Students with a dense family history of alcoholism are most at risk of alcohol-use disorders

This study looks at first-, second- and third-degree relatives instead of just one parent, usually paternal

Not all university students will “mature out” of their heavy-drinking habits.

A new study examines the density of college students’ family history of alcoholism.

This type of measure – looking at first-, second- and third-degree relatives – identified a significant number of at-risk individuals who would have been missed using regular family-history measures.

While many university students tend to “mature out” of heavy-drinking behavior by the time they become young adults, some go on to develop alcohol-use disorders (AUDs). Most genetic research on an individual’s family history of alcoholism (FHA) has looked at the parents’ – usually paternal – alcohol use. New findings indicate that looking at the density of FHA – including first-, second- and third-degree relatives – is much more telling.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“Using a density measure of FHA can identify a greater number of individuals who may be at risk for developing an alcohol problem,” said Christy Capone. “The greater number of affected relatives … the greater the potential risk of developing an AUD. Ours is the first published study to examine this measure among college students.”

“Family density appears to be a promising method to identify a higher percentage of at-risk individuals,” agreed John Hustad, research associate at Brown University. “For example, in this study, approximately 44 percent of the at-risk participants would have been missed if a typical family-history measure had been used instead of the family-history density approach.”

The study population for this research consisted of 408 undergraduate students (293 females, 115 males) from a northeastern U.S. university who were asked to complete an anonymous survey for course credit during the 2005-2006 academic year.

“Our use of a density measure identified a large proportion of students, about 29 percent, who are at potentially greater risk for development of AUDs based on their report of alcoholism among first- and second-degree relatives,” said Capone. “Our other key finding was the relationship between FHA and other potential risk factors – behavioral undercontrol, age of onset of drinking (AOD), and cigarette use.”

All of these risks factors are inter-related, added Hustad. “First, family-history density was related to AOD, behavioral undercontrol, and current cigarette use which, in turn, are related to alcohol use and/or alcohol-related problems in this sample of college students. Second, behavioral undercontrol was associated with alcohol problems but not the degree of alcohol consumption; this suggests that individuals with a family-history density of AUDs and behavioral undercontrol are more likely to behave irresponsibly when drinking.”

“The importance of identifying these risk factors is the idea that they can be useful markers of at-risk status and can help us to develop appropriate intervention strategies,” said Capone. “Although, given the fact that many students come to college already having experience with alcohol, I believe that preventive interventions should begin early in the high-school years or during the transition from middle school to high school.”

Hustad agreed. “Due to the relationship between earlier AOD and more alcohol-related problems during college, it is clear that education and prevention efforts should begin well before the college years,” he said. “Until that happens, the risk factors identified in this research can be easily implemented in any screening and brief intervention for incoming college students. For example, these results suggest that effective interventions addressing tobacco use may have a positive influence on both smoking and alcohol-related consequences.”

“It is important to remember that not everyone with density of familial alcoholism will go on to develop a long-term problem with alcohol themselves,” said Capone. “Alcohol dependence is a very complex disorder and FHA is but one influence on its development. However, college students who are heavy drinkers and have a greater density of familial alcoholism are certainly at higher risk of continuing to drink in a problematic fashion after the college years.”

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• AA Offers Recovery Not Religion
• Twelve Step Facilitation
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Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism by AA Services Read more about this title…

Lesbian Alcoholics were Unloved, Unwanted and Alcoholic had Parents; Social Supports and Lesbian Alcoholics

The purpose of this study was to investigate the relationship between social support and alcoholism among lesbians.

Fifteen lesbian alcoholics and 15 lesbian non-alcoholics were administered a questionnaire covering their childhood and adolescent history, social support systems, history of drinking, and demographic information.

The findings suggested that the alcoholic lesbians’ current support systems were not as disrupted as had been anticipated.

However, the alcoholic lesbians more often reported;

• having had a less supportive childhood and adolescence,
• feeling unloved and unwanted,
• experiencing conflict with adults in their families, and
• having had a parent with a drinking problem.

Social Supports and Lesbian Alcoholics. Rebecca Schilit, W. Mark Clark, and Elizabeth Ann Shallenberger. Affilia 1988; 3; 27.

Alcohol intervention may help.

