Alcoholism is the excessive and chronic consumption of alcohol over time. The American Medical Association and other influential groups recognize and treat alcohol dependence as a disease. Alcoholism among pregnant women is a serious social problem today. Alcohol abuse during pregnancy can cause severe and irreversible mental and physical problems in children. If an alcoholic woman with a CRISIS PREGNANCY is considering adoption for her child, physicians should carefully monitor the pregnancy and assist her in entering a detoxification program as soon as possible. (See FETAL ALCOHOL SYNDROME.)
Studies of adopted adults from the 1970s to date indicate that the rate of alcohol abuse is about the same as for adults in the general population. However, some studies, such as those done by Bohman and Sigvardsson, show that children adopted after the age of nine months have a higher rate of alcohol abuse as adults than do adopted adults who were placed at a younger age.
There are numerous studies on alcoholism among adopted adults, and one might wonder why there are so many studies if adopted adults are not at higher risk for alcoholism that the nonadopted population. Perhaps British author and researcher David Howe explained it best in his book Patterns of Adoption:
The choice of behaviours by scientists is often that which also concerns policy makers and practitioners: education, mental health and antisocial behavior. To this extent, the knowledge produced about adopted children's development appears a little imbalanced, concentrating mainly on the disturbed and the deviant. More "normal" behaviours receive less attention. Thus, a digest of behavioural genetic research that might interest adoption workers needs to be read with this distortion in mind. By association, one can have the feeling that because these scientists write a lot about schizophrenia or crime using adoption as one of their "natural experiments," then adoptions themselves are beset with these behaviours. This, of course, is not the case.
In looking at studies, it is important to ascertain whether the researcher reported on whether the subjects were adopted as infants or older children. Often, that information is not provided, and in that case, one can assume the researcher did not consider its relevance.
However, the age at the point of adoption is significant because an older child may have experienced abuse and neglect, and it could be those environmental problems, rather than genetic problems, that contribute to such problematic behavior as alcoholism. It is also true that analysis can be confounded because often it cannot be determined whether heredity or environment is a driving force to maladaptive behavior.
Certain subcultures and ethnic groups appear to have a greater problem with alcoholism than others; for example, many Native American tribes have a documented problem with alcoholism, a problem many are working to prevent. (Because of the great diversity in drinking practices among individuals in their various tribal groups, however, it is impossible to generalize about the drinking problems of Indians as a whole.)
A Genetic Predisposition
Studies of adopted persons, adoptive parents and birthparents have revealed that alcoholism is at least partially an inherited trait; consequently, adopted persons with alcoholic birthparents may have a genetic predisposition to the disease. However, the majority of adopted persons do not exhibit alcoholic behavior, even when birthparents are alcoholics. Currently, most scientists agree that alcoholism is based on a complex mix of genetic, cultural and social factors. Much of the current evidence for a genetic contribution to alcoholism is derived from Scandinavian studies of the incidence and patterns of the disease among adopted adults, as well as of adopted twins who were separated at birth.
In his adoption studies, researcher Remi Cadoret has reported a linkage between alcoholic birthparents and alcoholism in children they had placed for adoption. However, he also found a linkage between alcoholism in adoptive parents (presumably, a rare occurrence) and alcoholism in the children they adopted. Said Cadoret in a 1995 issue of Alcohol Health & Research World, on one of his studies:
In the study, 160 male adoptees, their biological relatives, and their adoptive families were analyzed regarding alcohol problems, antisocial behavior, and other psychological variables. The study found that a genetic influence, such as alcohol problems in first-degree (i.e., parents) or second-degree (i.e., grandparents) biological relatives, increased an adoptee's risk for alcohol problems 4.6-fold.
Similarly, an environmental influence, such as alcohol problems in a member of the adoptive family, resulted in a 2.7-fold higher risk for alcohol problems in the adoptee, compared with adoptive families without alcohol problems.
In April of 1990, it was reported in the Journal of the American Medical Association that a research team headed by Dr. Ernest P. Noble of the University of California at Los Angeles and Dr. Kenneth Blum of the University of Texas Health Science Center in San Antonio had identified a gene that is believed to be linked to a higher risk of alcoholism. The gene, located on chromosome 11, is the "D2" receptor gene for dopamine, a chemical tied to pleasure seeking behavior, and was found in the brains of 77% of the 35 people studied who had died of alcoholism. The gene was present in the brains of only 28% of the nonalcoholics studied. The finding will need to be repeated on a large number of alcoholics before it can be considered certain.
The most frequently cited studies supporting a genetic role in alcoholism are the Scandinavian adoption studies, which consistently show that the biological susceptibility for alcoholism is active even when children are separated from their biological families. These studies have become increasingly sophisticated since the landmark Swedish finding in 1960 that, of identical twins separated at birth, the chance that one twin would become alcoholic if the other did as well was 74%. (In contrast, the concordance of alcoholism between fraternal twins was found to be 26%.) Given their number and variety, it is possible to report on these studies in only a cursory way here, and readers are referred to sources at the end of this entry for more information. Among the most compelling findings of these adoption studies, it was found that the biological sons of alcoholics, as well as the biological daughters of alcoholic mothers, were three times as likely as other adopted persons to develop alcoholism. The most recent research in this area has focused on heritability of specific drinking behaviors, such as frequency, quantity and regularity of drinking at particular times. Interestingly, the heritability estimates for these behaviors have been found to range from 36% to 40%.
