1. Chapter Five: Etiology of Alcohol Dependence

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

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

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

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

6. 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”

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. 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

17. 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

18. 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 yrs.

19. 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