The Disease Concept and Brain Chemistry of Alcoholism and Drug Addiction

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People talk to each other by using words to convey a message. Some messages we send may request an action be performed from the person we are communicating to. Our brains communicate from one cell to the other via chemicals, and these are called neurotransmitters. When one cell communicates to another these chemicals may also require an action be taken or sensation produced, (like breathing, muscle contraction, body temperature regulation, and also feelings).

There are 5 main neurotransmitters affected by the disease of alcoholism and drug addiction. Two of these chemicals, dopamine and serotonin, have a profound affect upon the alcoholic and/or drug addict. These two neurotransmitters affect the addicted person by changing how they respond under stress, what moods are experienced, and also communicate feelings of pleasure and/or pain.

Dopamine, when depleted by alcohol and/or drug use, can leave a person with a high tolerance to pain and reduced level of pleasure one feels when doing an activity.

Serotonin depletion can lead to sensory deprivation, body temperature anomalies, and also depression.

These two chemicals, needed by the brain to convey feelings of health and wellness, can when affected by alcohol and drugs, lead to an inability to function in society.

In the above diagram you can see how the mechanism of brain chemistry functions. The cell on the left is communicating to the cell on the right via neurotransmitters like dopamine and serotonin. When there is a lack of serotonin in the synapse we experience this by having depression. In alcoholics and addicts this brain chemical depletion is common place.

The brain chemistry imbalance in alcoholics and addicts is one of permanent damage.

It’s like taking a cucumber and changing it into a pickle- you can’t go back once the change occurs. There is hope and help for this condition, and we will address this later.

Ask yourself this question, "Can you say how many serotonin molecules are in the synapse right now?" You can’t. If you have too few you could say that you have depression, and this is manifested by feeling sad. This is also evident by the fact that you may be isolative, have poor hygiene, and are apathetic.

If asked the same question again, but added the four other chemicals in imbalance you still would be unable to answer the question; however, if you had no symptoms you would think all is alright within you. Here is the catch, the alcoholic and addict have all this brain chemistry imbalance going on, and keeping in mind they can’t tell they have serious neurotransmitter depletion, they think all’s well. This is why the disease of alcoholism / drug addiction is a disease that tells you, you don’t have it.

For years the alcoholic and addict has been playing neurochemistry without a license, and damage has occurred. Sometimes the damage is severe, and sometimes it is minor. Some of the damage is irreversible, but even this can be dealt with effectively. The damage that is permanent is usually in the areas of thinking and acting. It is true that, once an alcoholic / addict, always an alcoholic / addict. This is said because of the altered brain chemistry. The good news is that this can be worked out through action taking steps.

Stress in sobriety produces the same brain chemistry reaction as when a person is drinking and/or taking addictive drugs; hence, the correlation between unresolved stress in recovery and relapse- it is the brain chemistry that can fuel a relapse.

So what is the answer to the brain chemistry imbalance problem? Are alcoholics and addicts doomed to a life of relapses? How can others help? Do I need to walk on eggshells around them? And what does the alcoholic and/or addict need to do to improve their chances at staying sober?

We will now discuss the road map to success.

The chemical imbalances can be addressed by seeing a medical professional. Sometimes a person may need to take an anti-depressant to correct the imbalance and start to get un-depressed. An important factor to consider is old drug seeking thoughts and behaviors. If a person states they have anxiety, it may not be in their best interest to seek medication for this condition. Many in early recovery experience what is known as PAWS, (Post Acute Withdrawal Symptoms). PAWS can be felt by a recovering person in many ways. These are described as mental confusion, lethargy, difficulty concentrating, memory loss, physical aches, unsteady gait, and anxiety to name a few. Anti-depressants are non-addicting, non-narcotic, and correct the brain chemistry imbalance.

Anti-anxiety medications are typically mood altering, addictive, and do not address or correct the problem. These types of medications only mask the real problem- that of not having the coping mechanisms to deal with life on life’s terms. If a person stays sober and works a good program of recovery, the signs and symptoms of PAWS will disappear without having to take narcotics, sedatives, and other mood altering chemicals.