Among the most important of adoption studies was the analysis of Swedish research that has revealed the existence of two types of genetic predispositions to alcoholism (Cloninger et al., 1981). Type I, or milieu-limited, alcoholism fit most closely into existing causal patterns for alcoholism. This type was found to occur in both sexes (it could be transmitted by either biological parent and could be passed to children of either sex) and was implicated in most cases of alcoholism. It was associated with low-level, late-onset drinking behavior in either biological parent and little parental criminal behavior (a further indicator of a lower severity of drinking behavior). Adopted persons with this type of predisposition were reported to be heavily influenced in their drinking behavior by factors in their postnatal environment-or milieu-rather than exclusively by the genes they inherited from their biological parents.
Type II alcoholism was said to be male-limited, as it was transmitted exclusively from father to son and accounted for approximately 25% of male alcoholics. This type of susceptibility was found to be unaffected by environment. In cases of severe alcoholism in the biological father, for example, as evidenced by early-onset drinking as well as increased criminal behavior and extensive treatment, adopted sons, regardless of their postnatal environment, were nine times more likely than controls to abuse alcohol. Despite the strong heritability of this type of alcoholism, some environmental influence was suspected in the severity of alcohol abuse, as the sons tended to be less alcoholic than their biological fathers.
Interestingly, in milieu-limited alcoholism, the type of postnatal environmental provocation that was likely to act as a factor in alcohol abuse was not alcoholism in the adoptive parents. Instead, the only significant factor that was found necessary to activate susceptibility was a low socioeconomic status of the adoptive parents.
In one interesting study published in a 1998 issue of Psychiatry, of adult twins who were separated as infants, one adopted and the other reared by a biological parent (drawn from the Colorado Adoption Study), researchers found little differences between the twins, and both groups were within the normal range of behavior. However, the twin reared by the biological mother had attained a lower socioeconomic status and was more likely to drink excessively than the adopted twin. The researchers speculated that the more positive socioeconomic status of the adopted adult probably mitigated against excessive use of alcohol.
Because such social problems as alcoholism and criminality can destroy an individual and his or her family and waste millions of dollars as well as lives, it is hoped that scientists will continue to analyze this problem, its genetic basis and any identified environmental causal factors. (See also CRIMINAL BEHAVIOR IN ADOPTED ADULTS; FETAL ALCOHOL SYNDROME; GENETIC PRE-DISPOSITIONS; PSYCHIATRIC PROBLEMS OF ADOPTED PERSONS.)
Kenneth Blum, Ph.D., Ernest P. Noble, Ph.D., M.D., Peter J. Sheridan, Ph.D., Anne Montgomery, M.Sc., Terry Ritchie, Ph.D., Pudur Jagadeeswaran, Ph.D., Harou Nogami, Ph.D., Arthur H. Briggs, M.D. and Jay B. Cohn, M.D., Ph.D., "Allelic Association of Human Dopamine D2 Receptor Gene in Alcoholism," Journal of the American Medical Association 263 (April 18, 1990): 2055-2077.
Michael Bohman, M.D., "Alcoholism and Crime: Studies of Adoptees," Substance and Alcohol Actions/Misuse 4 (1983): 137-147.
M. Bohman and S. Sigvarsson, "Outcomes in Adoption: Lessons from Longitudinal Studies," in The Psychology of Adoption (New York: Oxford University Press, 1990).
Remi J. Cadoret, "Adoption Studies," Alcohol Health & Research World 19, no. 3 (summer 1995): 195-201.
Remi J. Cadoret, M.D., Colleen A. Cain and William M. Grove, M.S., "Development of Alcoholism in Adoptees Raised Apart from Alcoholic Biologic Relatives," Archives of General Psychiatry, 37 (May 1980): 561-563.
C. Robert Cloninger, "Neurogenetic Adaptive Mechanisms in Alcoholism," Science 236 (1987): 410-416.
C. Robert Cloninger, M. Bohman and S. Sigvardsson, "Inheritance of alcohol abuse," Archives of General Psychiatry 38 (1981): 861-868.
Kathleen Whalen Fitzgerald, Ph.D., Alcoholism: The Genetic Inheritance (New York: Doubleday, 1988).
Enoch Gordis, M.D., ed., Seventh Special Report to the U.S. Congress on Alcohol and Health (Rockville, Md.: NIAAA, 1990), chapter III.
David Howe, Patterns of Adoption (Oxford, England: Blackwell Science, 1998).
Robert O'Brien and Morris Chafetz, M.D., The Encyclopedia of Alcoholism (Editor of the 2nd Edition: Glen Evans) (New York: Facts On File, 1991).
John S. Searles, "The Role of Genetics in the Pathogenesis of Alcoholism," Journal of Abnormal Psychology 97 (May 1988): 153-167.
Michael A. Smyer, et al., "Childhood Adoption: Long-Term Effects in Adulthood," Psychiatry 61 (Fall 1998): 191-205.
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©2000 by Christine Adamec and William Pierce, Ph.D. Reprinted from The Encyclopedia of Adoption, 2nd Edition (2nd Edition) with permission of Facts On File, Inc.