Alcoholism (Thompson, 2020) – Is alcoholism genetic?

photograph of three glasses of wine alcohol

Nebula Genomics DNA Report for Alcoholism

Is alcoholism genetic? We created a DNA report based on a study that attempted to answer this question. Below you can see a SAMPLE DNA report. To get your personalized DNA report, purchase our Whole Genome Sequencing!

A sample report on alcoholism from Nebula Genomics
A sample report on alcoholism genetic variants from Nebula Genomics

To learn more about how Nebula Genomics reports genetic variants in the table above, check out the Nebula Research Library Tutorial.

Additional Information

What is Alcoholism? (Part 1 of Is alcoholism genetic?)

Typical symptoms of alcohol addiction include the progressive loss of control over drinking behavior up to compulsive consumption, neglect of former interests in favor of drinking, denial of addictive behavior, withdrawal symptoms with reduced consumption, tolerance, as well as changes in personality.

The number of people suffering from the disorder and the resulting social and economic consequential damage are many times higher in absolute figures in Europe and the USA than for other drugs. 

Pictorial representation of the feeling of alcoholism
Alcoholism can feel like a prison to those who suffer from it. Wikipedia CCAttribution-Share Alike 4.0 International

In 1849, the Swedish physician Magnus Huss was the first to define alcoholism as a disease. He distinguished between “acute alcoholic disease or intoxication” and “alcoholismus chronicus.” However, this recognition did not prevail for a long time. Elvin Morton Jellinek, who worked for the World Health Organization (WHO), gained worldwide acceptance in 1951 with his view, inspired by his work with Alcoholics Anonymous, that alcoholism was a disease.

Is alcoholism genetic?

A 2008 study conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reviewed much of the research on genetics of this disorder. The study concluded that genetic factors account for 40-60 percent of the variance among people who struggle with the disorder. Since then, scientists have identified some specific genes that contribute to a genetic predisposition to alcoholism. 

Some genes correlate with the development of reward. That is, a predisposition to metabolize drinks in such a way that the pleasurable effects are more prominent than negative effects such as nausea and headaches increases the risk of developing the disorder. 

One such gene is  a gene responsible for the movement of gamma-aminobutyric acid (GABA) in synapses between neurons appears to be a strong gene associated with a higher risk of disorder development. 

Another genetic factor may be an association of a variant of the DRD2 gene which affects the neurotransmitter dopamine. Dopamine is released in greater quantities when alcohol is consumed and lifts the mood, activating the brain’s reward system.

A neurotransmitter
Alcoholism is thought to be influenced by genetic variants in neurotransmitters. Wikipedia. CCAttribution-Share Alike 4.0 International

The disorder can also be genetically influenced due to genetic differences in tolerance or liver degradation capacity. These include, for example, the enzyme alcohol dehydrogenase. In some people, a variant with reduced activity is present, resulting in more severe symptoms of intoxication. This makes dependence less likely. On the other hand, people who can tolerate comparatively large amounts are at particular risk of becoming dependent in the long term.

Alteration of the MAOA gene appears to be associated with alcoholism, substance abuse, and antisocial behavior.

Epidemiology (Part 3 of Is alcoholism genetic?)

According to the World Health Organization, worldwide drinking patterns vary across countries. In 2017, binge drinking prevalence was reported to be highest in Europe overall with Eastern European countries, as well as France and England, reporting some of the highest rates of binge drinking. 

In the United States, the prevalence of alcohol use in 12 months in 2012 rose from approximately 65% to just over 72%. This increase was most highly observed in women, rural citizens, those with lower socioeconomic status, and minorities. From 2001 – 2012, the disorder increased by 50 percent, and this increase was more pronounced in women, rising 80% over the time frame. In 2020, one estimate suggests that as many as 18 million adults in the country struggle with the disorder.

Worldwide, the ratio of men to women who drink alcohol is 3.8, with 54% of men and 32% of women reporting being drinkers. Although women are starting to experience an increase. 