Beyond Codependency: And Getting Better All the Time

By Melody Beattie

Review By Neal J. Pollock (VA USA)

While I have not read Melody Beattie’s other works, I thought this a very valuable book in and of itself. It sheds much light on the topic and helped me to become sensitized to the obvious signs of codependency in people. By doing this, it enabled me to avoid situations where I could become codependent in a relationship.

I think that, as in the Diagnostic and Statistical Manual, there are levels of psychological situations and/or problems. Thus, there may be people inherently inclined towards codependency, but there may also be people who are thrust into it due to the demands of others. The latter may find this book incredibly helpful in avoiding such relationships and in helping their dependent person seek real help vs. codependency from another person. There are also a number of great quotes by the author in this book. A few are:

p. 70: “It’s hard to feel compassion for someone while that person is using or victimizing us.”

p. 71: “If everything looks black, we’ve probably got our eyes shut.”

p. 164: “Who we’re in a relationship with says as much about us as it does about them.” Earnie Tucker (quoted by Melody Beattie)

Codependency is not something to make light of, it’s as much (if not more) the codependent’s problem as the dependent’s. As Caroline Casey humorously noted in “Making the Gods Work for You” (Harmony Books NY 1998), on page 72:
“What do codependents see when they die? Someone else’s life flashes before their eyes.”

This is literally a life-changing book for codependents.

Reviewer: A reader

Once Melody Beattie’s Codependent No More has been “digested”, Beyond Codependency helps to move the recovering codependent past the hurt and on to the business of literally changing behaviors and making a better life. I absolutely recommend this book above any others to recovering codependents.

Obstetricians Often Overlook Alcohol Consumption In Pregnancy, says the Australian And New Zealand Journal Of Obstetrics And Gynaecology

One in every two pregnant Australian woman still consume alcohol during pregnancy, according to a study in the Australian and New Zealand Journal of Obstetrics and Gynaecology. The responsibility of providing accurate information about the harmful effects of alcohol and its lifelong effects on the child falls on obstetricians and other health professionals.

And yet, almost half of the obstetricians interviewed said they did not routinely ask about alcohol consumption in pregnancy.

An editorial by Professor Elizabeth Elliot from the University of Sydney titled “Alcohol and Pregnancy: the Pivotal Role of the Obstetrician”, discusses the state of awareness about the adverse effects of alcohol consumption during pregnancy and the obstetricians’ participation in educating against maternal drinking.

Only 16% of the obstetricians routinely provided information about the consequences of alcohol in pregnancy, while only 5% gave advice which were consistent with the latest guidelines of The National Health and Medical Research Council of Australia (NHMRC) – which states that, for pregnant women, ‘no drinking is the safest option’.

Professor Elliot says, “Failure to provide information about the dangers of alcohol consumption in the antenatal consultation represents a lost opportunity. Accurate recording of antenatal alcohol exposure will help identify children who require pediatric assessment, since the effects of alcohol may not be obvious at birth.”

“More importantly, identifying the women who are unable to stop drinking provides an important opening for the management of problem drinking and prevention of exposure to alcohol in future pregnancies,” added Professor Elliot.

Alcohol consumption during pregnancy has been associated with increased risks of miscarriage, stillbirth, intrauterine growth restriction, pre-term birth and low birth-weight. However, the best known adverse effect of alcohol exposure on the fetus is the fetal alcohol syndrome (FAS) – which is associated with a wide range of birth defects and ongoing educational, behavioral and psychological problems.

This paper is published in the June 2008 issue of Australian and New Zealand Journal of Obstetrics and Gynaecology (Vol. 48, Issue 3, 2008).

See also;

1. Facial features of fetal alcohol syndrome
2. Alcohol and Pregnancy
3. Alcohol Free Pregnancies
4. Alcohol intervention may help.
5. Brief-TSF can assist patients cease alcohol consumption.

Women Can Inherit Drinking Problem Too, Study Finds

In the first major twin study to compare genetic and environmental factors that contribute to the risk of alcoholism in both sexes, researchers have found that genetics plays an important role in determining alcohol dependence in women as well as in men. The study contradicts the long-held assumption that a woman’s environment is more likely to influence whether she becomes dependent on alcohol.

