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ALCOHOL DEPENDANCE

Alcohol abuse and dependence in men--"Drunkards beget drunkards"--Plutarch (A.D. 46-120?). Among males, two patterns are recognized for development of alcohol-related behavioral problems. They were called Type I and Type II alcoholism by Cloninger (1981). Both have some genetic determinism, but this is greater for Type II, in which alcohol abuse and dependency develop at earlier ages, often before persons reach their 20s. Contrasts are seen in Table 4. * Twin studies and genetics of alcohol dependence. A U.S. study of 3,516 male identical and fraternal twins found that a genetic factor accounted for more than 50% of the variability in risk of developing abuse or dependence toward alcohol. The residual 50% risk was attributed to those environmental influences not shared by family members. Research has suggested but not yet confirmed a dopaminergic neurochemical mechanism mediating the genetic influence. *

Alcohol problems of women. Alcoholism occurs at seemingly lower rates in women for unknown reasons. Despite the lower abuse susceptibility, alcoholic women have higher vulnerability to injurious effects of alcohol on the body. Their mortality rates from alcohol-related diseases exceed those of male alcoholics. Women who drink heavily are more likely to incur serious results: hypertension or stroke; psychological distress; depression; physical, emotional, or sexual abuse; unwanted pregnancy; and hepatitis. More women than male alcoholics die by homicide, suicide or other traumatic violence. Moreover, women develop many alcohol-related medical pathologies after a lower cumulative alcohol exposure than that affecting men. This likely reflects not only women's generally lower total body water (thus a lower volume of distribution for equal body weights) but also a difference between sexes in their metabolizing of alcohol. For example, alcohol-induced chronic liver disease develops in women over a shorter interval and after lower total alcohol intake. Impairment of reproductive physiology is caused by heavy drinking in both women and men. It may cause premature menopause in women. Men may show low testosterone levels; develop feminized breasts, reduced libido, or impotence; and have abnormal sperm cells. *

Fetal alcohol toxicity. Large numbers of children are adversely altered by parental alcohol abuse that begins prior to their birth. Women are at risk of injuring the fetus from drinking while pregnant. The main emphasis since rediscovery of such toxicity in 1970 (first known in the 18th century) has been the consequence known as fetal alcohol syndrome (see Table 5). There also are data showing offspring of alcoholic fathers have reduced learning ability, poor language skills, and problems of temperament like those in FAS. The prevalence of FAS is unknown; studies using different methods and data sources yield estimated rates for the United States ranging from 3 to 22 per 10,000 live births. At these rates, between 1,300 and 8,000 U.S. children are born each year with FAS. Many others are born with a neurodevelopmental disorder that is alcohol-related but lacking the morphologic defects of FAS. Prenatal/neonatal deaths occur from defects of internal organs.
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