Meanwhile, in another development, Timmen Cermak, one of the founders of the newly formed National Association for Children of Alcoholics, stated in an interview that "children of alcoholics require and deserve treatment in and of themselves, not as mere adjuncts of alcoholics," and that they can be just as legitimately diagnosed as can alcoholics, even in the absence of actual drinking problems (Korcok, 1983, p. 19). This broad diagnostic net is being utilized in combination with a far more aggressive thrust in treatment services (Weisner and Room, 1984). For example Milam and Ketcham (1983), while in other places reinforcing traditional contentions about the disease of alcoholism with contemporary biological research, take issue with A.A.'s reliance on the alcoholic to "come to grips with his problem and then get himself into treatment" in favor of "forc(ing) the alcoholic into treatment by threatening an even less attractive alternative" (p. 133). Such an approach entails confronting the individual's resistance to seeing the true nature of his or her drinking problem.

How all of this may be interpreted by treatment personnel is illustrated in two articles (Mason, 1985; Petropolous, 1985) in a recent issue of Update, published by the Alcoholism Council of Greater New York. One article takes the vulgarization of genetic discoveries, as outlined in Milam and Ketcham's (1983) book, somewhat further:

Someone like the derelict . . ., intent only on getting sufficient booze from the bottle poised upside-down on his lips to obliterate ... all of his realities ... [is] the victim of metabolism, a metabolism the derelict was born with, a metabolic disorder that causes excessive drinking.... The derelict, unfortunately, has superb tolerance. He cannot help but get hooked as the enzyme back-up in his liver, along with other biochemical disturbances, make his discomfort without more 'hair of the dog' so intense. He will got to any length to drink... which turns into more acetaldehyde production ... more withdrawal... no amount is ever enough. Tolerance to alcohol is not learned. It is built into the system (Mason, 1985, p. 4).

The other article describes how the son of an alcoholic had to be forced into treatment based on a rather vague symptomatology and his need to face up to his clinical condition:

Jason, a sixteen-year old boy with serious motivational problems, was brought in by his parents because of failing grades. His alcoholic father was sober one year, the approximate length of time his son had begun experiencing school problems, including cutting classes and failing grades. The boy was aloof and closed off to his feelings. The counselor suspected some drug involvement because of his behavior. It was clear that the boy needed immediate help. He was referred to an alcoholism clinic offering specific help for young children of alcoholics, as well as to Alateen. He balked at the idea, but with pressure from his parents he accepted an intake appointment at the clinic. He will need a lot of help to recognize and accept his feelings.... (Petropolous, 1985, p. 8).

Is there anyone listening to this boy's plea that the standard diagnostic categories for which he has been fitted are not appropriate? Is the denial of his self-perception and personal choice justified by what we know about the etiology of alcoholism and chemical dependence and by firm conclusions about the genetic and other legacies that offspring of alcoholics carry?

Conclusion

Those who investigate the genetic transmission of alcoholism offer a different cast to their models of the predisposition to become alcoholics than do the models quoted in the previous section. Schuckit (1984b), for example, announces "that it is unlikely that there is a single cause for alcoholism that is both necessary and sufficient to produce the disorder. At best, biologic factors explain only a part of the variance...." (p. 883). Vaillant, in an interview published in Time ("New insights into alcoholism," 1983) following publication of his book, The Natural History of Alcoholism (1983), put the matter even more succinctly. He indicated that finding a biological marker for alcoholism "would be as unlikely as finding one for basketball playing" and likened the role of heredity in alcoholism to that in "coronary heart disease, which is not due to twisted genes or to a specific disease. There is a genetic contribution, and the rest of it is due to maladaptive life-style" (p. 64).

Vaillant's quote is entirely consistent with his and other data in the field, all of which support an incremental or complex, interactive view of the influence of inheritance on alcoholism. No findings from genetically-oriented research have disputed the significance of behavioral, psychodynamic, existential and social-group factors in all kinds of drinking problems, and results of laboratory and field research have repeatedly demonstrated the essential role of these factors in explaining the drinking of the alcoholic individual. To overextend genetic thinking so as to deny these personal and social meanings in drinking does a disservice to the social sciences, to our society and to alcoholics and others with drinking problems. Such an exclusionary approach to genetic formulations defies ample evidence already available to us and will not be sustained by future discoveries.

Acknowledgments

I thank Jack Horn, Arthur Alterman, Ralph Tarter and Robin Murray for invaluable information they provided and Archie Brodsky for his help in preparing the manuscript.

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