The study was conducted by scientists at Washington University School of Medicine in St. Louis and Australian collaborators at the Queensland Institute of Medical Research. It was funded by the U.S. National Institute of Alcoholism and Alcohol Abuse, and the findings were published in a recent issue of the journal Psychological Medicine.

While there is ample evidence for an important genetic influence on alcoholism risk in men, the tie between genetics and alcoholism in women has been uncertain, said the paper’s lead author, Andrew Heath, Ph.D., a professor of psychiatry at Washington University.

The study sought to address this shortcoming. It involved 2,685 pairs of twins, all participants in an adult twin study started in Australia in 1978 and maintained by the Australian National Health and Medical Research Council. The two members of each pair were raised in the same home environment. The study included — for the first time — twins of opposite sex as well as twins that were either both male or both female.

Telephone interviews with the twins were conducted to assess whether the participants had lost control over their drinking, were unable to cut back on drinking or had similar problems with alcohol.

Twins who had an alcoholic identical twin were much more likely to be alcoholic themselves than were twins who had an alcoholic fraternal twin, and this was equally true in women and in men. More surprisingly, men who had an alcoholic twin sister had very high rates of alcoholism.

“If shared environmental factors are of predominant importance in women but genetic influences predominate in men — a commonly held belief — then we would have expected to see very low concordance for alcoholism of unlike-sex twin pairs,” Heath said. “That wasn’t the case.”

The study also found that women with an alcoholic identical (monozygotic) twin sister were six times more likely to be alcohol dependent than other women. Monozygotic twins share the same genetic makeup. Dizygotic, or nonidentical, twins, who are not more alike genetically than ordinary sisters, were only three times more likely to be alcohol dependent if their twin had a drinking problem.

The study also examined whether psychiatric disorders that commonly precede or coexist with alcoholism, such as childhood behavior problems like lying and stealing or depression, were as strongly associated with risk of alcoholism in women as in men.

“It used to be believed that depression predicted increased risk of alcohol problems in women, whereas a history of childhood behavior problems predicted alcoholism risk in men. We found that depression is a potent predictor for alcohol dependence in both men and women,” said Heath. “A history of behavior problems also is as strong a predictor in women than in men — slightly more powerful in women, in fact.”

Heath AC, Bucholz KK, Madden PAF, Dinwiddie SH, Slutske WS, Bierut LJ, Statham DJ, Dunne MP, Whitfield JB, Martin NG. “Genetic and Environmental Contributions to Alcohol Dependence Risk in a National Twin Sample — Consistency of Findings in Women and Men”. Psychological Medicine. 27(6):1381-1396, 1997 November.

The National Institute on Alcohol Abuse and Alcoholism has established through years of clinical research the effectiveness of the following interventions to treat alcohol problems.

Professional delivery of these interventions follows established protocols that have been published in manual form.

Cognitive behavioral therapy (CBT) primarily targets alcohol dependent individuals. It assumes that alcoholism is learned problematic behavior that begins and continues with the patient’s distorted belief that alcohol helps him or her cope with stress.

CBT therapists usually try to change how a patient thinks about alcohol, and to assist a patient in identifying stressful situations and alternative ways of coping with these situations. CBT allows patients to establish the goals of treatment. These can range from controlled drinking to abstinence.

Motivational enhancement therapy (MET) targets all problem drinkers, including alcohol dependent individuals.

It is based on principles of motivational psychology and focuses on increasing a patient’s internal motivation to change his or her drinking behavior.

MET doesn’t try to guide the patient through recovery step-by-step. Instead, it uses objective feedback and empathic listening techniques to influence positive change.

MET is a less intensive intervention, requiring only four sessions to complete.

Twelve-step facilitation therapy (TSF) primarily targets alcohol dependent individuals. It is grounded in the concept of alcoholism as spiritual and medical disease.

Patients are encouraged to accept an alcoholic identity and to become involved in support group activities (going to Alcoholics Anonymous meetings, getting a sponsor and working the 12 steps of AA). Abstinence is the goal of TSF.

Behavioral marital therapy (BMT) and other couples and family therapies primarily target alcohol-dependent individuals.

They recognize that spouses, significant others and family members of patients being treated for alcoholism can play a critical role in recovery.

