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What other risk factors are associated with alcoholism?

The concept of risk is a modem one. The word derives from the Italian riscare, meaning "to dare." Before such a concept, the future could only be predicted by consulting the gods, prophets, or astrologers, and when bad things happened, they were attributed to fate. The concept of risk was born out of a simple yet practical question regarding games of chance when money was at stake. Given certain known events that just occurred in the game, what are the odds for winning the game? From there, everything about predicting the future grew, and forecasting with degrees of certainty for future events of all kinds developed. Humans, however, are poor at assessing risk, and as a result, they are lousy predictors of the future. Studies have regularly demonstrated that humans overly focus on sensational events that are highly unpredictable to the exclusion of much more mundane events that pose greater risks and are more predictable.

The most common example of this is fear of flying because of plane crashes and more recently terrorism, yet the person doesn't give any thought that driving one's car to work daily poses a far greater risk. The lesser fear associated with driving one's own car comes from both the illusion of control and its daily occurrence. A less common but more recently described sensational example is the risk associated with swimming pools verses guns. What is more dangerous: a swimming pool or a gun? This answer, based on simple statistics, is swimming pools. In 1997, 550 children who were 10 years old and younger drowned in swimming pools. There are 6 million swimming pools in the United States, which translates statistically into one drowning annually for every 11,000 pools. In 1998, 175 children 10 years old and younger died as a result of guns. Approximately 200 million guns are in the United States, translating into one death for every million guns. Thus, if you own both a gun and a swimming pool, your child is 100 times more likely to die from the swimming pool than the gun.

Knowledge of risk provides some power over predicting future events so as to make the odds more favorable to attaining one's goals. For example, although wearing seat belts does not change the odds of getting into an accident, it does change the odds of surviving one. In medicine, knowledge of risk helps the clinician understand the odds of developing certain diseases. Remember, however, that odds, no matter how favorable or unfavorable, are still just odds, with the outcome for any particular event still unknown. Just because the odds of developing lung cancer are greater for one who smokes a pack of cigarettes a day than one who does not does not mean that the outcomes are certain.

Some risk factors you can change, and other risk factors you cannot. Individuals cannot change the genes inherited from their parents, but they can use the knowledge of their family history to help make choices in life to reduce other risk factors contributing to the probability of developing a particular disease. Modifiable risk factors are those factors that can be changed, such as stopping smoking, changing one's diet and exercise regimen, or abstaining from alcohol. Other opportunities for "beating the odds" include following the recommendations for various diagnostic tests for breast cancer, colon cancer, and heart disease, depending on whether someone has a family history for a particular condition. Now that you have been introduced to the concept of "risk," here are some of the risk factors associated with alcoholism.

Individuals cannot change the genes inherited from their parents, but they can use the knowledge of their family history to help make choices in life to reduce other risk factors contributing to the probability of developing a particular disease.

Being poor and uneducated increases the risk for alcoholism. George Valliant, the doyen of alcohol research, found that innercity, non college-educated men began drinking approximately 10 years earlier than college- educated men. They were also more likely not to drink, but if they drank, they were more likely to die as a result of their drinking. This fact demonstrates that it is not the frequency of alcohol consumption as much as it is the pattern of alcohol consumption that places a person at risk. Mortality from both groups, however, was more commonly related to tobacco use.

Being Caucasian or Hispanic as opposed to African American increases the risk for alcoholism. Additionally, Native Americans tend to have the highest rates of alcoholism, whereas Asian Americans have the lowest. This may be partly due to the genetic variation in alcohol-metabolizing enzymes alcohol dehydrogenase, which depends on one's race (see Table 6).

Table 6 Genetic Variation in Alcohol-Metabolizing Enzymes

• Alcohol Dehydrogenase

Polymorphism occurs at ADH2 and ADH3 gene

ADH2*1

ADH2*2

ADH2*3

ADH3*1

ADH3*2

White American

95%

< 5%

< 5%

50%

50%

African American

85%

< 5%

15%

85%

15%

Asian

15%

85%

< 5%

95%

5%

15% of African Americans have the ADH2*3 allele, causing an increased alcohol metabolic rate and an increased elimination of acetaldehyde.

* Aldehyde Dehydrogenase (ALDH)

85% of Asians have the ALDH2*2 allele, causing a decreased elimination of acetaldehyde (and alcohol) and flushing response

Males are at greater risk for alcoholism than females. Lifetime prevalence was 20% in men and only 8% in women. When examining rates in the past year, they are 10% and 4%, respectively. This is partly attributed to the fact that women do not metabolize alcohol as efficiently as men and thus are more prone to the immediate negative effects of it. When women do develop problems with alcohol, they tend to develop them later in life, tend to combine alcohol with prescription drugs, and are less likely to be recognized as having a problem or receive treatment for their problem. This may be because women are less likely to work outside of the home, and thus, they are less exposed to the financial, occupational, and legal troubles that may accompany heavy drinking.

Finally, as you age, the prevalence of alcoholism decreases. The prevalence of alcoholism in people over 65 years old is around 3%; however, these numbers may not be as reliable and are harder to recognize, and less alcohol is required to cause a significant problem for the individual.

 
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