Chapter Four: Etiology of Alcohol Dependence

1
Chapter Four Etiology of Alcohol Dependence
2
public health model

• Agent alcohol
• Host the individual
• Environment family community culture

3
the agent alcohol

• Effects inviting use
• depressant drug
• diminution of inhibition/relaxation
• speed of action
• Socially accepted and widely available

4
the host

• Multiple theories advanced
• Nature versus nurture
• Nature genetic make-up
• Nurture individuals circumstances
• Dilemma separating these factors

5
research models

• Twin and adoption studies
• Studies of nonalcoholic blood relatives
• Genetic marker studies

6
findings suggesting role of heredity in alcoholism

1. Epidemiological studies alcoholism runs in
   families
2. If one twin alcoholic, more common in an
   identical twin than a fraternal twin
3. Studies of step-siblingsalcoholic home vs.
   alcoholic parent
4. Animal studies such as drinking rats

7
what is inherited ?

• Less sensitivity to acute effects handle alcohol
  too well
• Greater sense of relaxation with alcohol
• Neuropsychological differences
• Differences in metabolism
• Differences in brain chemistry
  neurotransmitters

8
the individual
Kinney

1. Early psychological approaches
2. application of personality theories
3. alcoholic personality not supported
4. Current approaches
5. core psychological needs
6. learning theory
7. role of temperament
8. stressful events

9
individual factors temperament

• Traits exist on continuum
• Traits can predispose or be protective
• Cognitive structure
• Harm avoidance
• Impulsivity
• Playfulness
• Sensation seeking

10
environmental factors

• Cultural orientation defines acceptable and
  unacceptable use
• cultural orientation characteristics
• abstinence drinking not accepted
  
• ritual use clear rules for drinking
• convivial use drinking within social life
• utilitarian use personal discretion

11
international comparisons

• rank country total
  (liters) 1. Luxembourg 12.2
• 2. Ireland 11.6
• 3. Portugal 11.0
• 4. France 10.7
• 5. Germany 10.6
• 6. Czech Republic 10.5
• 7. Romania 10.3
• 8. Spain 9.9
• gt25 United States 6.6
  1999, per capita consumption absolute alcohol

12
Environmental factors drinking styles problems

• Norms also influence rates of problems
• Rates of problems associated with
• solitary drinking
• over-permissive norms
• tolerating drunkenness
• tolerating negative consequences
• absence of ritualized use

13
environment drinking styles problems
(cont)

• tolerating negative consequences
• drinking separate from meals
• absence of child socialization todrinking
• drinking with strangers
• drinking pursued as recreation
• drinking concentrated in young males
• culture stressing individualism, self-
  reliance, achievement

14
environment legal approaches

• Among most potent influences
• laws to limit access hours of sales,
  drinking age
• tax structure
• restrictions on advertising

15
cross-cultural comparison

• Countries vary in legal drinking age
• Within countries, further variations depending
  on type of beverage location separate or
  with meals
• Europe legal age ranges from 15 to 20 yrs.

16
current social issues in US

• health insurance coverage
• host liability
• role of harm reduction
• drinking as recreational activity (college
  campus, among young adults)
• limitations on advertising