For years, conventional wisdom said alcohol dependence was a character defect. New research points to a genetic basis for it, but not everyone is convinced.
Jim Milam thinks there's a revolution going on. "You can really sense that things are starting to change," he says from his home outside Seattle. "People are really starting to get it."
According to Milam, a clinical psychologist and author of Under the Influence: A Guide to the Myths and Realities of Alcoholism, people are gaining a new understanding of what constitutes alcoholism, a disease the federal government claims costs the United States more than $80 billion a year. Milam has dedicated 30 years of his life to the study of alcohol addiction. He has produced a substantial body of scholarly work, including a recent paper titled "The Alcoholism Revolution," and is champion of what he considers a world-changing idea: The causes of alcoholism strictly are biological.
"When people say that someone's environment or mental or emotional problems turned them into an alcoholic, that is like saying loneliness causes syphilis," says Milam. "Environment may increase exposure to alcohol, but the actual process that results in addiction is biochemical and involuntary."
In Under the Influence and on his World Wide Web site (aaw.com) Milam cites research indicating that in some people alcohol affects brainwave patterns, enzymes and metabolism differently than others, and that it is such biological differences--not emotional, environmental or familial problems--that lead to alcoholism. He calls alcoholism "a deteriorative brain syndrome" that over time creates symptoms (depression, confusion, anxiety) that are misdiagnosed as the reason rather than the result of the addiction.
Among many researchers, Milam's theory that alcoholism is biological is regarded as partly valid. While startling developments have occurred during the last several years that lead experts to acknowledge certain genes as responsible for susceptibility to alcoholism, researchers are quick to point out that alcoholism is a complicated disorder and that declaring it solely genetic may be an oversimplification.
"There is no doubt that genetics plays a role in alcoholism," says Enoch Gordis, director of the National Institute on Alcohol Abuse and Alcoholism, or NIAAA, a federal agency in Rockville, Md. "We have twins and adoption studies going back 25 years that prove this. But do we say it's only genetic? Of course not. Social issues, family issues and environment all play out. We know that some people are loaded genetically, but obviously they can't become alcoholic unless they take a drink. The genes are for risk, not for destiny."
According to the NIAAA's most recent Special Report to Congress on Alcohol and Health, as many as 80 percent of alcoholics in treatment have "close biological relatives with a history of alcohol-related problems." Gordis estimates that 60 percent of alcoholics acquire their addiction genetically, leaving 40 percent who become alcoholics for psychological, social and environmental reasons.
Whether as a result of genetics, personality or environment, the cost of alcohol abuse and dependence is high. An estimated 15 million Americans have problems with alcohol abuse and dependence; alcohol is involved in half of all fatal car crashes and is directly responsible for 5 percent of all deaths in the United States. The medical consequences add up to more than $6 billion, including more than $1 billion to treat fetal alcohol syndrome. Considering that federally estimated total of $80 billion in total damages, this is just scratching the surface.
While Gordis is not ready to announce that all alcoholism is genetic, he believes the research increasingly is pointing in that direction. He cites the work of Marc Schuckit, a psychiatrist at the University of San Diego, who has conducted studies showing that, from the time they start drinking, some children of alcoholics metabolize alcohol abnormally and exhibit a genetically based higher tolerance for the drug than the general population. …