The Disease Concept and Brain Chemistry of Alcoholism and Drug
Addiction
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National Institute on Chemical Dependency
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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
It doesn’t matter whether you, as a family member,
friend, employer, etc., believe it’s a
disease. What really matters is that the person who is an alcoholic and/or
addict believes
it’s a disease, that they have it, and that it must be treated.
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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.
- Many people erroneously still believe that biological
and behavioral explanations are alternative or competing ways to
understand phenomena, when if fact they are complementary and integrative.
Modern science has taught that it is much too
simplistic to set biology in opposition to behavior or to pit willpower against
brain chemistry.
- Addiction involves inseparable biological and
behavioral components. It is the quintessential bio-behavioral
disorder.
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.
- Thus, having this brain disease does not absolve the
addict of responsibility for his or her behavior.
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.”
- However, 20 years of scientific research has taught
that focusing on this physical versus psychological distinction is off the
mark and a distraction from the real issues.
From both clinical and policy perspectives,
it actually does not matter very much what physical withdrawal symptoms occur.
- Physical dependence is not that important, because
even the dramatic withdrawal symptoms of heroin and alcohol addiction can
now be easily managed with appropriate medications.
- Even more important, many of the most dangerous and
addicting drugs, including methamphetamine and crack cocaine, do not
produce very severe physical dependence symptoms upon withdrawal.
What really matters most is whether or not a
drug causes what we now know to be the essence of addiction, namely
- The uncontrollable, compulsive drug
craving, seeking, and use, even in the face of negative health and social
consequences.
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:
- A condition caused by persistent
changes in brain structure and function.
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:
- Addiction is a brain disease expressed
in the form of compulsive behavior.
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.
- It is as if a threshold has been crossed.
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.
- Addiction should be understood as a chronic recurring
illness.
- Although some addicts do gain full control over their
drug use after a single treatment episode, many have relapses.
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.
- Individuals differ substantially in how
easily and quickly they become addicted and in their preferences for
particular substances.
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.
- Over time the addict loses substantial control over
his or her initially voluntary behavior, and it becomes compulsive. For
many people these behaviors are truly uncontrollable, just like the
behavioral expression of any other brain disease.
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.
- All of the environmental cues surrounding initial
drug use and development of the addiction actually become
“conditioned” to that drug use and are thus critical to the
development and expression of addiction.
Environmental cues are paired in time with an
individual’s initial drug use experiences and, through classical conditioning,
take on conditioned stimulus properties.
- When those cues are present at a later time, they
elicit anticipation of a drug experience and thus generate tremendous drug
craving.
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.
- The person who became addicted in the home
environment is constantly exposed to the cues conditioned to his or her
initial drug use, such as the neighborhood where he or she hung out,
drug-using buddies, or the lamppost where he or she bought drugs.
- Simple exposure to those cues automatically triggers
craving and can lead rapidly to relapses.
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.
- People often assume that because addiction begins
with a voluntary behavior and is expressed in the form of excess behavior,
people should just be able to quit by force of will alone.
- However, it is essential to understand when dealing
with addicts that we are dealing with individuals whose brains have been
altered by drug use.
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.
- However, longitudinal studies find that only a very
small fraction actually quit on their own. The rest have either been
successfully treated, are currently in maintenance treatment, or (for
about half) are dead.
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.
- Treatment compliance is the biggest cause of relapses
for all chronic illnesses, including asthma, diabetes, hypertension, and
addiction.
- Moreover, treatment compliance rates are no worse for
addiction than for these other illnesses, ranging from 30 to 50 percent.
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.
- Again, we must be careful not to pit biology against
behavior.
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.
- These might include such services as family therapy
to enable the patient to return to successful family life, mental health
services, education and vocational training, and housing services.
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."
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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: |
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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. |
 |
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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.
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