Which brings us to the solution part of the problem. Utilizing resources, like 12-Step attendance, is an excellent way of attacking and finding a solution to the problem.

The first thing alcoholics and addicts must do is get out of the victim role. Once in recovery, the alcoholic and addict can’t blame their behavior on having a disease. Recovery from alcoholism and drug addiction is the sole responsibility of the person suffering with the disease. They must do what is necessary to stay sober. The family, friends, employers, etc. of the alcoholic and addict must never feel they need walk on eggshells. Being open, honest, and understanding, without enabling, is what is needed most from all who are in support of the individual who is in recovery.

 If we have a leaking water pipe we fix it. If we have the flu we need time to heal- we can’t fix the flu. Stopping alcohol and drugs is the fix; however, the healing process takes a long time- there is no fix, just a recovery period which takes a lifetime of healing .

I have included a list of the minimums to working a healthy recovery program that, if followed, will keep a person sober.

1. Meetings (90 meetings in 90 days at the start and then regular attendance- at least three per week after that)

2. Sponsor (called every day)

3. Home Group

4. Working the Steps (with their sponsor)

5. Reading recovery literature

 

Additional suggestions:

1. Prayer and Meditation

2. Service Work

3. Working with others

 

Final Thoughts

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Methamphetamine- Extensive Brain Damage

Abstract Article on Meth use

For additional information on serotonin click any where on this text

The brain and depression

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Additional:

The Brain: Understanding Neurobiology

Addiction is a Brain Disease

By   ALAN I. LESHNER, MD

A core concept evolving with scientific advances over the past decade is that drug addiction is a brain disease that develops over time as a result of the initially voluntary behavior of using drugs.  (Drugs include alcohol.)

The consequence is virtually uncontrollable compulsive drug craving, seeking, and use that interferes with, if not destroys, an individual’s functioning in the family and in society.  This medical condition demands formal treatment.

• We now know in great detail the brain mechanisms through which drugs acutely modify mood, memory, perception, and emotional states.
• Using drugs repeatedly over time changes brain structure and function in fundamental and long-lasting ways that can persist long after the individual stops using them.
• Addiction comes about through an array of neuro-adaptive changes and the lying down and strengthening of new memory connections in various circuits in the brain.

The High jacked Brain
We do not yet know all the relevant mechanisms, but the evidence suggests that those long-lasting brain changes are responsible for the distortions of cognitive and emotional
functioning that characterize addicts, particularly including the compulsion to use drugs that is the essence of addiction.

It is as if drugs have high jacked the brain’s natural motivational control circuits, resulting in drug use becoming the sole, or at least the top, motivational priority for the individual.

Thus, the majority of the biomedical community now considers addiction, in its essence, to be a brain disease:

This brain-based view of addiction has generated substantial controversy, particularly among people who seem able to think only in polarized ways.

Modern science has taught that it is much too simplistic to set biology in opposition to behavior or to pit willpower against brain chemistry.

Many people also erroneously still believe that drug addiction is simply a failure of will or of strength of character.  Research contradicts that position.

Responsible For Our Recovery
However, the recognition that addiction is a brain disease does not mean that the addict is simply a hapless victim.  Addiction begins with the voluntary behavior of using drugs, and addicts must participate in and take some significant responsibility for their recovery.

But it does explain why an addict cannot simply stop using drugs by sheer force of will alone.

The Essence of Addiction
The entire concept of addiction has suffered greatly from imprecision and misconception.  In fact, if it were possible, it would be best to start all over with some new, more neutral term.

The confusion comes about in part because of a now archaic distinction between whether specific drugs are “physically” or “psychologically”addicting.

The distinction historically revolved around whether or not dramatic physical withdrawal symptoms occur when an individual stops taking a drug; what we in the field now call “physical dependence.”

From both clinical and policy perspectives, it actually does not matter very much what physical withdrawal symptoms occur.

What really matters most is whether or not a drug causes what we now know to be the essence of addiction, namely

This is the crux of how the Institute of Medicine, the American Psychiatric Association, and the American Medical Association define addiction and how we all should use the term.

It is really only this compulsive quality of addiction that matters in the long run to the addict and to his or her family and that should matter to society as a whole.