These therapies seek to enhance communication between couples and among family members to improve the functioning of relationships.

This leads to longer retention in treatment for patients, longer periods of abstinence among patients, and less anxiety and enabling behavior among nonalcoholic spouses, significant others and family members.

Research Sources: Project MATCH Research Group. 1997; National Institute on Alcohol Abuse and Alcoholism. 2003. List of Alcohol Interventions for Substance Abuse and Mental Health Services

From; www.ensuringsolutions.org

Brief-TSF follows the principles of full TSF and is designed for non-specialist healthcare workers as an earlier intervention.

• 12-Step Recovery Theory And Application
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• Alcohol Consumption In Patients Pancreatitis
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• Alcoholics Can Benefit From Al-Anon
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• Prescription Drug Overdose Becomes Big Killer
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• Research Evidence For TSF  .
• Return To Drinking After Liver Transplantation For Alcoholic Liver Disease
• Role Of Significant Others
• Screening Can Decrease Teen Risk Behaviour
• Sleep Problems Affect Alcoholism Recover
• Spirituality And Helping In Alcoholics Anonymous
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• Sweet Tooth And Alcoholism
• Symptoms Of Alcoholism
• Teen Drinking Leads To Risk Of Alcoholism And Social Exclusion
• The Aging Alcoholic
• The Classification Of Alcoholics
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• Thyroid Function In Depression And Alcohol Abuse
• TSF Description
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Research Summary; Women and men appear to have different genetic and environmental risk factors for alcoholism, Reuters reported Jan. 24/2006.

A quartet of new family studies on alcoholism show, for example, that while both sexes are more likely to develop alcoholism if they have a history of aggressive behavior in childhood, women who experienced severe physical punishment in childhood were also at elevated risk, while men were not.

“Clearly, there are some common antecedents (to alcoholism), such as conduct disorder or symptoms, but there are also predictors unique to each gender,” said researcher Aruna Gogineni of the Johns Hopkins University School of Medicine. “These are the kinds of findings that call out for many more studies on women in order to determine how the mechanisms of alcoholic parental risk may differ in men and women.”

Researchers affirmed that children of alcoholics were generally more likely to have alcohol problems themselves, but said that genetic makeup may be more important for men, while environmental factors may have more of an impact on women. For example, one study comparing children of biological and adopted parents with alcoholism found that male children of alcoholics related by blood were more likely to be alcoholics themselves.

The research appears in the February 2006 issue of the journal Alcoholism: Clinical & Experimental Research.

From; Join Together Online

See also;

• 12-Step Treatment More Effective than Alternative
• Twelve Step Facilitation
• Brief-TSF can assist patients cease alcohol consumption.
• Subscribe to BriefTSF by e-Mail

Understanding and Counseling: Persons With Alcohol, Drug, and Behavioral Addictions : Counseling for Recovery and Prevention Using Psychology and Religion by Howard Clinebell Read more about this title…

Impact of parental history of substance use disorders on the clinical course of anxiety disorders.

Abstract; Background Among the psychological difficulties seen in children of parents with substance use problems, the anxiety disorders are among the most chronic conditions.

Although children of alcoholic parents often struggle with the effects of parental substance use problems long into adulthood, empirical investigations of the influence of parental substance use disorders on the course of anxiety disorders in adult offspring are rare.

The purpose of this study was to examine prospectively the relationship between parental substance use disorders and the course of anxiety disorders in adulthood over the course of 12 years.

Methods; Data on 618 subjects were derived from the Harvard/Brown Anxiety Research Project (HARP), a longitudinal naturalistic investigation of the clinical course of multiple anxiety disorders. Kaplan-Meier survival estimates were used to calculate probabilities of time to anxiety disorder remission and relapse. Proportional hazards regressions were conducted to determine whether the likelihood of remission and relapse for specific anxiety disorders was lower for those who had a history of parental substance use disorders than for individuals without this parental history.

Results; Adults with a history of parental substance use disorders were significantly more likely to be divorced and to have a high school level of education.

History of parental substance use disorder was a significant predictor of relapse of social phobia and panic disorders.

Conclusions; These findings provide compelling evidence that adult children of parents with substance use disorders are more likely to have relapses of social phobia and panic disorders.

