Biological Factors
GENETICS.
A variety of studies investigating family history, adopted vs. biological children living in the same families, and twins separated and living in different families all indicate that genetics plays a substantial role in some forms of alcohol dependence and heavy drinking. A large number of genes is likely involved, each contributing a small part of the overall risk (Rachel F. Tyndale, "Genetics of Alcohol and Tobacco Use in Humans," Annals of Medicine, 2003).
Table 4.7 shows the percentage of U.S. adults eighteen years of age and over with prior-to-past year (2001-2002) alcohol dependence by selected characteristics. Notice that more than 75% of this alcohol-dependent sample had a family history of alcoholism. Most studies
TABLE 4.4
Trends in alcohol abuse, by age, sex, and race/ethnicity: 1991-92 vs. 2001-02
| Male | Female | Total | ||||
| Sociodemographic characteristic | NLAESa (1991-1992) | NESARCb (2001-2002) | NLAESa (1991-1992) | NESARCb (2001-2002) | NLAESa (1991-1992) | NESARCb (2001-2002) |
| Total | ||||||
| Total | 4.67 | 6.93 | 1.51 | 2.55 | 3.03 | 4.65 |
| 18-29 | 9.26 | 9.35 | 3.83 | 4.57 | 6.54 | 6.95 |
| 30-44 | 4.58 | 8.69 | 1.50 | 3.31 | 3.02 | 5.95 |
| 45-64 | 2.38 | 5.50 | 0.38 | 1.70 | 1.35 | 3.54 |
| 65+ | 0.55 | 2.36 | 0.04 | 0.38 | 0.25 | 1.21 |
| White | ||||||
| Total | 5.09 | 7.45 | 1.71 | 2.92 | 3.33 | 5.10 |
| 18-29 | 10.75 | 10.19 | 4.83 | 5.56 | 7.83 | 7.86 |
| 30-44 | 5.16 | 10.10 | 1.68 | 4.13 | 3.41 | 7.09 |
| 45-64 | 2.55 | 5.97 | 0.44 | 2.02 | 1.47 | 3.96 |
| 65+ | 0.52 | 2.38 | 0.04 | 0.36 | 0.24 | 1.21 |
| Black | ||||||
| Total | 2.38 | 5.71 | 0.73 | 1.41 | 1.46 | 3.29 |
| 18-29 | 3.83 | 6.92 | 1.27 | 2.10 | 2.44 | 4.28 |
| 30-44 | 2.54 | 7.04 | 1.00 | 1.51 | 1.70 | 3.95 |
| 45-64 | 1.19 | 4.48 | 0.02 | 1.25 | 0.54 | 2.66 |
| 65+ | 0.00 | 1.79 | 0.00 | 0.12 | 0.00 | 0.78 |
| Native American | ||||||
| Total | 12.80 | 7.47 | 4.31 | 4.18 | 8.14 | 5.75 |
| 18-29 | 27.88 | 15.25 | 8.19 | 6.68 | 17.59 | 10.35 |
| 30-44 | 2.64 | 7.67 | 3.73 | 6.52 | 3.22 | 7.07 |
| 45-64 | 0.00 | 4.85 | 0.00 | 0.00 | 0.00 | 2.57 |
| 65+ | 0.00 | 3.59 | 0.00 | 4.12 | 0.00 | 3.91 |
| Asian | ||||||
| Total | 1.65 | 3.20 | 0.47 | 1.13 | 1.08 | 2.13 |
| 18-29 | 3.30 | 4.77 | 0.74 | 3.89 | 2.02 | 4.35 |
| 30-44 | 1.67 | 4.22 | 0.21 | 0.23 | 0.93 | 2.18 |
| 45-64 | 0.00 | 1.13 | 0.66 | 0.20 | 0.30 | 0.61 |
| 65+ | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 |
| Hispanic/Latino | ||||||
| Total | 4.15 | 6.21 | 0.87 | 1.65 | 2.52 | 3.97 |
| 18-29 | 5.85 | 9.08 | 1.56 | 3.04 | 3.71 | 6.28 |
| 30-44 | 3.30 | 4.88 | 0.86 | 1.46 | 2.15 | 3.23 |
| 45-64 | 3.08 | 4.35 | 0.13 | 0.63 | 1.60 | 2.43 |
| 65+ | 2.90 | 3.69 | 0.00 | 0.00 | 1.16 | 1.56 |
| aNLAES=National Longitudinal Alcohol Epidemiologic Survey | ||||||
| bNESARC=National Epidemiologic Survey on Alcohol and Related Conditions | ||||||
suggest that genetic factors play a role in alcoholism and alcohol use in women as well as in men. Nonetheless, controversy remains as to the comparative strength of this role across genders. (See Table 4.6.)
