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Yet it is unlikely that treatment centers and AA would recant their commitment to total abstinence for alcoholics. Nonetheless, it is in these quarters that we can expect the most enthusiastic reception for the Blum-Noble research, because genetic causation of alcoholism is seen to support their fundamental assumption that alcoholism is an involuntary disease.
What Now?
The New York Times and other media claimed that the JAMA study appeared to offer "strong new evidence" for the heritability of alcoholism (this was, of course, the point of the AMA press release), an issue that has "been widely debated for decades." Actually, enthusiasm for the idea that alcoholism is inherited has prevailed in the United States for some time. AA and most proponents of the disease theory (including most of the people who manage America's 4,600 private alcohol-treatment programs) have for a long time insisted that alcoholism is an inherited disease. For about the past decade the number of researchers investigating the topic has been growing, along with the assumption that alcoholism is at least in part genetically caused. For example, the National Institute on Alcohol Abuse and Alcoholism published a pamphlet in 1985 titled "Alcoholism: An Inherited Disease."
Even many psychologists now assert that the problem drinking of at least some alcoholics has a significant genetic component. Moreover, the public has accepted the idea that alcoholism is inherited. A 1987 Gallup poll found that nearly 90 percent of Americans believe alcoholism is a disease, and more than 60 percent think it may be inherited. Both figures represent a steep rise from earlier ones; even five years previously a solid majority of respondents to the second question had said they didn't believe that alcoholism is inherited. Thus the JAMA report did little more than affirm what most Americans—including alcoholics, treatment personnel, and researchers—already believe.
Although the heritability of alcoholism is often presented as a modern discovery, alcoholism (along with sexual promiscuity, intelligence, criminality and insanity) was widely believed to be an inherited trait in the nineteenth century. That view receded in this century; in 1938 Karl Menninger could state, "The older psychiatrists . . . considered alcoholism to be an hereditary trait. Of course, scarcely any scientist believes so today, although it's still a popular theory. Alcoholism cannot possibly be an hereditary trait...." Today, obviously, the tide has shifted again. As Robin Murray, a British psychiatrist, notes, "Students of alcoholism must continually beware lest they fall victim to the extravagant swings of intellectual fashion that bedevil the field, and nowhere is such vigilance more necessary than in considering the possible etiological role of heredity." Murray's views are particularly interesting because he is Britain's leading investigator of the heritability of alcoholism. Murray and his research team have found that the rates of coincidence of alcoholism are similar for identical and fraternal twins, a result that substantially undermines genetic hypotheses—and one that is almost never cited by American researchers.
Will views on this question swing back? Oddly, the attention attracted by the JAMA study may encourage them to, as bold genetic claims draw sophisticated clinical geneticists into the field. (As far as I am aware, the leading current investigators in human studies of the heritability of alcoholism are not trained as genetic researchers. ) Paul Billings, the director of the Clinic for Inherited Disease at New England Deaconess Hospital, was interviewed about the JAMA study for The New Republic. Billings commented, "If this type of genetic analysis was carried out for a disease or a behavior less attractive than alcoholism, it would never get published. It tells you nothing of significance."
What Does Cause Alcoholism?
Doubts about genetic research aside, a large body of findings about alcoholism and its correlates cannot possibly be translated directly into biological and genetic terms. One such area of research concerns drinkers' expectations. Alcoholics have stronger expectations about how alcohol will affect them than other drinkers do. Alcoholics believe that alcohol transforms their personalities, making them more attractive to others, more relaxed, more alert, and more sexually responsive, even though in alcoholics it usually has the opposite effect in all these areas.
Mark Goldman, a psychologist at the University of South Florida, and his colleagues have extended research on expectations to college problem drinkers and even adolescents. Goldman and his colleagues found they could predict the likelihood that adolescents would develop drinking problems on the basis of their expectations about alcohol—before they had begun drinking. Furthermore, even elementary school children have distinct beliefs about how alcohol will affect them. Thus when Cathleen Brooks, the president of the National Association for Children of Alcoholics, describes her first drink, at age eleven, in euphoric terms—''I remember the warmth, I remember the well-being"—she is more likely reflecting what she had seen or been taught than what her body inherited.
Expectations about the effects of alcohol relate to parental, peer-group, and cultural influences. The psychiatrist George Vaillant's widely cited 1983 book, The Natural History of Alcoholism, examined the drinking histories of more than 600 men over forty years. Vaillant found that Harvard students were a third to a quarter as likely to develop alcoholism as inner-city Boston ethnics, and that Irish-Americans in Boston were seven times as likely to become alcoholic as Italian-Americans.
If a researcher were to find a biological marker for alcoholism as strong and reliable as the ethnic and social markers Vaillant identified, he or she would likely win the Nobel Prize. Yet the discrepancy between Irish and Italian alcoholism rates is far from the largest ethnic difference. Two sociologists, Barry Glassner and Bruce Berg, expected to find the legendary moderation of Jewish drinkers much attenuated in an assimilated upstate New York Jewish community. They found instead that none of their eighty-eight Jewish subjects had ever had a drinking problem. The most dire count of the city's Jewish alcoholics implies an alcoholism rate of about 0.1 percent for that Jewish community, or one hundredth the rate reported for Americans at large.
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