Clinicians who treat adults with anxiety disorders should assess parental substance use disorders and dependence histories. Such information may facilitate treatment planning with regards to their patients’ level of vulnerability to perceive scrutiny by others in social situations, and ability to maintain a long-term panic-free state.

Research; Impact of parental history of substance use disorders on the clinical course of anxiety disorders. Maria E. Pagano, Richard Rende, Benjamin F. Rodriguez, Eric L. Hargraves, Amanda T. Moskowitz, & Martin B. Keller. Substance Abuse Treatment, Prevention, and Policy 2007, 2:13

Substance abuse among the elderly: A growing problem

In her early years, Eva would probably have been called a "teetotaler." Except for an infrequent sip of wine on special occasions, she never drank alcoholic beverages. But after her children moved away and her husband and many of her close friends died, Eva turned to the bottle for escape and companionship. Now in her late 70s, Eva is an alcoholic.

Harry has had problems with substance abuse since his late teens. Although drinking binges were often followed by periods of sobriety, he inevitably returned to his addictive ways. At 75, he is on several prescription medications, some of which should not be taken with alcohol. His children, long ago burned out from trying to persuade him to get help, have come to believe that you really can’t "teach an old dog new tricks."

These two composite situations illustrate what has been called one of the fastest growing health problems in this country–substance abuse among the elderly. More people are living longer and more of them are abusing drugs and alcohol in their later years.

Recent census data estimates that nearly 35 million people in the United States are 65 years or older. Substance abuse among those 60 years and older (including misuse of prescription drugs) currently affects about 17 percent of this population. By 2020, the number of older adults with substance abuse problems is expected to double.

As demographics change, attitudes about and use of alcohol and drugs change as well. "In January 2006, the leading edge of the baby-boom generation (those born during the population swell of 1946-1964) will turn 60," said Frederic Blow, professor in the Department of Psychiatry at the University of Michigan and a Huss Research Chair on Older Adults and Alcohol/Drug Problems at Hazelden’s Butler Center for Research. "These individuals have had more exposure to alcohol and illegal drugs, and there is more acceptance among them about using substances to ‘cure’ things. We expect to see an increase in drug and alcohol use; and more use means more problems."

Blow said there has also been an attitude shift regarding addiction and treatment, and that gives him hope that older substance abusers will get the help they need. "There is less shame and guilt associated with substance abuse now and more acceptance of treatment as a way to make things better," he said.

According to Blow and other experts, when people age, their sensitivity to alcohol increases as their tolerance decreases. Also, the percent of their body weight composed of water decreases, and alcohol–which is water-soluble–affects them more quickly and to a greater degree. Alcohol takes longer to metabolize in older persons, accumulating in their bodies and leading to intoxication if consumption is not controlled. Because of their physical make-up, older women are more vulnerable to the negative effects of alcohol.

As a whole, more older men have substance abuse problems than do older women, but women are more likely than men to start drinking heavily later in life. Substance abuse is more prevalent among persons who suffer a number of losses, including death of loved ones, retirement, and loss of health. The fact that women are more likely to be widowed or divorced, to have experienced depression, and to have been prescribed psychoactive medications that increase the negative effects of alcohol help explain these gender differences.

Unfortunately, health care providers often overlook substance abuse among older adults because they don’t know what to look for or they mistakenly assume that older adults cannot be successfully treated. Loved ones, too, may excuse an older relative’s substance abuse as a result of grief or loss or a reaction to boredom. Or family members may not want to confront an elder, fearing they will offend or anger them or get "written out of the will," said Blow.

Yet Blow said there is "good evidence" that older adults do as well as young people when it comes to treating substance abuse and that they may even do somewhat better. "Older adults can recognize all kinds of benefit from treatment," stressed Blow. "There are often direct health benefits, improved cognition, more independent living, more and better social connectedness, and new hobbies. The benefits are enormous."

The U.S. Substance Abuse and Mental Health Services Administration (http://www.samhsa.gov/) offers a wide range of information and resources to help identify, treat, and prevent substance abuse among older adults.

The pamphlet " How to Talk to an Older Person Who Has a Problem With Alcohol or Medications" is available on the Hazelden Web site.