Medicine: Out in the Open

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Though awareness of alcoholism's destructiveness is growing, the sheer number of alcoholics shows no sign of abating. Young people are especially vulnerable. Bowen states that nearly 5 million adolescents, or three in every ten, have drinking problems. Several studies show that children are beginning to drink earlier than ever before, and a Weekly Reader study earlier this year reported that 36% of fourth-graders were pressured by peers to drink. "Kids are making decisions about alcohol and drugs when they are 12 to 14, whereas in the preceding generation they made those decisions at ages 16 to 18," says Lee Dogoloff, executive director of the American Council for Drug Education. "The younger a person starts drinking, the more likely he is to develop problems later in life."

Who, exactly, is an alcoholic? The question is a tricky one: symptoms are not always clear cut, and even doctors do not agree on a definition of the disease. The extreme cases are obvious. A person in the grip of alcoholism blacks out from drinking too much, suffers memory loss, and wakes up trembling with craving for another drink. But most cases show fewer dramatic symptoms. Also, the behavior of alcoholics fluctuates wildly. Some drink heavily every day, while others can stop for brief periods, only to go off on binges. This past year the American Psychiatric Association settled on three basic criteria to define and diagnose alcoholism: physiological symptoms, such as hand tremors and blackouts; psychological difficulties, which include an obsessive desire to drink; and behavioral problems that disrupt social or work life.

The search for alcoholism's genetic underpinnings began in earnest in the early 1970s with a simple question: Why does the disease seem to run in families? Dr. Donald Goodwin, chairman of the psychiatry department at the University of Kansas School of Medicine, set about seeking an answer by studying 133 Danish men who were all adopted as small children and raised by nonalcoholics. Goodwin divided his subjects into two categories: those with nonalcoholic biological parents and those with at least one alcoholic parent. Then he interviewed each of the adopted men in depth and examined health records to see which of them developed alcoholism in adulthood. If the disease had a genetic basis, Goodwin reasoned, then the children who had an alcoholic biological parent would wind up with drinking problems more often than the others.

His findings were startling. The sons of alcoholics turned up with drinking problems four times as often as the sons of nonalcoholics. That result helped put to rest the popular assumption that alcoholics took up drinking simply because they learned it at home or turned to it because of abuse suffered at the hands of an alcoholic parent. The study, however, did not rule out environmental factors. Indeed, scientists now estimate that fully 30% of alcoholics have no family history of the disease. But Goodwin showed that some inherited attribute was involved. "What we learned from the adoption studies," says Dr. C. Robert Cloninger, a professor of psychiatry at Washington University in St. Louis, "is not that nature was important or / nurture was important but that both are important."