How family history influences your drinking

Alcohol was a big part of family life for Stephen growing up. Holidays, backyard barbecues and a hard day at work were all reasons for his father and uncles to drink a six-pack of beer – or more.

“There was nothing going on that didn’t involve tons of alcohol,” says Stephen, now 53 and a doctor. (He requested that only his middle name be used to protect his and his family’s privacy.)

From the age of fourteen, Stephen was allowed to have a beer with his father every now and then. As he grew older, he modeled his drinking on that of his family, with every social gathering in his 20s involving “a boatload of alcohol.”

Both of Stephen’s parents had told him stories about their own father’s struggles with alcoholism, and how they sometimes became violent. But because the behavior of his immediate family was not like this, Stephen did not view their drinking as problematic for a long time.

Stephen stopped drinking while in medical school, partly to prove to himself that he didn’t have a problem. When he started again during residency in his late 30s, alcohol affected him differently. “Suddenly 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 shows that having an immediate family member, such as a parent or brother or sister, with the disorder increases the chance that someone will develop the disorder. three to fourfold. About 50 percent of a person’s risk comes from their genes, but their home and social environment are also important factors.

Here’s what you need to know about how alcoholism runs in families and some ways to protect yourself from it.

How does genetics put you at risk?

No single gene is responsible for developing an alcohol use disorder; instead, experts say hundreds genes probably play a role.

Scientists have identified some of the traits that affect these genes, starting with the way the body processes alcohol. When alcohol metabolism is disrupted, drinking can be physically unpleasant, causing people to feel nauseous and develop headaches. Having this trait, which is associated with at least two gene variants most common in people of Asian descent, lowers a person’s risk for alcohol use disorder because a person is less likely to drink a lot or not at all.

At the other end of the spectrum are people who can “pretty much drink other people under the table” before feeling the effects of alcohol, said Dr. Marc Schuckit, a professor of psychiatry at the University of California, San Diego. These people are at greater risk for alcohol use disorders because they tend to drink more.

Having a high tolerance for alcohol may also be related to the way the body metabolizes the substance, although scientists have not identified specific gene variants for this, as they have for low tolerance. Dr. Schuckit added that some people don’t feel so drunk as others do when they have had a lot to drink, or they may not realize how drunk they actually are and therefore miss the signal to slow down or stop.

Our genes can also influence impulsivity and how the brain responds to rewards – traits linked to alcohol use disorders, as well as other forms of addiction. These characteristics can lead a person to seek out fun or pleasurable experiences, such as drinking more heavily, without thinking about the consequences.

What explains the rest of a person’s risk?

The environment in which someone grows up also has a major influence on their drinking behavior. If someone grows up in a household where excessive drinking is normal, and if they have positive associations with alcohol, they are more likely to try it, says R. Kathryn McHugh, chief of psychology at McLean Hospital in Massachusetts.

The age at which someone starts drinking makes a big difference in terms of risk. According to a often cited studyAbout 16 percent of people who first try alcohol between the ages of 11 and 12 develop dependence, while only 1 percent of people who start drinking at 19 or older do so.

“The longer you can delay someone’s first drink, you reduce your risk of developing alcoholism manyfold,” says Dr. Kathleen Brady, professor of psychiatry and behavioral sciences at the Medical University of South Carolina. Experts think this is because early exposure to alcohol can cause it change the brain while still developing, especially in areas related to self-control.

Exposure to childhood trauma also puts one at risk. One theory is that trauma in early life increases the brain’s stress response. “Maybe the same stressor is coming at you, but your body, your brain, is actually reacting amplified to that stress,” explained Dr. McHugh out. Because alcohol is often used to cope, feeling more stressed can lead people to drink more.

How can you protect yourself?

While there are many factors that contribute to a person’s risk for alcohol use disorder, there is only one way to eliminate it: not drinking. “That’s a pretty extreme solution, but it’s the solution that works best,” said Dr. Henry Kranzler, professor of psychiatry at the University of Pennsylvania’s Perelman School of Medicine.

In the absence of complete abstinence, experts recommended drinking in moderation: no more than one drink per day for women and two for men. “Set some personal limits, write them down and try to stick to them,” said Dr. Brady. “And if you can’t stick to that, you may very well need more professional help.”

The experts also suggested examining why you drink so you can be more strategic about cutting back. If you are primarily a social drinker, be extra conscious of your alcohol consumption at parties. Also look for social activities that have nothing to do with drinking. On the other hand, if you drink more when you’re anxious, try avoiding alcohol when you’re stressed and look for alternative ways to cope.

“Everyone is going to look a little different in terms of why they drink alcohol, what environments they drink alcohol in, what their personal risk factors might look like,” said Dr. McHugh.

Having a friend or partner who knows about your risk can also help you resolve any issues. For Stephen, that person was his wife. Once they got married and moved in together, he could no longer hide the extent of his drinking – or ignore the fact that he had a problem. Stephen’s wife insisted he seek help, and although it took him a few years to get sober, he hasn’t drunk in seven years.

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