Thus, the majority of the biomedical community now considers addiction, in its essence, to be a brain disease:

This results in compulsive craving that overwhelms all other motivations and is the root cause of the massive health and social problems associated with drug addiction.

The Definition of Addiction
In updating our national discourse on drug abuse, we should keep in mind this simple definition:

Both developing and recovering from it depend on biology, behavior, and social context.

It is also important to correct the common misimpression that drug use, abuse and addiction are points on a single continuum along which on slides back and forth over time, moving from user to addict, then back to occasional user, then back to addict.

Clinical observation and more formal research studies support the view that, once addicted, the individual has moved into a different state of being.

Very few people appear able to successfully return to occasional use after having been truly addicted.

The Altered Brain - A Chronic Illness
Unfortunately, we do not yet have a clear biological or behavioral marker of that transition from voluntary drug use to addiction.

However, a body of scientific evidence is rapidly developing that points to an array of cellular and molecular changes in specific brain circuits.  Moreover, many of these brain changes are common to all chemical addictions, and some also are typical of other compulsive behaviors such as pathological overeating.

The complexity of this brain disease is not atypical, because virtually no brain diseases are simply biological in nature and expression.  All, including stroke, Alzheimer's disease, schizophrenia, and clinical depression, include some behavioral and social aspects.

What may make addiction seem unique among brain diseases, however, is that it does begin with a clearly voluntary behavior- the initial decision to use drugs.  Moreover, not everyone who ever uses drugs goes on to become addicted.

Consistent with the bio-behavioral nature of addiction, these individual differences result from a combination of environmental and biological, particularly genetic, factors.

In fact, estimates are that between 50 and 70 percent of the variability in susceptibility to becoming addicted can be accounted for by genetic factors.  Although genetic characteristics may predispose individuals to be more or less susceptible to becoming addicted, genes do not doom one to become an addict.

Schizophrenics cannot control their hallucinations and delusions.  Parkinson’s patients cannot control their trembling.  Clinically depressed patients cannot voluntarily control their moods.

Thus, once one is addicted, the characteristics of the illness- and the treatment approaches- are not that different from most other brain diseases.  No mater how one develops an illness, once one has it, one is in the diseased state and needs treatment.

Environmental Cues
Addictive behaviors do have special characteristics related to the social contexts in which they originate.

Environmental cues are paired in time with an individual’s initial drug use experiences and, through classical conditioning, take on conditioned stimulus properties.

Cue-induced craving is one of the most frequent causes of drug use relapses, even after long periods of abstinence, independently of whether drugs are available.

The salience of environmental or contextual cues helps explain why reentry to one’s community can be so difficult for addicts leaving the controlled environments of treatment or correctional settings and why aftercare is so essential to successful recovery.

This is one reason why someone who apparently overcame drug cravings while in prison or residential treatment could quickly revert to drug use upon returning home.

In fact, one of the major goals of drug addiction treatment is to teach addicts how to deal with the cravings caused by inevitable exposure to these conditioned cues.

Implications
It is no wonder addicts cannot simply quit on their own.

They have an illness that requires biomedical treatment.

They need drug addiction treatment.

We know that, contrary to common belief, very few addicts actually do just stop on their own.

Observing that there are very few heroin addicts in their 50s or 60s, people frequently ask what happened to those who were heroin addicts 30 years ago, assuming that they must have quit on their own.

Consider the example of smoking cigarettes:  Various studies have found that between 3 and 7 percent of people who try to quit on their own each year actually succeed.

Science has at last convinced the public that depression is not just a lot of sadness; that depressed individuals are in a different brain state and thus require treatment to get their symptoms under control.  It is time to recognize that this is also the case for addicts.

The Role of Personal Responsibility
The role of personal responsibility is undiminished but clarified.

Does having a brain disease mean that people who are addicted no longer have any responsibility for their behavior or that they are simply victims of their own genetics and brain chemistry?  Of course not.

Addiction begins with the voluntary behavior of drug use, and although genetic characteristics may predispose individuals to be more or less susceptible to becoming addicted, genes do not doom one to become an addict.

