1. 1 Etiology and Natural History of Alcoholism NIAAA Social Work Education Module 2 (revised 3/04)

2. 2 Outline A.Genetic and Biological Basis of Alcoholism B.Cognitive Factors C.Childhood Problems, Temperament D.Psychological Models of Etiology E.Sociocultural Models and Causality F.Clinical Heterogeneity G.Conclusions

3. 3 Genetic Basis of Alcoholism Alcohol dependence is a complex disorder Many pathways lead to the development of alcohol dependence Many genes are likely involved in the development of alcohol dependence ©2002 Microsoft Corporation.

4. 4 The evidence of a genetic basis for alcohol dependence comes from a variety of sources: Pedigree studies of large, multigenerational families Studies of adoptees Studies of identical (MZ) and fraternal (DZ) twins Genetic Basis of Alcoholism (contd)

5. 5 Source: Dawson et al., 1992 FHP2 = hx alcoholism 1 st degree relatives only. FHN= no fam hx of alcoholism FHP1= hx alcoholism 2 nd or 3 rd degree relatives only FHP3 = hx alcoholism 1 st degree relatives + either 2 nd /3 rd degree relatives

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7. 7 Alcoholism among Female Relatives of an Alcoholic

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10. Adoptee Risk of Alcoholism by Alcoholism in Biological Parents 10

11. Risk of Alcoholism by Alcoholism in Adoptive Parents 11

12. 12 Genetic Factors Genetics Predestiny Genetic factors are related to: –an increased vulnerability for alcohol dependence –an increased invulnerability for alcohol dependence ©2002 Microsoft Corporation.

13. Genotype-Environment Interaction Low genetic loading Low environ. sensitivity Moderate genetic loading High environ. sensitivity High genetic loading Low environ. sensitivity Genetic Loading Probability Alcoholic 13

14. Cumulative Probability of Alcohol Dependence by Birth Cohort 1968-741958-67 1948-57 1938 -47 1894-1937 Source: Grant, 1997 Age in Years Cumulative Probability 14

15. 15 Course of Alcoholism and Ethnicity Source: Hesselbrock M., et al, 1998

16. 16 Cognitive Factors and Risk for Alcoholism Neuropsychology –Memory –Attention span –Abstract thinking –Verbal reasoning –Visual-spatial skills Electrophysiology –EEG/ERP ©2002 Microsoft Corporation.

17. 17 Childhood Problem Behavior and Risk for Alcoholism Conduct problems Attention deficit problems Hyperactivity Oppositional behavior

18. 18 Source: Hesselbrock, V., et al., 2000 Childhood Aggression, ASPD, and Alcoholism by Gender 18

19. Alcohol-Related Violence, ASPD, and Alcoholism by Gender: COGA Family Study Source: Hesselbrock, V., et al., 2000 19

20. 20 Temperament Traits and Increased Risk for Alcoholism Novelty seeking Reward dependence Harm avoidance Difficult temperament Internalizing / externalizing

21. 21 Psychological Models of Etiology Psychoanalytic models – Oral fixation – Ego malfunction Behavioral – Substance use is learned – Maintained through conditioning response Cognitive – Cognition, feelings, direct behavior – Alcohol use perceived as positive / negative reinforcement

22. 22 Psychological Models of Etiology (contd) Social Learning – Focus on cognitive constructs – Expectancies – Self efficacy – Attributions Alcohol Expectancies – Positive expectancies of effects of alcohol – Social facilitation – Enhanced sexual performance – Increased personal power – Social assertiveness / relaxation

23. 23 Correlations & Causality Cautions Possible explanations for an association between variables A & B: A B B A A B A C B

24. 24 Sociocultural Models of Etiology Family violence Family interaction – Family disease – Family systems – Behavioral family Peer influence Social environments

25. 25 Social Policy Issues Controlling alcohol abuse through: – Availability – Legal constraints – Taxation

26. 26 Source: Schuckit et al., 1995 Clinical Heterogeneity

27. Source: Schuckit et al., 1995 Comparison of Type A and B Men on the 17 Dimension Scores 27

28. Comparison of Type A and B Women on the 17 Dimension Scores Source: Schuckit et al., 1995 28

29. Sequence of Development of Alcohol-Related Life Experiences for Men and Women Overall rho =.84; p <.0001 Source: Schuckit et al., 1995 29

30. 30 What We Know Alcohol dependence is highly heritable. There is no evidence that specific genes pre- determine alcoholism. Social, psychological, and environmental factors interact along with genetic susceptibility to influence overall risk for alcoholism. Individual variations in alcohol sensitivity and affective tolerance are likely important determinants.

31. 31 What We Know (continued) Genetic studies may help us to understand the biological bases of alcohol dependence. There may be genes which are protective. The identification of protective and susceptibility genes may lead to the development of targeted prevention and intervention strategies that work.

32. 32 Additional Information Slides Appendices:

33. Alcoholics with ASPD typically have earlier onset and a more severe form of alcoholism than alcoholics without ASPD. Male and female alcoholics with ASPD have a similar course and chronicity of alcoholism. ASPD alcoholics have approximately two times more comorbid psychopathology (anxiety, affective, other substance) than non-ASPD alcoholics. Female alcoholics with ASPD are particularly disadvantaged educationally and economically. Further, they have significant psychological and physical problems due to alcoholism similar to ASPD males. Female ASPD alcoholics display aggressive behaviors (both antisocial and alcohol-related behaviors) similar to ASPD alcoholic males. ASPD alcoholics are 2-3 times more likely to have received treatment, and at an earlier age, than non-ASPD alcoholics. Antisocial Personality Disorder (ASPD) and Alcohol Dependence 36

34. 34 Prevalence of Aggressive Behaviors Apart from Alcohol Use Among Alcohol Dependent Subjects Source: Source: Hesselbrock, V et al., 2000

35. 6,241 genes 13,600 19,000 25,500 about 50,000 Gene Count Comparison 38

36. FH ASPD, Alcohol & Drugs FH Alcohol & Drugs No ASPD FH Alcohol Only Behavioral Undercontrol Negative Affectivit y Non Alcohol Related Disinhibition Alcohol Related Disinhibition Depression Negative Affect Neuroticism Conduct Problems Onset of Drug Use P300 Boredom Susceptibility 39