ALCOHOL REACTIVITY (SENSITIVITY).
Alcohol reactivity or sensitivity refers to the sense of intoxication one has when drinking alcohol. The research on this topic has been primarily conducted on sons of alcoholics and reveals that, in general, they have a lower reactivity to alcohol. That is, when given moderate amounts of alcohol, sons of alcoholics report a lower subjective sense of intoxication compared with sons of nonalcoholics. Sons of alcoholics also show fewer signs of intoxication on certain physiological indicators than do the sons of nonalcoholics. Without early signals of intoxication, men with a low reactivity to alcohol may tend to drink more before they begin to feel drunk and thus may develop a high physiological tolerance for alcohol, which magnifies the problem. Susan Nolen-Hoeksema notes in "Gender Differences in Risk Factors and Consequences for Alcohol Use and Problems" (Clinical Psychology Review, 2004) that "long-term studies of men with low reactivity to moderate doses of alcohol suggest they are significantly more likely to become alcoholics over time than are men with greater reactivity to moderate doses of alcohol." (See Table 4.6.)
TABLE 4.5
Trends in alcohol dependence, by age, sex, and race/ethnicity: 1991-92 vs. 2001-02
| Male | Female | Total | ||||
| Sociodemographic characteristic | NLAESa(1991-1992) | NESARCb(2001-2002) | NLAESa(1991-1992) | NESARCb(2001-2002) | NLAESa(1991-1992) | NESARCb(2001-2002) |
| Total | ||||||
| Total | 6.33 | 5.42 | 2.58 | 2.32 | 4.38 | 3.81 |
| 18-29 | 12.81 | 13.00 | 6.01 | 5.52 | 9.40 | 9.24 |
| 30-44 | 6.07 | 4.98 | 2.47 | 2.61 | 4.25 | 3.77 |
| 45-64 | 3.19 | 2.67 | 1.12 | 1.15 | 2.12 | 1.89 |
| 65+ | 0.63 | 0.39 | 0.23 | 0.13 | 0.39 | 0.24 |
| White | ||||||
| Total | 6.16 | 5.41 | 2.67 | 2.37 | 4.35 | 3.83 |
| 18-29 | 13.59 | 15.10 | 7.28 | 6.38 | 10.48 | 10.71 |
| 30-44 | 6.12 | 5.13 | 2.43 | 2.84 | 4.27 | 3.98 |
| 45-64 | 2.80 | 2.56 | 1.03 | 1.15 | 1.89 | 1.84 |
| 65+ | 0.57 | 0.32 | 0.24 | 0.08 | 0.38 | 0.18 |
| Black | ||||||
| Total | 5.86 | 5.09 | 2.21 | 2.39 | 3.84 | 3.57 |
| 18-29 | 8.54 | 8.75 | 2.14 | 3.79 | 5.07 | 6.03 |
| 30-44 | 6.13 | 4.40 | 3.26 | 2.53 | 4.57 | 3.36 |
| 45-64 | 4.05 | 3.98 | 1.95 | 1.74 | 2.89 | 2.72 |
| 65+ | 0.83 | 1.10 | 0.00 | 0.71 | 0.32 | 0.87 |
| Native American | ||||||
| Total | 11.00 | 8.38 | 7.38 | 4.49 | 9.01 | 6.35 |
| 18-29 | 13.34 | 15.96 | 14.67 | 8.73 | 14.03 | 11.83 |
| 30-44 | 8.85 | 10.94 | 2.15 | 5.77 | 5.32 | 8.27 |
| 45-64 | 4.61 | 5.11 | 4.73 | 2.53 | 4.68 | 3.90 |
| 65+ | 25.39 | 0.00 | 0.00 | 0.00 | 9.75 | 0.00 |
| Asian | ||||||
| Total | 3.06 | 3.56 | 1.41 | 1.34 | 2.26 | 2.41 |
| 18-29 | 4.09 | 10.22 | 3.77 | 4.27 | 3.93 | 7.39 |
| 30-44 | 3.02 | 0.28 | 0.00 | 0.59 | 1.50 | 0.44 |
| 45-64 | 2.90 | 1.42 | 0.73 | 0.15 | 1.90 | 0.72 |
| 65+ | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 |
| Hispanic/Latino | ||||||
| Total | 9.40 | 5.90 | 2.15 | 1.94 | 5.78 | 3.95 |
| 18-29 | 15.44 | 9.58 | 2.97 | 3.85 | 9.21 | 6.92 |
| 30-44 | 6.56 | 5.33 | 2.70 | 1.65 | 4.74 | 3.55 |
| 45-64 | 6.70 | 2.06 | 0.63 | 0.46 | 3.65 | 1.23 |
| 65+ | 0.00 | 0.85 | 0.62 | 0.00 | 0.37 | 0.36 |
| aNLAES=National longitudinal alcohol epidemiologic survey | ||||||
| bNESARC=National epidemiologic survey on alcohol and related conditions | ||||||
Psychosocial Factors
SOCIAL SANCTIONS, GENDER ROLES, AND COPING STYLES.