This is one major reason why efforts to prevent drug use are so vital to any comprehensive strategy to deal with the nation’s drug problems.  Initial drug use is a voluntary, and therefore preventable, behavior.

Moreover, as with any illness, behavior becomes a critical part of recovery.  At a minimum, one must comply with the treatment regimen, which is harder that it sounds.

Thus, for drug addiction as well as for other chronic diseases, the individual’s motivation and behavior are clearly important parts of success in treatment and recovery.

Alcohol/ Drug Treatment Programs
Maintaining this comprehensive bio-behavioral understanding of addiction also speaks to what needs to be provided in drug treatment programs.

The National Institute on Drug Abuse’s recently published Principles of Effective Drug Addiction Treatment provides a detailed discussion of how we must treat all aspects of the individual, not just the biological component or the behavioral component.

As with other brain diseases such as schizophrenia and depression, the data show that the best drug addiction treatment approaches attend to the entire individual, combining the use of medications, behavioral therapies, and attention to necessary social services and rehabilitation.

That does not mean, of course, that all individuals need all components of treatment and all rehabilitation services. Another principle of effective addiction treatment is that the array of services included in an individual's treatment plan must be matched to his or her particular set of needs. Moreover, since those needs will surely change over the course of recovery, the array of services provided will need to be continually reassessed and adjusted.

We believe holistic approaches ranging from brain wave biofeedback to yoga and acupuncture are an important part  of the "array of  services" to which he refers.

Recommended Reading
J. D. Berke and S. E. Hyman, "Addiction, Dopamine, and the Molecular Mechanisms of Memory," Neuron 25 (2000): 515~532 (http://www.neuron.org/cgi/content/full/25/3/515/).

H. Garavan, J. Pankiewicz, A. Bloom, J. K. Cho, L. Sperry, T. J. Ross, B. J. Salmeron, R. Risinger, D. Kelley, and E. A. Stein, "Cue-Induced Cocaine Craving: Neuroanatomical Specificity for Drug Users and Drug Stimuli," American Journal of Psychiatry 157 (2000): 1789~1798 (http://ajp.psychiatryonline.org/cgi/content/full/157/11/1789).

A. I. Leshner, "Science-Based Views of Drug Addiction and Its Treatment," Journal of the American Medical Association 282 (1999): 1314~1316
(http://jama.ama-assn.org/issues/v282n14/rfull/jct90020.html).

A. T. McLellan, D. C. Lewis, C. P. O'Brien, and H. D. Kleber, "Drug Dependence, a Chronic Medical Illness," Journal of the American Medical Association 284 (2000): 1689~1695 (http://jama.ama-assn.org/issues/v284n13/rfull/jsc00024.html).

National Institute on Drug Abuse, Principles of Drug Addiction Treatment: A Research-Based Guide (National Institutes of Health, Bethesda, MD, July 2000) (http://165.112.78.61/PODAT/PODATindex.html).

National Institute on Drug Abuse, Preventing Drug Use Among Children and Adolescents: A Research-Based Guide (National Institutes of Health, Bethesda, MD, March 1997) (http://165.112.78.61/Prevention/Prevopen.html).

E. J. Nestler, "Genes and Addiction," Nature Genetics 26 (2000): 277~281 (http://www.nature.com/cgi-taf/DynaPage.taf?file=/ng/journal/v26/n3/full/ng1100_277.html).

Physician Leadership on National Drug Policy, position paper on drug policy (PLNDP Program Office, Brown University, Center for Alcohol and Addiction Studies, Providence, R.I.: January 2000) (http://center.butler.brown.edu/plndp/Resources/resources.html).

F. S. Taxman and J. A. Bouffard, "The Importance of Systems in Improving Offender Outcomes: New Frontiers in Treatment Integrity," Justice Research and Policy 2 (2000): 37~58.

