Alcoholism and Family History: What to Know About Your Risk

Alcohol was a big part of family life for Stephen growing up. Holiday parties, backyard barbecues and a hard day at work were all reasons for his father and uncles to have a six-pack of beer — or more.

“There was nothing that went on that didn’t have scads and tons of alcohol built into it,” said Stephen, now 53 and a physician. (He requested to use only his middle name to protect his and his family’s privacy.)

Starting when Stephen was 14, he was allowed to join his father for the occasional beer. As he got older, he modeled his drinking after his family’s, with any social gathering in his 20s involving “a boatload of alcohol.”

Both of Stephen’s parents had told him stories about their own fathers’ struggles with alcoholism, and how they sometimes became violent. But because his immediate family’s behavior didn’t look like that, Stephen didn’t see their drinking as problematic for a long time.

Stephen stopped drinking while he was in medical school, in part to prove to himself that he didn’t have an issue. When he started again during his residency, then in his late 30s, alcohol affected him differently. “All of a sudden, I was drinking to the point where I realized that I couldn’t stop,” he said.

Alcohol use disorder — the inability to stop or control one’s drinking despite negative consequences — is a highly heritable condition. Research suggests that having an immediate family member, like a parent or sibling, with the disorder increases an individual’s chances of developing it roughly three- to fourfold. Approximately 50 percent of a person’s risk comes from their genes, but their home and social environments are also important factors.

Here’s what to know about how alcoholism runs in families and a few ways to guard yourself against it.

How do genetics put you at risk?

No single gene is responsible for a person developing alcohol use disorder; instead, experts say hundreds of genes likely play a role.

Scientists have identified some of the traits that these genes influence, starting with how the body processes alcohol. If alcohol metabolism is impaired, drinking can be physically unpleasant, giving people nausea and headaches. Having this trait, which is associated with at least two gene variants that are most common in people of Asian descent, lowers someone’s risk of alcohol use disorder because they’re less likely to drink very much, or at all.

On the other end of the spectrum are people who “can pretty much drink other people under the table” before feeling the effects of alcohol, said Dr. Marc Schuckit, a professor of psychiatry at the University of California, San Diego. These people have a greater risk for alcohol use disorder because they’re more likely to drink more.

Having a high tolerance for alcohol may also be connected to how the body metabolizes the substance, though scientists haven’t pinpointed specific gene variants for that, like they have for low tolerance. Dr. Schuckit added that some people don’t feel as intoxicated as others do when they’ve had a lot to drink, or they may not recognize how drunk they actually are and therefore miss the signal to slow down or stop.

Our genes can also affect impulsivity and how the brain responds to rewards — traits that are linked to alcohol use disorder, as well as other types of addiction. These characteristics can influence someone to seek out fun or pleasurable experiences, such as heavier drinking, without thinking about the consequences.

What accounts for the rest of a person’s risk?

A person’s environment growing up also has a large impact on their drinking behavior. If someone is raised in a household where drinking excessively is normal, and if they have positive associations with alcohol, they are more likely to try it, said R. Kathryn McHugh, the chief of psychology at McLean Hospital in Massachusetts.

The age someone starts drinking makes a big difference in terms of their risk. According to one often-cited study, roughly 16 percent of people who first try alcohol between the ages of 11 and 12 go on to develop a dependence, while just 1 percent of people who start drinking when they are 19 or older do.

“The longer you can postpone somebody’s first drink, you decrease their risk of developing alcoholism multifold,” said Dr. Kathleen Brady, a professor of psychiatry and behavioral sciences at the Medical University of South Carolina. Experts think that’s because early exposure to alcohol can change the brain while it’s still developing, particularly in areas related to self-control.

Being exposed to childhood trauma also raises a person’s risk. One theory is that early life trauma increases the brain’s stress response. “You might have the same stressor coming at you, but your body, your brain, is actually having an amplified response to that stress,” Dr. McHugh explained. Because alcohol is often used to cope, feeling more stress can lead people to drink more.

How can you protect yourself?

While there are many factors that contribute to a person’s risk for alcohol use disorder, there’s only one way to eliminate it: don’t drink. “That’s a pretty extreme solution, but it’s the one that works the best,” said Dr. Henry Kranzler, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine.

In the absence of complete abstinence, experts advised drinking in moderation — no more than one drink per day for women and two for men. “Set some personalized limits, write it down and try to stick to them,” Dr. Brady said. “And if you can’t stick to them, then it may well be that you need more professional help.”

The experts also suggested examining why you drink, so you can be more strategic as you cut down. If you’re mostly a social drinker, be extra conscious of your alcohol consumption at parties. Seek out social activities that are unrelated to drinking, too. If, on the other hand, you drink more when you’re anxious, try to avoid alcohol when you’re stressed and look for alternative coping mechanisms.

“Everybody’s going to look a little bit different in terms of why they drink alcohol, what environments they drink alcohol in, what their personal risk factors might look like,” Dr. McHugh said.

Having a friend or partner who knows about your risk can also help you catch any potential problems. For Stephen, that person was his wife. Once they got married and moved in together, he couldn’t hide the extent of his drinking anymore — or ignore that he had a problem. Stephen’s wife insisted he seek help, and although it took him a few years to get sober, he hasn’t had a drink in seven years.

An “irony of alcoholism,” Stephen said, is that “sometimes you don’t recognize it in yourself.”