Social sanctions are a mechanism of social control for enforcing a society's standards. Social sanctions may be one factor explaining why men drink more alcohol than women. A "double standard" appears to exist for men and women in American society with regard to consuming alcohol. Research findings support this idea. For example, a national survey conducted by Wilsnack in 1996 found that women thought that 50% of people at a party would disapprove of a woman getting drunk, but only 30% would disapprove of a man doing the same. (See Table 4.6.)
In addition to social sanctions against women drinking as heavily as men, the American culture appears to identify alcohol consumption as part of the male gender role but not as part of the female gender role. The results of several studies reviewed by Nolen-Hoeksema (Clinical Psychology Review, 2004) "find that people, particularly women, who endorse traditionally feminine traits (nurturance, emotional expressivity) report less quantity and frequency of alcohol use." (See Table 4.6.) In contrast, traits often associated with the male gender role, such as aggressiveness and overcontrol of emotions, have been associated with heavy and problem alcohol use in both men and women.
TABLE 4.6
Risk factors for alcohol use, abuse, and dependence
| Risk factor | Evidence |
| Genetics | Most studies find genetics contribute to alcoholism and alcohol use in both women and men; some studies suggest genetics play a stronger role in alcoholism for men than for women. |
| Alcohol reactivity | Studies of men find low alcohol reactivity is associated with a history of familial risk for alcohol use disorders and the development of alcohol use disorders in men. There are only a few small studies of women, but these studies also tend to find an association between familial risk for alcoholism and low alcohol reactivity. It is unknown whether there are gender differences in alcohol reactivity, but other studies find women may be more cognitively and motorically impaired at lower doses of alcohol, suggesting they have greater alcohol reactivity. |
| Social sanctions | Social sanctions are perceived to be greater for women drinking than for men drinking. It is unclear whether or not women actually suffer more negative social consequences as a result of heavy drinking than men. |
| Gender roles | Feminine traits (e.g., nurturance and warmth) are associated with less use and fewer alcohol problems. Undesirable masculine traits (aggressiveness and overcontrol) are associated with heavy and problematic alcohol use. Socially desirable masculine traits (instrumentality) are associated with fewer drinking problems. Patterns are generally the same for males and females. One study found that gender differences in gender role traits mediated gender differences in alcohol use and problems. |
| Coping styles | Avoidant coping is more consistently associated with alcohol consumption and drinking problems in men than in women. It is not clear whether there are gender differences in avoidant coping. |
| Motives and expectancies | Drinking to cope with distress and positive expectancies for the outcomes of alcohol consumption (e.g., that it will reduce distress) are associated with alcohol consumption and problem drinking; this relationship tends to be stronger for men than for women. Men tend to be more likely than women to report drinking to cope and positive expectancies for alcohol use. |
| Depression/distress | Among social drinkers, some studies show a stronger relationship between distress and drinking for men than women, whereas others show the opposite gender pattern; among alcoholics, the relationship between distress and alcohol use or problems is stronger for women than men. |
| Self-esteem | Some evidence suggests that low self-esteem is associated with alcohol-related problems in women more than men, but this result is inconsistent. |
| Behavioral undercontrol/sensation-seeking/impulsivity | Men score higher than women on measures of behavioral undercontrol, sensation-seeking, and impulsivity. These variables are consistently associated with alcohol use and problems in men, less consistently so in women. |
| Antisociality | Males are more likely to show symptoms of antisociality and delinquency than females. Antisociality is associated with alcohol use and disorders in both males and females. |
| Interpersonal relationships | There are strong similarities between partners in heterosexual couples in drinking patterns. It is not clear whether the effects of a partner on the individual's drinking are stronger for women or men. |
| Sexual assault | A history of sexual assault is associated with problem drinking and alcohol use disorders in both women and men. Women are more likely to have a history of sexual assault. |
In fact, heavy drinking may be a way that some people cope with stress and avoid emotions, a behavior referred to as "avoidant coping."
DRINKING MOTIVES, EXPECTATIONS, AND DEPRESSION/DISTRESS.
