Family History; No Predictor of Remission from Alcoholism

 A family history of alcoholism is a risk factor for the development of alcohol addiction, but it does not predict remission from the disorder, according to a study presented here at the American Psychiatric Association (APA)  Annual Meeting.

Although subjects in the study were followed for 40 years, researchers from the University of Kansas Medical Center, in Kansas City, Kansas, and the University of Copenhagen, in Denmark, were unable to find a link between a positive family history of alcoholism and whether or not subjects went into recovery. But 9 methods of assessing family history were able to predict the development of an alcohol-use disorder by the age of 40.

“Family history predicted who would get sick but not who would get better,” study investigator Elizabeth Penick, PhD, from the University of Kansas Medical Center. Dr. Penick added that the researchers found that other factors — personality characteristics rather than family history — are more important in predicting remission. “Our research has shown that 2 basic measures predict who will and will not go into remission — impulse discontrol and mild cognitive dysfunction,” she said.

Worse Cases More Likely to Recover

The study used a cohort of 9182 people born from 1959 to 1961 in Denmark. When the subjects were 17 years old, the researchers conducted a search for 8440 fathers in the Central Psychiatric Register and local alcoholism treatment clinics in Copenhagen to find those who had been treated for alcoholism. High-risk sons of alcoholic fathers — 220 in all — were followed for 40 years, as were 109 “low-risk” matched controls with no family history of dependence or abuse.

Subjects were assessed at ages 20, 30, and 40 years with a series of structured interviews, psychometric tests, and an examination by a senior psychiatrist. Nine methods of defining familial alcoholism were derived from the data, and all were strongly correlated with each other and with the development of alcohol dependence or alcohol abuse by age 40.

Of the 52 men who developed alcohol dependence, 58% recovered and went into remission. Of the 35 men who abused alcohol, 88% experienced a remission.

“Those who were sicker from alcoholism tended to get better,” Dr. Penick said. The average duration of remission for those who recovered from alcoholism was 11.1 years, she added.

Genetics of Alcoholism “Extremely Complex”

“We know that heredity is a good predictor of onset, and it can tell you who is at increased risk for alcoholism. Yet it doesn’t tell you what happens afterward,” said Mark Willenbring, MD, director of the division of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism.

Dr. Willenbring noted that those with a family history of alcoholism are at risk for a variety of psychiatric disorders, including alcohol abuse and dependence. Research has found that sons of alcoholic fathers are more likely to show a reduced response to alcohol — they can “hold their liquor.”

This characteristic, combined with behavioral discontrol, is a predictor for the later development of alcohol dependence. “But these characteristics can also predict depression, antisocial behavior, and eating disorders,” Dr. Willenbring said.

Dr. Willenbring noted that the genetics of alcoholism is extremely complex, and there may be multiple genes involved in the development of alcoholism. “It’s very difficult to understand what’s inherited and what comes about through environment,” he said.

At the same time, he added, there are still gaps in research knowledge about what predicts remission among those who develop alcohol dependence or abuse. “It may be different personality factors, but it may also revolve around how strong the person’s social networks are,” he said.

The study was funded by grants from the National Institute on Alcohol Abuse and Alcoholism,

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