Researchers find three chromosomal areas with links to alcoholism vulnerability                                                "Holding young people solely responsible for underage drinking is like holding fish responsible for dying in a polluted stream." This quote from Laurie Lieber (Center on Alcohol Advertising) raises awareness of the impact of environmental influences.   Both the environment and genetics play a role in a person’s risk for alcoholism. Prior research has shown that genetics significantly influence a person’s response to alcohol. New research has identified three chromosomal regions in the human genome that appear to hold genes that affect a person’s low level of response to alcohol. Both environmental and genetic factors are involved in the risk for alcohol dependence. Genetically influenced characteristics are numerous, and include a low level of response (LR) to alcohol. A low LR to alcohol is reflected by relatively little effect at a given blood alcohol concentration, or through a self-report of numerous drinks required for specific alcohol effects. A study in the July issue of Alcoholism: Clinical & Experimental Research has identified three chromosomal regions in the human genome that appear to hold genes that affect low LR to alcohol. "Prior research has shown that a significant proportion of the risk for having a low response to alcohol is genetic," said Kirk C. Wilhelmsen, principal investigator at the Ernest Gallo Clinic and Research Center and first author of the study. "In other words, most of what accounts for the variation among us in terms of our response to alcohol probably comes from genes. But the research doesn’t tell us how many genes are involved, or how the genes work to cause this effect." "All behavior, thinking and feeling are controlled by the actions of molecules in the brain," added Ivan Diamond, professor and Vice Chairman of the department of neurology at the University of California, San Francisco. "Brain molecules can be changed by experiences in our environment, diseases, drugs and genes. Genes control the proteins which regulate the molecules that carry out all of the functions in the brain. If we could identify genes that confer risk for alcoholism or allow alcoholism to develop, then we could begin to understand which molecules are behaving abnormally or which molecules are responsible for contributing to alcoholism." Diamond, who is also the founding director of the Ernest Gallo Clinic and Research Center, said that identification of chromosomes and eventually, specific genes, is a logical step in ongoing research. "About 25 years ago, Dr. Marc Schuckit started to measure responses to alcohol in young college students," he said. "None of these young men were alcoholics when they were tested. Many years later, however, he discovered that those young men who exhibited a low response to a drink of alcohol were more likely to become alcoholics in the future. Therefore, it seems that a diminished response to alcohol appears to predict the development of alcoholism in some people. If you are easily intoxicated by small amounts of alcohol, it is unlikely that you will ever become an alcoholic. On the other hand, if you can ‘hold your liquor’ at an early age, you have a greater risk of becoming an alcoholic years later." For the current study, researchers initially chose participants from students attending two San Diego universities: each was between 18 and 29 years of age, had an alcohol-dependent parent, a personal history of drinking but not alcohol dependence, and a full sibling with similar characteristics. Full siblings (n=139 pairs) and available parents were then genotyped for 811 satellite markers. Subjects were given eight minutes to consume a beverage (20% by volume solution of 0.75 ml/kg of 95% alcohol for women and 0.90 ml/kg for men) from a closed container, designed to disguise the alcohol taste and the amount consumed. Measurements of body sway and both positive and negative subjective feelings were collected at baseline and then at 15 minutes, 30 minutes, and every half-hour thereafter during the three-hour testing session. "We found there were three locations that had the largest evidence for genes that affect the level of response to alcohol," said Wilhelmsen. These were chromosomes 10, 11 and 22. "Identification of chromosome locations for genes … that may affect someone's risk for becoming an alcoholic is important because this may lead to the identification of specific genes that determine how alcohol makes us feel, give us new insight into how the brain works, and help us understand why some people become addicted to alcohol," said Diamond. "We still don’t know which genes or how many genes are involved," said Wilhelmsen. "What we do know is that there are some genes with big effects on the level of response to alcohol, and we know the approximate chromosome location. In terms of a puzzle, we now not only know which pieces contain the critical clues, we also know that probably the puzzle is solvable." Next, Wilhelmsen and his colleagues will investigate if individual variations of these genes correlate with level of response to alcohol. "Each region that we’ve implicated typically contains about 200 to 300 genes," he said. "Because of the human genome project, we know a lot about some of the genes in this region, but some of the genes we know very, very little about. If we’re lucky, one of the genes that we think we understand something about will prove to play a role. However, if we’re unlucky, we’ll end up doing a systematic search of all the genes that are in the regions that have been implicated." Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA. Articles were written based on the following published research: Wilhelmsen, K.C., Schuckit, M., Smith, T.L., Lee, J.V., Segall, S.K., Feiler, H.S., Kalmijn, J. (July 2003). The search for genes related to a low-level response to alcohol determined by alcohol challenges. Alcoholism: Clinical & Experimental Research, 27(8), 1041- 1048 Younger People Are at Greater Risk for Alcohol Problems Younger people are both drinking and developing alcohol problems at an earlier age People who develop alcoholism early in life have greater social and legal problems Women seem to be ‘catching up’ to men in terms of problem drinking Both family history and social changes play a role in who becomes alcohol dependent A recent study looking at three different age groups that spanned two generations found that the youngest age group began regular use of alcohol at an earlier age than the other two groups. Among those individuals who were alcohol dependent, those in the youngest age group were more likely to have developed alcohol problems before the age of 25. What this means is that people are starting to drink at an earlier age and, as a direct consequence, developing alcohol problems at an earlier age. "A lot of studies have shown that the earlier people start to drink regularly," said lead author Scott F. Stoltenberg, assistant research scientist at the Department of Psychiatry, University of Michigan Alcohol Research Center, "the more likely it is that they will eventually develop alcohol problems. So if you can put off a person’s initiation into regular drinking into their 20s or so, they’re a lot less likely to develop these kinds of problems." It’s no secret that early use of alcohol, cigarettes and other drugs can ‘set the stage’ for long-term health and behavioral problems. Although alcohol is thought to be the most commonly used psychoactive substance during adolescence, its use has a complicated relationship with the use of other substances such as tobacco and illegal drugs. Furthermore, numerous studies have found a strong association between early use of these substances and later-in-life alcohol-use disorders, depression, and multiple health-risk behaviors that include violence and suicide plans. Why does this happen? "There are probably two answers," said Victor Hesselbrock, professor of psychiatry at the University of Connecticut School of Medicine. "First, developing a substance-use disorder requires a certain amount of exposure to the substance. You can’t become an alcoholic, a heroin addict, a cocaine addict, or addicted to cigarettes unless you use that substance a significant amount. The earlier you start, the more exposure you have to the drug. Second, there are problem-behavior children. They have what we call conduct disorder; these are the kids who have trouble with their parents, they’re unresponsive to discipline, they’re a problem in school, they’re unruly, they get into trouble in the neighborhood and for whatever reason, they start using these substances at an early age." The generational study, published in the December issue of Alcoholism: Clinical & Experimental Research, looked at three "cohorts" or groups of people: those born before 1930 (referred to as "old); those born between 1930 and 1949 (referred to as "middle"); and those born after 1949 (referred to as "young"). Those considered "young" began regular use of alcohol at an earlier age than the other two groups. They were also more likely to develop drinking problems before the age of 25, called "early-onset alcoholism." In addition, this same group was more likely to exhibit elements of what is called "anti-social alcoholism," such as fighting while drinking, involvement with the police and drunk driving. Another finding of interest concerned women: age of first regular alcohol use among women declined more dramatically than it did among men, suggesting a related increase in problem drinking among women. Finally, the study found that a strong family history of alcohol problems was highly correlated with younger ages of regular drinking, early-onset alcoholism and alcohol-related antisocial behavior. "In the study of alcoholism and other disorders," explained Hesselbrock, "you find something called a ‘secular trend.’ When people about 15 years ago spoke of early-onset alcoholism, it meant before the age of 25. The more we study this, the more we see that age march down. Right now, early-onset alcoholism probably begins before the age of 21." Early-onset alcoholism is one of the defining features of anti-social alcoholism. "Generally these are the people that you would have met in high school," said Stoltenberg, "probably not in college because a lot of these folks don’t go to college. They get arrested, they drive while drunk; generally they’re thought to be very impulsive. ‘Impulsivity,’ or the lack of impulse control, has a lot to do with whether or not a person can keep themselves from doing whatever comes into their head." In other words, anti-social behavior involves a range of behaviors that tend to get people into trouble; early-onset alcoholism facilitates anti-social behavior in those individuals who already have impulse-control problems, most likely by further weakening impulse control. "This paper not only confirms that the age of onset for alcohol problems and alcoholism is marching down, getting younger and younger," said Hesselbrock. "It also shows that the risk for women of developing these disorders, particularly women who are problem-behavior oriented, is probably not that different from men’s." The study, funded by the National Institute of Alcohol Abuse and Alcoholism, also found support for a genetic tendency for alcoholism. Both Hesselbrock and Stoltenberg spoke of an unknown number of genes - six to eight, 10 or more - that each has an influence vis-à-vis vulnerability or susceptibility to alcohol disorders that can be ‘shared’ with other disorders such as depression and nicotine dependence. "No single gene causes alcoholism," noted Stoltenberg. Hesselbrock added that "genes do not predetermine, they only increase risk." Yet not even a body of genes, let alone a solitary gene, entirely explains the conundrum. "When you talk about these cohort effects," explained Stoltenberg, "you’re talking about social changes rather than genetic changes. Clearly an individual with a dense family history of alcoholism has a much greater risk for alcohol problems than an individual without that history. In the couple of generations involved in this study, however, there’s no genetic change going on, so the effects have to be due to social or environmental changes." The prevalence of drinking and age of first regular alcohol use among women are prime examples of social changes, noted Stoltenberg. "Maybe men and women have the same biological predisposition to behave this way," he said, "but 50 years ago it wasn’t socially acceptable for women to go into bars and drink. Certainly they weren’t considered ‘good girls.’ Now it’s a lot more acceptable for women to go out and drink like men." Those considered "young" in the study would be almost 50 years old today. Stoltenberg said that even though "it’s hard to extrapolate from one cohort to another, I wouldn’t be surprised if the rates of these kinds of behaviors are going to be even higher in groups in their 20s and 30s right now." Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA. Articles were written based on the following published research: Stoltenberg, S.F., Hill, E.M., Mudd, S.A., Blow, F.C., & Zucker, R.A. (1999, December). Birth cohort differences in features of antisocial alcoholism among men and women. Alcoholism: Clinical and Experimental Research, 23(12), 1884. Tenth Special Report Perhaps the single greatest influence on the scope and direction of alcohol research has been the finding that a portion of the vulnerability to alcoholism is genetic. This finding, more than any other, helped to establish the biological basis of alcoholism. It also provided the basis—and justification—for much of the progress in genetics, neuroscience, and neurobehavior described in the Tenth Special Report. Today we know that approximately 50 to 60 percent of the risk for developing alcoholism is genetic. Genes direct the synthesis of proteins, and it is the proteins that drive and regulate critical chemical reactions throughout the human body. Genetics, therefore, affects virtually every facet of alcohol research, from neuroscience to Fetal Alcohol Syndrome. It is clear from the findings presented in the Tenth Special Report that although much remains to be discovered, progress has been made toward understanding how genes are involved in the etiology of alcohol use problems, including how genes interact with other genes and with the environment to produce disease. Most drink responsibly, and not very often, and actually the majority of those who drink make up small percentage of the national overall consumption .  In other words a small percentage of the population make up the greatest portion of the alcohol industries revenues. Most people overestimate the levels of alcohol consumption in our society. As these data suggest, alcohol is not an important part of life for most Americans. Yet we generally concur with the alcohol industry's common assertion that "the overwhelming majority of adults drink [alcohol] responsibly."18 This is true only if you include abstainers and very light drinkers; moderate drinkers (those who average two drinks or less a day) make up only about one quarter of the industry's sales.19 Recovering parents, Children with a  family history, especially at risk! Children prone to addiction, and the problems with alcohol being advertised. Alcohol is a drug, an illegal drug for those under 21 to purchase and consume. Yet millions of dollars are spent each year by advertisements to our children.  There is great business to be made off a child prone to genetic patterns of high consumption.  It makes good business sense, especially considering the research published by the American Medical Association shows brain development continues until the age of 20.  If alcohol consumption is put off to age 21, the risk of developing dependence to alcohol decreases.  If your business depends on "consumption"  your profits are not increased by this report.