People consume alcohol for various reasons—as part of a meal, to celebrate certain occasions, and to reduce anxiety in social situations. But Nolen-Hoeksema comments that people also consume alcohol to cope with distress or depression, or to escape from negative feelings. Consequently, people expect that drinking alcohol will reduce tension, increase social or physical pleasure, and facilitate social interaction. Those who have positive expectations for their drinking, such as the belief that alcohol will reduce distress, tend to drink more than those who have negative expectancies, such as the belief that alcohol will interfere with the ability to cope with distress. In general, men have more positive expectations concerning alcohol consumption than women. These stronger motives to drink are more strongly associated with alcohol-related problems in men than in women (see Table 4.6), although Nolen-Hoeksema reports that the relationships among depression, general distress, alcohol consumption, and problems are quite complex.
SELF-ESTEEM, IMPULSIVITY, SENSATION-SEEKING, BEHAVIORAL UNDERCONTROL, AND ANTISOCIALITY.
As Table 4.6 shows, research results are inconclusive regarding the relationship between self-esteem and alcohol use. However, impulsivity, sensation-seeking, and behavioral undercontrol (not controlling one's behavior well) are consistently associated with alcohol use and problems in men. This association is less clear in women and may be another factor determining why a higher percentage of men than women are alcohol dependent. (See Table 4.7.)
Antisociality is a personality disorder that includes a chronic disregard for the rights of others and an absence of remorse for the harmful effects of these behaviors on others. People with this disorder are usually involved in aggressive and illegal activities. They are often impulsive and reckless and are more likely to become alcohol dependent. Males are more likely than females to demonstrate antisociality. (See Table 4.6.)
INTERPERSONAL RELATIONSHIPS AND SEXUAL ASSAULT.
Married couples often have strongly similar levels of drinking. It is unclear whether men and women with problem drinking patterns seek out partners with similar drinking patterns, or whether either is influenced by the other to drink during the marriage. However, marital discord is often present when spouses' drinking patterns differ significantly.
Sexual assault is a risk factor for problem drinking. The results of numerous studies have shown that women with a history of sexual assault, whether during childhood
TABLE 4.7
Characteristics of adults with prior-to-past-year alcohol
dependence
| Characteristic | n | Percentage distribution |
| Ages 18-29 | 1081 | 26.6 |
| Ages 30-44 | 1763 | 39.6 |
| Ages 45 and over | 1578 | 33.8 |
| Male | 2782 | 67.5 |
| Female | 1640 | 32.5 |
| White, non-Hispanic | 3027 | 78.9 |
| Black, non-Hispanic | 566 | 7.1 |
| Other, non-Hispanic | 210 | 5.7 |
| Hispanic | 619 | 8.3 |
| Less than high school graduate | 591 | 12.3 |
| High school graduate | 1192 | 27.7 |
| Attended/completed college | 2639 | 60.0 |
| Married | 2096 | 56.6 |
| Not married | 2326 | 43.5 |
| Family history of alcoholism | 3381 | 76.5 |
| No family history of alcoholism | 1041 | 23.5 |
| Avg. daily ethanol intake <1 oz | 890 | 21.2 |
| Avg. daily ethanol intake 1-4.9 oz | 1911 | 47.3 |
| Avg. daily ethanol intake 5+ oz | 1192 | 31.5 |
| <Age 18 at onset of dependence | 639 | 15.2 |
| Ages 18-24 at onset of dependence | 2175 | 52.7 |
| Ages 25+ at onset of dependence | 1523 | 32.1 |
| 3-9 life-time dependence symptoms | 1354 | 29.5 |
| 10-14 life-time dependence symptoms | 1468 | 33.4 |
| 15-19 life-time dependence symptoms | 740 | 17.6 |
| 20+ life-time dependence symptoms | 860 | 19.4 |
| Ever used tobacco | 3274 | 74.2 |
| Never used tobacco | 1148 | 25.8 |
| Any dependent use of illicit drugs | 658 | 14.7 |
| Any non-dependent use of illicit drugs | 2059 | 47.5 |
| Never used illicit drugs | 1705 | 37.8 |
| Any life-time mood/anxiety disorder | 2442 | 54.0 |
| No life-time mood/anxiety disorder | 1980 | 46.0 |
| Any life-time personality disorder | 1542 | 34.5 |
| No life-time personality disorder | 2880 | 65.5 |
| Total | 4422 | 100.0 |
| Note: n=number of persons. Adults=18 years of age and over. | ||
or as an adult, are at increased risk for problem drinking and alcohol use disorder. The correlation is not as clear in men (Nolen-Hoeksema, Clinical Psychology Review, 2004).
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