., Bai, Y., Beerman, M.B., Goldstein, A.M., & Goldin L.R. (2003). Genomic regions linked to alcohol consumption in the Framingham Heart Study. BMC Genetics 2003, 4, 1. Retrieved July 20, 2008 from, http://www.biomedcentral.com/1471-2156/4/S1/S101. Bergen, A.W., Yang, X. R., Bai, Y., Beerman, M.B., Goldstein, A.M., & Goldin L.R. (2003). Genomic regions linked to alcohol consumption in the Framingham Heart Study. BMC Genetics 2003, 4, 1. Retrieved July 20, 2008 from, http://www.biomedcentral.com/1471-2156/4/S1/S101. BioMed Central (2007, October 31). Bar Flies: Fruit Flies Help Unravel The Genetics Of Alcohol Sensitivity. ScienceDaily. Retrieved July 26, 2008, from http://www.sciencedaily.com/releases/2007/10/071030184518.htm BioMed Central (2007, October 31). Bar Flies: Fruit Flies Help Unravel The Genetics Of Alcohol Sensitivity. ScienceDaily. Retrieved July 26, 2008, from http://www.sciencedaily.com/releases/2007/10/071030184518.htm Edenberg, H., & Foroud, T. (2006, September). The genetics of alcoholism: identifying specific genes through family studies. Addiction Biology, 11(3/4), 386- 396. Retrieved July 27, 2008, doi:10.1111/j.1369-1600.2006.00035.x Edenberg, H., & Foroud, T. (2006, September). The genetics of alcoholism: identifying specific genes through family studies. Addiction Biology, 11(3/4), 386- 396. Retrieved July 27, 2008, doi:10.1111/j.1369-1600.2006.00035.x Edenberg,H.J., & Kranzler H.R. (2005). The contribution of genetics to Edenberg,H.J., & Kranzler H.R. (2005). The contribution of genetics to addiction therapy approaches. Pharmacol Ther, 108, p86–93. addiction therapy approaches. Pharmacol Ther, 108, p86–93. Goodwin, D.W.,Schulsinger, F., Knop, J., Mednick, S., & Guze, S.B. (1997). Alcoholism and depression in adopted-out daughters of alcoholics. Archives of General Psychiatry 34:751-755. Goodwin, D.W.,Schulsinger, F., Knop, J., Mednick, S., & Guze, S.B. (1997). Alcoholism and depression in adopted-out daughters of alcoholics. Archives of General Psychiatry 34:751-755.

15. Kendler, K.S., Heath, A.C., Neale, M.C., Kessler, R.C., & Eaves, L.J. A population- based twin study of alcoholism in women. Journal of the American Medical Association, 268, p1877-1882. Kendler, K.S., Heath, A.C., Neale, M.C., Kessler, R.C., & Eaves, L.J. A population- based twin study of alcoholism in women. Journal of the American Medical Association, 268, p1877-1882. Koskenvuo, M., Langinvainio, J., Kaprio, J.; Lonnqvist, J., & Tienari, P. (1984). Psychiatric hospitalization in twins. Acta Geneticae Medicae et Gemellologiae 33, p321-332. Koskenvuo, M., Langinvainio, J., Kaprio, J.; Lonnqvist, J., & Tienari, P. (1984). Psychiatric hospitalization in twins. Acta Geneticae Medicae et Gemellologiae 33, p321-332. McGue, M. (1990). The behavior genetics of alcoholism. Current Directions in Psychological Science, 8, p109-115. McGue, M. (1990). The behavior genetics of alcoholism. Current Directions in Psychological Science, 8, p109-115. NIAAA, (2008). Brochure from National Institute on alcohol abuse and alcoholism. Retrieved July 25, 2008 from http://www.niaaa.nih.gov/publications/booklet.htm NIAAA, (2008). Brochure from National Institute on alcohol abuse and alcoholism. Retrieved July 25, 2008 from http://www.niaaa.nih.gov/publications/booklet.htm Perkinson, R. (2008). Alcoholism. Retrieved July 24, 2008, from http://www.robertperkinson.com/ Perkinson, R. (2008). Alcoholism. Retrieved July 24, 2008, from http://www.robertperkinson.com/ Preuss, U., Schultz, G., Wong, W., Watzke, A., Barnow, S., & Zimmermann, J. (2004, October). Current Perspectives in Genetics and Genomics of Alcohol Dependence. Current Genomics, 5(7), 601-612. Retrieved July 27, 2008, from Academic Search Premier database. Preuss, U., Schultz, G., Wong, W., Watzke, A., Barnow, S., & Zimmermann, J. (2004, October). Current Perspectives in Genetics and Genomics of Alcohol Dependence. Current Genomics, 5(7), 601-612. Retrieved July 27, 2008, from Academic Search Premier database. Uhl, G.R., Liu, Q.R., & Naiman D. (2002). Substance abuse vulnerability loci: converging genome scanning data. Trends Genet, 18, p.420-425. Uhl, G.R., Liu, Q.R., & Naiman D. (2002). Substance abuse vulnerability loci: converging genome scanning data. Trends Genet, 18, p.420-425.