As reported in the World Mental Health Surveys in 2020, 15% of all lifetime cases develop alcoholism before age 18. Higher household income and being older at time of interview, married, and more educated, were associated with a lower risk for lifetime alcoholism.

Symptoms (Part 4 of Is alcoholism genetic?)

The course of the disorder varies among individuals.

According to WebMD, it is a chronic, relapsing brain disease that includes:

  • Compulsive drinking
  • Loss of control when drinking
  • A noticeable bad mood when not drinking

The disorder can begin with regular alcohol consumption of small amounts and people may be oblivious to frequent intoxication. It is not always noticeable by others. If the affected person is still able to function, they are referred to as a functioning alcoholic. The disease often progresses relatively inconspicuously and slowly, usually over several years. Sufferers can be unaware of the severity of their illness and may deny it altogether.

Additionally, it isn’t just about how much you drink. It’s also about:

  • How often you drink
  • What the effects are
  • What happens when you try to cut back
Two people sitting with alcoholic drinks between them
In addition to quantity, alcoholism also involves how often one drinks and what kind of effects it has. Pixabay

At first, the earliest stages may include:

  • Drinking more than planned
  • Continuing to drink despite concerns from others
  • Frequent attempts to cut down on or quit drinking

As the disease progresses, an individual will usually need to consume larger quantities to get the desired effect. If alcohol is not available, the individual may go through withdrawal syndrome. 

In the next stage, blackouts and loss of control may occur. Personality changes and additional physical effects begin to show.

This progression, continuing until the individual hits the bottom with excessive drinking and then moves back up to rehabilitation, is called the Jellinek curve.

E. Morton Jellinek, a pioneer in the study of alcohol abuse and dependence, suggested the “progressive phases of alcoholism” which came to be known as the Jellinek curve in 1950, which is still widely used today with modifications.

Alcohol withdrawal syndrome (Part 3.1 of Is alcoholism genetic?)

Withdrawal syndrome can occur when consumption is reduced or one stops drinking suddenly. Severe to life-threatening withdrawal symptoms may occur. Withdrawal symptoms include nausea, nervousness, sleep disturbances, the strong urge to drink (“binge drinking”), irritability and depression. If the physical alcohol dependence is already advanced, for example, heavy sweating, trembling (especially of the hands), flu-like symptoms and – in extremely bad cases – seizures with tongue biting and hallucinations are added.

Personality changes

The change in character varies among individuals. In addition to memory loss, concentration, drive and attention, a frequent occurrence of jealousy mania is noticeable. Affected are mainly the reaction patterns to everyday stresses and conflicts, as a result of which the overall personality appears unharmonious-differentiated. Depression can also occur. 

As a consequence of long-term alcoholism, psychotic disorders can occur. In addition, interests are strongly narrowed to addiction, while previous activities as well as personal hygiene and care are neglected. Very problematic is the often increased aggressiveness and propensity to violence. The change in character also includes a tendency to deny or trivialize the problem.

Physical effects

People struggling with this disorder average 20-year shorter life expectancy. Long-term abuse often causes (sometimes chronic) secondary diseases:

  • Malignant tumors
  • Liver disease
  • Pancreas
  • Damaged muscles
  • Alcoholic myopathy
  • Metabolic disorders
  • Cardiovascular disorders
  • Gastrointestinal issues
  • Nervous system and neurological disorders

Causes (Part 5 of Is alcoholism genetic?)

Research currently suggests that the risk of the disorder in close relatives of alcoholics tends to be higher than in relatives who don’t drink. However, the genetic component tends to explain only about half of the risk. The other half is influenced by environmental factors and interpersonal factors (e.g., cultural attitudes, availability, expectations about the effects of drinking on mood and behavior, personal experiences, and stress). 

