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What causes the disease of alcoholism?

The facile answer would be drinking alcohol in excess causes alcoholism, but that begs this question: Why do some people drink to excess, whereas others do not? Why can some people drink larger quantities than others and suffer no ill effects? If alcoholism is a disease (see Question 11), then it should be considered a disease of lifestyle — that is, alcoholism is the consequence of particular cultural and environmental forces playing on one's biological predisposition. Consequently, multiple causes, rather than one simple cause, must exist. This is true for most medical conditions. The three leading causes of death — heart disease, stroke, and cancer — are all diseases of lifestyle. For example, consider the link between smoking and lung cancer. Smoking did not exist in Western culture until the discovery of the New World in the late 15th century. For centuries later it gradually took root as an acceptable and perhaps even healthy habit. It was only in the last 50 to 60 years that doctors began to suspect that it was responsible for the rise in lung cancer. Still, it took many years of statistical analysis before scientists could demonstrate a clear causal link between cigarette smoking and lung cancer. Even this statistical analysis required a cultural shift to accept that fact. Even today, people argue, "My grandmother smoked her entire life and died at the ripe old age of 90 from natural causes. How can cigarettes possibly cause cancer?" The reality is that cigarette smoking is only one piece, albeit a big one, of the causal puzzle that leads to lung cancer. Instead, when physicians talk about cause, they are really talking about various risk factors that influence the odds of developing a particular illness. This is discussed at greater length in Questions 21 and 22. Alcohol use is a necessary but not sufficient cause in the development of alcoholism.

A variety of sources inside and outside of a person impact the odds of becoming alcoholic. The biopsychosocial model provides a framework for understanding the multifactorial causes of alcoholism. In this model, considerations are given to biological, psychological, and social factors that influence the odds of developing any particular disease. This model provides a greater understanding of "diseases of lifestyle." For example, applying the biopsychosocial model to lung cancer demonstrates the biological risk factors of family history, the presence of particular genetic markers, and the direct effects of particular carcinogens acting on the tissues; psychological risk factors of addictive personality, and/or certain mental illnesses such as schizophrenia, that make an individual more prone to smoking; and the social risk factors of exposure to peers who smoke, the person's diet and activity level, or exposure to other environmental toxins. All of these factors influence the odds of having lung cancer.

Biologically, alcoholism is associated with changes in various neurotransmitter levels and activity. Additionally, alcoholism frequently runs in families, suggesting a genetic, or heritable, aspect to the illness. Psychologically, certain personality types are more prone to developing alcoholism. People who are antisocial or prone to risk taking are more likely to abuse drugs and alcohol. Also, people who are anxious, particularly in social situations, are susceptible to alcohol abuse and dependence. Socially, alcoholism is linked to stressful life events, usually entailing an overwhelming psychological trauma. Individuals with a posttraumatic stress disorder (PTSD) are more prone to alcoholism. In summary, no one cause of alcoholism exists. It is a multifactorial disorder caused by a genetic predisposition, personality traits, psychological trauma, and environmental factors.

People who are antisocial or prone to risk taking are more likely to abuse drugs and alcohol. Also, people who are anxious, particularly in social situations, are susceptible to alcohol abuse and dependence.

Posttraumatic Stress Disorder (PTSD) a mental/emotional disorder that is characterized by persistent distressing symptoms lasting longer than 1 month after exposure to an extremely traumatic event.

Susan's comment:

The "biopsychosocial" model can easily be applied to Ben.

Biologically, a very significant family history of alcohol abuse exists on both sides. In addition, Ben suffered a skull fracture in three places as a result of a fall when he was 2.5 years old. Two CAT scans of his brain about 2 years apart in the past 5 years reveal "diffuse cerebral atrophy fairly severe for the patient's age. "Everyone agrees that there is a relationship between that event and how severe his disease is. If nothing else, this serves as more evidence that it is "not his fault," which a mother needs to believe.

Psychologically, Ben was diagnosed with moderate to severe ADHD in the fourth grade, but at the time, I was not a believer in a condition that seemed like an excuse for lack of attention and laziness. He was excitable as a small child, and as he grew, that turned into serious anxiety.

Socially, Bens father lost his business in a very public and humiliating way, a consequence of drinking, about a year after the first withdrawal. Along with that, Bens accustomed lifestyle was lost: his own convertible, a waterfront house with a boat, country club membership, etc. In addition, Bens dad also had a much-loved girlfriend who died suddenly at around the same time. Currently, the worst source of inner conflict for him is his relationship with his father, who still drinks actively. I have done everything to keep them apart but have failed, and the loyalty of this son to his father is both destructive and unshakable. My remarriage almost 6 years ago has been a huge adjustment for Benny, who was used to having me all to himself.

 
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