The Genetics of Alcoholism

Alcoholism is a complex disorder caused by a combination of genetics, lifestyle, and environmental factors. Although you cannot change your genes, being aware of your risk factors can help you be cautious about alcohol consumption.

The Link Between Genetics and Alcoholism

Millions of Americans misuse alcohol, and it can have serious and terrible impacts on their friends, family, jobs, and bodies. However, the body might hold the key to understanding why some people struggle with alcohol abuse and others do not. The genetics of alcoholism play a huge role in comprehending the disease.

Alcohol Use Disorder

Alcoholism, also called alcohol addiction or Alcohol Use Disorder (AUD), is when severe drinking meets the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). If a person meets 2-3 out of the 11 criteria during a 1-year period, they have a mild AUD. People who meet 4-5 criteria are considered to have a moderate AUD, and people who meet 6-11 criteria are considered to have a severe AUD. Some of the questions ask if the person has:

  • Spent a lot of time thinking about drinking, drinking or recovering from the effects of drinking?
  • Ever gotten into situations while or after drinking that increased your chances of getting hurt?
  • Continued to drink despite mental or physical health problems such as depression or anxiety?
  • Found that drinking, or being sick from drinking, often interfered with taking care of your home or family? Or caused job or school problems?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  • Experienced cravings: a strong need, or urge, to drink?

The more criteria people meet, the more urgent it is for them to get treatment. However, anyone who exhibits any of the criteria for an AUD is highly advised to seek treatment immediately. Sadly, less than 10 percent of people with an AUD get any treatment. According to the US National Library of Medicine, the causes include a combination of genetic, lifestyle, and environmental factors. While you may have control over some of these factors, you cannot control your genetics. How much do the genetics of alcoholism really come into play?

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Nature vs Nurture

Substance abuse very often travels from one generation to the next, and both men and women can inherit a propensity towards alcohol dependence. How a person is raised and what they are exposed to can be a predictor of becoming an alcoholic later in life. Early conduct problems and underage alcohol use often can be traced back to being raised in an alcoholic family.  These children may have poor emotional regulation and lack social skills. Poor social skills might get the kids rejected from a mainstream social circle and lead them to associate with substance-using peers instead.

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Being involved in school and having good parent support can protect a child’s mental health, but if the parent is an alcoholic and has a close relationship with their child, that makes the child more likely to imitate the parent’s drinking behaviors. People with avoidance coping styles are more likely to develop an AUD if they use alcohol to reduce stress and anxiety.

Education is a lifestyle factor that predicts alcohol abuse. In one poll, 45% of people with a college degree reported they had a drink in the past 24 hours, compared to people without any college education at 28%. Income also has a role, with 47% of people earning an annual $75,000 or more drinking within the past 24 hours. For people who earned $30,000 or less, only 18% of them had a drink. This is most likely because people with more disposable income can afford to take part in activities such as restaurants, vacations, and socializing with coworkers where alcohol is often served.

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Genetics of Alcoholism

Alcohol dependence is a genetic disease, with a wide variety of genes affecting whether or not a person develops an AUD. The two enzymes that are responsible for alcohol metabolism are encoded by different genes, and which enzymes a person carries influences their risk for developing alcoholism. These two enzymes are alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). ADH metabolizes alcohol to acetaldehyde, which is a highly toxic substance and well-known carcinogen. Second, acetaldehyde is further metabolized into another, less active byproduct, which is known as acetate. Acetate is then broken down into water and carbon dioxide where it is eliminated from the body. Alcohol metabolism is controlled by a number of genetic factors, such as variations in the enzymes that break down alcohol; and environmental factors, such as the amount of alcohol an individual consumes and their overall nutrition.

ADH and ALDH also determine if a person will get facial flushing when they consume alcohol. If there is too much acetaldehyde in the body as a result of an ALDH deficiency, a person will most likely have facial flushing. This is demonstrated in gene differences between European and East Asian populations. Up to 85% of East Asians have facial flushing, compared to up to 29% of Europeans.  Other consequences of an ALDH deficiency include rapid heartbeat, headache, nausea and vomiting. The greatest risk of this deficiency is the risk of developing high blood pressure or esophageal cancer if these individuals continue to drink.

Some genes, ADH1B and ALDH2, have been identified as the strongest risk for alcoholism. A study of 275,000 people by Penn Medicine found two genes that may need to be present for a person to develop an alcohol use disorder. These genes, DRD2 and SIX3, could predict the risk and help in the development of future medication to help treat an AUD.

Another study looked at over 3,500 twins to examine the influences of environment and genes. Researchers found that environmental factors, like parents, peers, and school, influenced them to start drinking alcohol. However, the gene’s role determined if they developed an alcohol dependence later in life.

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Dangers of Alcohol Use Disorder

The list of how alcohol abuse affects the body is long. Some health consequences include:

  • Inflammation of the stomach, liver, and pancreas
  • Bleeding in the stomach and esophagus
  • Nerve and brain damage
  • Heart failure
  • Inability to have an erection
  • Cirrhosis of the liver or liver failure

When someone becomes dependent on alcohol, they can experience withdrawal symptoms when they’re unable to drink, such as anxiety, fatigue, nausea and vomiting, and headaches. Severe alcohol withdrawal is potentially deadly.

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When to Seek Help

The signs of an AUD might be clear as day to friends and family, but alcoholics can have a difficult time admitting there is a problem and continue their lives in denial. Some signs you have an alcohol problem are if you continue to drink even when it negativity affects your family, friends, job, or school, when you give up on activities you enjoyed so you can drink instead, and if you have tried to stop or cut down and were unable to. Treatment centers and groups like Alcoholics Anonymous can offer support and tools for you to start on the path to recovery. If you’re concerned, don’t hesitate to reach out to a certified treatment provider and start the life you deserve.

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