In a twin study, researchers found that twins who were adopted by families with problems with alcohol were slightly more likely to abuse it themselves, However, the chance of the disorder was much higher if the twins’ biological father suffered from it, whether alcohol was present in the adoptive families or not. Generally, children of alcoholics are more likely to abuse it themselves.

Other Factors

Children of addicted parents are more likely to become addicted than other children. Physical, psychological and sexual violence combined with addiction in the family of origin are significant risk factors. Physically, adolescents with a family history of alcoholism have been shown in some studies to have a smaller amygdala (emotional center in the brain), that may affect cravings. 

Starting to drink at an early age and mental illnesses such as depression, anxiety, bipolar disorder, ADHD, and schizophrenia, also put an individual at a higher risk of developing the disorder. 

Diagnosis (Part 6 of Is alcoholism genetic?)

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides eleven criteria, of which at least two must be present over a twelve-month period for a diagnosis. Most clinicians use the term “alcohol use disorder” to help emphasize the disease value of the disorder and reduce inhibitions to seek medical help. 

  1. Drinking occurs in greater quantities or for longer than intended
  2. Persistent desire or unsuccessful attempts to reduce or control consumption
  3. High time expenditure to obtain or consume alcohol or to recover from alcohol effects
  4. Craving or a strong desire to consume alcohol
  5. Repeated use that results in failure to fulfill important responsibilities at work, school, or home
  6. Continued use despite ongoing or repeated social or interpersonal problems caused or exacerbated by the effects of drinking
  7. Important social, occupational, or recreational activities are abandoned or curtailed
  8. Repeated consumption in situations where consumption results in physical danger
  9. Continued use despite knowledge of a persistent or recurring physical or psychological problem that is likely caused or exacerbated by drinking
  10. Development of tolerance, defined by any of the following:
    1. Desire for marked increases in dose to bring about a state of intoxication or a desired effect
    2. Markedly diminished effect with continued consumption of the same amount of alcohol
  11. Withdrawal symptoms manifested by any of the following:
    1. Characteristic withdrawal syndrome
    2. Drinking (or a very similar substance, such as benzodiazepines) is used to relieve or avoid withdrawal symptoms

The disorder can be divided into three severity levels (mild, moderate, severe):

  • Mild: 2-3 symptom criteria are met
  • Medium: 4-5 symptom criteria are met
  • Severe: 6 or more symptom criteria are met

Most individuals or family members eventually notice the common signs of the disorder without physician intervention. Self tests from support and counseling centers may be useful at this point.

Treatment (Part 7 of Is alcoholism genetic?)

Speaking with a medical physician is a good first step to treat alcoholism. A physician may be able to tell you if you need assistance, work with you to put together an addiction treatment plan, possibly including medication, and/or refer you to a support group or counseling.

If the disorder is serious, attempts to stop heavy drinking very suddenly may lead to serious complications, including withdrawal syndrome and seizures. Some individuals may need to reduce the drug in a hospital or rehabilitation setting to medically manage acute withdrawal. After detox, an individual may choose to attend either residential treatment facilities or outpatient treatment programs.

Both types of treatment programs tend to prioritize the following approaches:

  • Behavioral therapy, including cognitive-behavioral therapy (CBT) and motivational enhancement
  • Family therapy
  • Treatment for dual diagnosis (i.e. depression)
  • 12-step or other mutual support group meetings

Sometimes, medication may be recommended as a treatment for alcoholism to reduce cravings and reduce the chances of relapsing for long term treatment.

  • Campral (acamprosate) acts on the GABA and glutamate neurotransmitter systems. It helps to control the insomnia, anxiety, and restlessness that often accompany withdrawal.
  • Disulfiram (Antabuse) deters drinking in patients highly motivated to quit. If a person takes disulfiram and then drinks, the result is flushing, nausea, and heart palpitations.
  • Naltrexone acts on the opioid receptors in the brain to block the reward of drinking and potentially reduce cravings. 
  • Topiramate is sometimes used off-label to help decrease continued drinking behavior in recovering individuals.

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