Alcohol: how family history influences how you drink – 01/14/2024 – Balance

Alcohol was an important part of family life when Stephen was a child. Parties on holidays, barbecues in the backyard and a hard day at work were all reasons for his father and uncles to have a load of beer or more.

“Nothing happened without buckets of beer included,” said Stephen, now 53 and a doctor. (He asked that we use only his middle name to protect his and his family’s privacy.)

Since Stephen was 14, he was able to have a beer every now and then with his father. As he matured, he began drinking according to the family model: in his 20s, any social gathering meant “liters of liquor.”

Stephen’s parents had told him stories about their own parents’ problems with alcoholism, and how they sometimes became violent. But because his immediate family’s behavior wasn’t like that, Stephen didn’t consider his drinking a problem for long.

He stopped drinking when he was in medical school, in part to prove to himself that he didn’t have this problem. When he started drinking again during his residency, in his late 40s, alcohol affected him differently. “All of a sudden I was drinking to the point where I realized I couldn’t stop,” he said.

Alcohol use disorder —the inability to stop or control drinking despite negative consequences—is a highly heritable condition. Research suggests that having an immediate relative, such as a father, mother or sibling, with the disorder increases an individual’s likelihood of developing the problem by about three or four times. Approximately 50% of the risk comes from a person’s genes, but their family and social environments are also important factors.

Here’s what you need to know about how alcoholism is passed down in families, and some ways to protect yourself against it.

How genetics puts you in risk?
No single gene is responsible for a person developing alcohol use disorder, but experts say hundreds of them likely play a role.

Scientists have identified some traits that these genes influence, starting with how the body processes alcoholic beverages. If alcohol metabolism is impaired, drinking can be physically unpleasant, causing nausea and headaches. Having this trait, which is associated with at least two gene variants that are more common in people of Asian descent, decreases the risk of alcohol use disorder because the person is less likely to drink heavily, or not at all.

On the other end of the spectrum are people who “can practically drink non-stop” before feeling the effects of drinking, said Dr. Marc Schuckit, a professor of psychiatry at the University of California, San Diego. These people have a higher risk of alcohol use disorder because they tend to drink more.

Having a high tolerance for alcohol may also be linked to how the body metabolizes the substance, although scientists have not identified specific gene variants for this, as they have for tolerance. Schuckit added that some people don’t feel as drunk as others when they drink a lot, or they may not recognize how drunk they really are, and so they don’t see the signal to cut down or stop drinking.

Our genes can also affect impulsivity and how the brain responds to rewards — traits that are linked to alcohol use disorder, as well as other types of addiction. These characteristics can influence someone to seek fun or pleasurable experiences, such as stronger drinks, without thinking about the consequences.

What constitutes the most risk to the person?
Your childhood family environment also has a big impact on your drinking behavior. If a person is raised in a household where it is normal to drink excessively, and if they have positive associations with drinking, they will be more likely to try it, said Kathryn McHugh, chief of psychology at MacLeran Hospital in Massachusetts.

The age at which a person starts drinking makes a big difference in terms of the level of risk. According to a widely cited study, approximately 16% of people who try alcoholic beverages between the ages of 11 and 12 develop dependence later, compared to just 1% of people who start drinking at age 19 or older.

“The longer you delay a person’s first drink, the lower their risk of developing alcoholism,” said Kathleen Brady, MD, professor of psychiatry and behavioral sciences at the University of South Carolina. Experts believe this is because early exposure to Alcohol can modify the brain while it is developing, particularly in areas related to self-control.

Being exposed to childhood trauma also increases a person’s risk. One theory is that early-life trauma increases the brain’s stress response. “You may have the same stressor, but your body, your brain, is actually having an amplified reaction to that stress,” McHugh explained. Because alcohol is often used to “calm down,” feeling more stress can often lead people to drink more.

How can you protect?
Although there are many factors that contribute to the risk of alcohol use disorder, there is only one way to eliminate it: not drinking. “It’s a pretty radical solution, but it’s the one that works best,” said Henry Kranzler, a professor of psychiatry at the University of Pennsylvania.

In the absence of total abstinence, experts advise drinking in moderation — no more than one drink per day for women and two for men. “Set personal boundaries, write them down, and try to stick to them,” said Dr. Brady. “And if you can’t meet them, perhaps you need more professional help.”

Experts also suggest examining why you drink so you can be more strategic about cutting back. If you are primarily a social drinker, be more conscious about your alcohol consumption at parties. Also look for non-drinking social activities. If, on the other hand, you drink more when you’re anxious, try avoiding alcohol when you’re stressed and look for alternative mechanisms to calm yourself.

“Everyone is a little bit different in terms of why they drink alcohol, what environments they drink it in, what their risk factors would be,” Dr. McHugh said.

Having a friend or partner who knows your risk will also help you notice any potential problems. For Stephen, that person was his wife. When they married and moved in together, he could no longer hide the level of his drinking — or ignore that he had a problem. Stephen’s wife insisted he get help, and although it took him a few years to get sober, he hasn’t had a drink in seven years.

One “irony of alcoholism,” Stephen said, is that “sometimes you don’t recognize it in yourself.”