General Risk Factors
An estimated 90% of adults drink alcohol, and up to half of men have problems that are caused by alcohol. Between 10% and 20% of men and between 3% and 10% of women either abuse or become dependent on alcohol, and some studies indicate that every day, more than 700,000 Americans are being treated for alcoholism.
Drinking in Adolescence.
Currently 1.9 million young people between the ages of 12 and 20 are considered heavy drinkers and 4.4 million are binge drinkers. Anyone who begins drinking in adolescence is at risk for developing alcoholism. Young people at highest risk for early drinking are those with a history of abuse, family violence, depression, and stressful life events. People with a family history of alcoholism are also more likely to begin drinking before the age of 20 and to become alcoholic. Such adolescent drinkers are also more apt to underestimate the effects of drinking and to make judgment errors, such as going on binges or driving after drinking, than young drinkers without a family history of alcoholism.
Drinking in the Elderly Population.
Although alcoholism usually develops in early adulthood, the elderly are not exempt. A survey of 5,000 adults over 60 reported that 15% of men and 12% of women were hazardous drinkers, and 9% of men and 3% of women were alcohol dependent. In another study, the prevalence of problem drinking was as high as 49% among nursing home patients. Alcohol also affects the older body differently; people who maintain the same drinking patterns as they age can easily develop alcohol dependency without realizing it. Physicians may overlook alcoholism when evaluating elderly patients, mistakenly attributing the signs of alcohol abuse to the normal effects of the aging process.
Most alcoholics are men, but the incidence of alcoholism in women has been increasing over the past 30 years. About 9.3% of men and 1.9% of women are heavy drinkers, and 22.8% of men are binge drinkers compared to 8.7% of women. In general, young women problem drinkers follow the drinking patterns of their partners, although they tend to engage in heavier drinking during the premenstrual period. Women tend to become alcoholic later in life than men, and it is estimated that 1.8 million older women suffer from alcohol addiction. Even though heavy drinking in women usually occurs later in life, the medical problems women develop because of the disorder occur at about the same age as men, suggesting that women are more susceptible to the physical toxicity of alcohol.
The risk for alcoholism in sons of alcoholic fathers is 25%. The familial link is weaker for women, but genetic factors contribute to this disease in both genders. In one study, women with alcoholism tended to have parents who drank. Women who came from families with a history of emotional disorders, rejecting parents, or early family disruption had no higher risk for drinking than women without such backgrounds. A stable family and psychological health, however, were not protective in people with a genetic risk. Unfortunately, there is no way to predict which members of alcoholic families are most at risk for alcoholism.
Overall, there is no difference in alcoholic prevalence among African Americans, Caucasians, and Hispanic people. Some population groups, however, such as Irish and Native Americans, have an increased incidence in alcoholism while others, such as Jewish and Asian Americans, have a lower risk. Although the biological or cultural causes of such different risks are not known, certain people in these population groups may have a genetic susceptibility or invulnerability to alcoholism because of the way they metabolize alcohol.
Emotional and Behavioral Disorders
Depression and Anxiety.
Severely depressed or anxious people are at high risk for alcoholism, smoking, and other forms of addiction. According to one 2000 study, for example, the risk for heavy drinking in women who are depressed was 2.6 times greater than the risk in women who are not depressed.
Depression and anxiety may play a major role in the development of alcoholism in the elderly, who are often subject to dramatic life changes, such as retirement, the loss of a spouse or friends, and medical problems. Problem drinking in these cases may be due to self-medication of the anxiety or depression. Major depression, in fact, accompanies about one-third of all cases of alcoholism.
Evidence suggests that 20% of people with a form of anxiety called social phobia abuse alcohol. Social phobia causes an intense fear of being publicly scrutinized and humiliated. Such individuals may use alcohol as a way to become less inhibited in public situations.
It should be noted, however, that long-term alcoholism itself causes chemical changes that produce anxiety and depression. In fact, a study on elderly people with depression reported that when even moderate drinkers reduced consumption, their mood improved. It is not always clear, then, whether people with emotional disorders are self-medicating with alcohol or whether alcohol itself is producing mood swings.
Behavioral Disorders and Lack of Impulse Control.
Studies are also finding that alcoholism is strongly related to impulsive, excitable, and novelty-seeking behavior, and such patterns are established early on. In a test of mental functioning, alcoholics (mostly women) did not show any deficits in thinking but they were less able to inhibit their responses. Children who later become alcoholics or who abuse drugs are more likely to have less fear of new situations than others, even if there is a greater risk for harm than in nonalcoholics. People with attention deficit hyperactivity disorder, a condition that shares these behaviors, have a higher risk for alcoholism.
Alcoholism is not restricted to any social or economic levels. For example, one small 2000 study found that 22% of resident physicians (physicians undergoing postgraduate training) who took a test for alcoholism had scores that were at least suggestive of alcoholism and 35% reported experiences of alcohol misuse. Additionally, a thorough 1996 study reported that no higher prevalence of alcoholism among adult welfare recipients than in the general population (about 7%). There was also no difference in prevalence between poor African Americans and poor Caucasians.
On the other hand, people in low-income groups who drank did display some tendencies that differed from the general population of drinkers. For instance, as many women as men were heavy drinkers in lower income groups. Excessive drinking may also be more dangerous in lower income groups; one study found that it was a major factor in the higher death rate of people, particularly men, in lower socioeconomic groups compared with those in higher groups.
Although 54% of urban adults use alcohol at least once a month compared to 42% in non-urban areas, living in the city or the country does not affect the risks for bingeing or heavy alcohol use. One study reported that people in the north central US are at highest risk for heavy drinking (6.4% heavy use and 19% binge drinking), and those in the Northeast have the lowest risk (4.5% heavy use and 13% binge drinking).
People who crave sugar may also be at higher risk for alcoholism. In one study, 62% of male alcoholics enjoyed a sweet sugar solution compared with only 21% of those without a drinking problem. It is not known, however, whether having a "sweet tooth" can be an early predictor of alcoholism or whether alcohol abusers simply develop a taste for sweetness as a result of their chronic alcohol abuse.