Etiology and Typology of Alcohol-Related Disorders

Introduction

• Etiology for alcohol-related disorders depends on social, religious, and personality factors.
• It includes initiation of drinking habits or temporary drinking problems.
• Genetic factors also influence alcohol-related disorders through impulsivity and risk-taking.

Etiology of alcohol use disorders (AUDs)

Genetic mediators of alcohol use disorders (AUDs) risk 

Genetic factors contribute to 60% of the risk for AUD. There is a 3-4 times higher risk if a close family member of the person is with AUds. The Risk increases with a greater number of such relatives, greater severity of AUDs, and closer genetic relationships. Risks are higher in monozygotic twins as compared to dizygotic twins. Adopted children of the person with AUD also show the risk of AUD with 4 times higher risk, given that he/she is not raised by the parents with AUD. Risk does not increase when adopted parents have AUD. A family history of alcoholism increases risk among people of different socioeconomic classes. Multiple factors increase risk (high impulsivity and low level of response to alcohol). Multiple gene interactions with the environment.

Biological mediators of AUD risk 

Biological mediators of AUD risk include the following factors:

1. Alcohol metabolizing enzymes:

It includes variations in genes that control alcohol dehydrogenase enzyme (ADH) on chromosome 4 and ALDH on chromosome 12. These variations can also decrease the risk of alcoholism. The most potent polymorphism occurs in the mitochondrial low km ALDH2 gene (ALDH2*2 genotype). It is seen in 40% of the Japanese, Chinese, and Korean populations.

2. Impulsivity and disinhibition

It happens through genes that affect sensation seeking, impulsivity, and disinhibition. Antisocial PD (extreme impulsivity, disinhibition). It increases the risk for AUDs and substance use disorders (SUDs) by 80%.

3. Independent Psychiatric disorders

It increases the risk for AUDs and SUDs through genes that increase the vulnerability to psychiatric disorders. Psychotic disorders include antisocial PD, schizophrenia, and bipolar disorder. Some relationships due to the use of alcohol or illicit drugs decrease psychiatric symptoms or decrease the effect of medications.

4. Low level of response (or sensitivity) to alcohol

It increases with the people who experience high stimulation at rising blood alcohol levels and lower response at peak and falling levels. Lower response rate, people need higher doses to get alcohol effects. It leads to an increase in consumption, increases positive expectations, and increases use to handle stress. Lower response is either due to genes or possible cognitive inefficiency, making it difficult to recognize the effects of low alcohol doses.

Psychological and Sociocultural theories in alcoholism risk

1. Stress / Adverse life events

• It has a complex bidirectional correlation. An increase in stress leads to heavy drinking and vice versa.

2. Person’s expectations of effects of alcohol

• A higher risk of positive expectations of drinking impacts social interaction and reduces sadness, anxiety, and sexual performance.
• Lowers the risk of expectations of alcohol interfering with relationships, sexual performance, or other negative outcomes.

3. Perceived pattern of drinking among peers 

• A person tends to overestimate the alcohol consumption of friends, which exaggerates the amount that is acceptable, healthy, and safe.
• It increases the risk of heavier drinking

4. Other factors:

• Other factors involve influence from the neighborhood, ease of availability, income levels, education levels, religious beliefs, and cultural practices.

To read about the factors that affect of Childhood history in alcoholism risk and Psychodynamic theories in alcoholism risk, sign up for the PrepLadder app Residency psychiatry program and learn from the best faculties in India.

Also Read: Nymphomania: Causes, Symptoms, Risk Factors, Diagnosis, Treatment

Topology of Alcohol-Related Disorders

Babor’s Classification

Cloninger Classification

Lesch typology (Syndrome)

Jellinek 5 ‘species’ 

1. Alpha: Excessive and inappropriate drinking to rescue physical or emotional pain
2. Beta: Drinking due to physical complications + no dependence
3. Gamma: It is known as malignant alcoholism (psychological + physical dependence)
4. Delta: Physical then psychological dependence (more social influence of drinking)
5. Epsilon: is known as dipsomania (compulsive drinking)

Frequently Asked Questions: 

Question: What percentage of the risk for Alcohol Use Disorders (AUDs) is attributed to genetic factors?

A. 20%

B. 40%

C. 60%

D. 80%

Answer: C. 60%

Question: Which gene controls the mitochondrial low km ALDH2 enzyme and significantly decreases the risk of Alcohol Use Disorder (AUD) when homozygous?

A. ADH1C

B. ALDH2

C. ADH1B

D. ALDH1A1

Answer: B. ALDH2

Question: What psychiatric disorder, characterized by extreme impulsivity and disinhibition, increases the risk of AUDs and Substance Use Disorders (SUDs) by 80%?

A. Bipolar Disorder

B. Antisocial Personality Disorder

C. Schizophrenia

D. Panic Disorder

Answer: B. 

Question: Which electrophysiological marker significantly reduces in one-third of sons of alcoholic fathers?

A. P3

B. Alpha waves

C. Theta waves

D. Delta waves

Answer: A. P3

Question: According to classic psychoanalytical theory, what developmental stage might individuals fixate on if they develop Alcohol Use Disorder (AUD)?

A. Genital stage

B. Phallic stage

C. Anal stage

D. Oral stage

Answer: D. Oral stage

Question: Which of the following is a characteristic of Type A Alcoholism?

A. Early age of onset

B. High personality impulsivity

C. More Severe

D. Coping skills training as a treatment

Answer: C. More Severe

Question: What is another name for Type B Alcoholism in Babor’s Classification?

A. APOLLO

B. BACCHUS

C. Dionysus

D. Hermes

Answer: B. BACCHUS

Question: In Lesch's Typology, which model attributes craving to cerebral damage or childhood problems?

A. Allergy model

B. Conflict-solving model

C. Depressive model

D. Conditioning model

Answer: D. Conditioning model

Question: What characterizes individuals in Jellinek's 'Delta' species?

A. Excessive and inappropriate drinking to rescue physical or emotional pain

B. Drinking due to physical complications without dependence

C. Physical then psychological dependence

D. Compulsive drinking (dipsomania)

Answer: C. Physical then psychological dependence

Also Read: Assessment And Prognosis of Alcohol-Related Disorders

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