People who develop an alcohol addiction continue to use alcohol compulsively, despite its negative impacts on their life. But why do some people develop an alcohol addiction while others don’t? The answer lies in the combination of different factors, where each of these factors interact with each other. Considering how addiction has a heritable component, genetics is one such factor.
Let’s look at the possibility of an addiction gene, whether or not you inherit alcohol tolerance, and if it’s possible to be born with alcohol addiction.
Do You Inherit Alcohol Tolerance?
Your alcohol tolerance is the amount of alcohol you need to drink in order to experience its desired effects. Think of when you first started drinking alcohol: three drinks may have been enough to make you feel confident, happy, and friendly. As you drink more and more often, you need to drink more to achieve the same effect. Now, three drinks aren’t enough to make you confident or friendly, so you have five or six instead.
This begs the question, can you inherit a tolerance for alcohol? Your genetics can influence the likelihood of developing AUD, but there’s no specific gene that instantly causes an AUD when you begin drinking.
According to the fifth edition of the DSM by the American Psychiatric Association, your parents have the highest impact on your genetic risk. But when you have several close relatives with AUD, you face a higher individual risk as well.
What Genes Are Responsible For a Higher AUD Risk?
Researchers have yet to narrow down a single gene or genetic variant that’s responsible for your risk of developing an addiction. In a study from 2023, researchers found that mutations in genes involved in neural plasticity and pain perception were linked excessive alcohol consumption.
In a 2020 review that looked at genome-wide analysis of over 435,000 people, researchers found 29 genertic variants that increased the risk of alcohol abuse.
But your genetics don’t just increase your risk of developing an addiction – they can have protective effects, too. In a 2016 review, researchers found that genes promoting alcohol metabolism and enzymes like alcohol and aldehyde dehydrogenase can have protective effects against AUD.
The Genetics of Alcohol Metabolism
Though you don’t inherit a specific tolerance for alcohol, your genes can influence how your body metabolises alcohol. Thism in turn, affects your tolerance because if your body metabolizes alcohol faster than you can feel its effects, you’ll end up drinking more. Gene variants like alcohol dehydrogenase and aldehyde dehydrogenase are just two examples.
But besides your genetics, other factors can affect your tolerance for alcohol. Your metabolism, gender, weight, and the type of medications you take influence your tolerance.
An increased tolerance for alcohol is a major sign of alcohol use disorder. If you’ve noticed that your tolerance is increasing, it’s recommended that you see an addiction expert to determine whether you have other AUD symptoms.
Can You Be Born With Alcohol Use Disorder
In order for someone to develop any mental disorder, whether it’s AUD or major depression, there needs to be an interaction between your genetics and environment. Because this necessary, you can’t be born with a alcohol use disorder.
Sure, you can have specific genes encoding enzymes involved in ethanol metabolism, but this only accounts for about half of the risk. The other predispositions come from your exposure to environmental and social factors you encounter throughout your life.
The Impact of Your Environment on Alcohol Consumption
Your environment strongly influences your drinking habits, whether it’s where you live, work, or study. For instance, living with parents who drink frequently, working with colleagues who frequently go out for drinks after work, or going to college where drinking is common among students.
But these aren’t the only things in your environment that can affect your drinking habits. Several other factors can increase the odds of developing an AUD, such as:
- having siblings who frequently drink in front of you
- your spouse or partner frequently drinks in excess
- having peers who drink heavily
- peer pressure to drink alcohol
- stressors like job loss, financial instability, or divorce
When you live or work in an unhealthy or stressful environment, it affects your decisions regarding how much you drink. If you’re already at risk of developing an AUD because of genetics, you need to be mindful of how your environment can influence your drinking habits.
What’s The Likelihood of Inheriting AUD from Parents
Studies show that about 50 to 60 percent of our vulnerability to alcohol use disorder is inherited from parents. It occurs because of variants across different genes, each of which have a small effect. These genes contribute to the risk by affecting different biological processes, mental states, and traits. For example, your body’s physiological response to stress and alcohol, impulsivity, and addiction-related neurobiology.
Considering the number of animal studies on this topic, there’s overwhelming evidence that genetic variations contribute to your risk of alcohol dependence.
Here are a few common examples:
Inheriting A Low/High Level Response To Alcohol
Your genes can affect your ability to ‘hold your liquour’ because it’s possible to have inherited a low level of response to alcohol. It means that your body experiences fewer effects from alcohol, causing an innate tolerance. This puts you at a higher risk of heavy or binge drinking and developing AUD.
Similarly, your genes can influence whether you experience stimulating or sedating effects from alcohol. Research shows that people who experience stimulating effects from alcohol are likely to drink more and have a higher risk of developing AUD.
Inheriting Neurochemical Elements of Addiction
In a 2017 study, researchers found that specific parts of human DNA are linked to AUD and related behaviours. Some genes affect how the brain regulates chemicals involved in addiction. It shows that some people’s inherited neurochemistry can make them vulnerable to developing AUD.
Inheriting Lower Alcohol Metabolism
As we mentioned earlier, your alcohol metabolism genes can affect your likelihood of developing AUD. But there’s also evidence that your ethnicity can play a role. Among people of East Asian descent, such as Japanese, Korean, or Chinese heritage, 36 percent carry gene variations that influence liver enzymes responsible for metabolising ethanol.
These ethanol metabolizing enzyme genes can cause a buildup of acetaldehyde, which causes nausea, tachycardia, and prominent facial flushing upon alcohol consumption. Though this physiological response reduces drinking, people who do drink have a higher risk of developing esophageal cancer.
Inherited Brain Chemistry
Your inherited biochemistry includes genes related to dopamine and serotonin, which affect your vulnerability to alcohol dependence. While dopamine influences pleasure, reward, and motivation, serotonin influences mood, memory, and sleep.
Genetic differences in how these neurotransmitters work can make your brain more or less responsive to alcohol’s effects. This can contribute to a higher likelihood of developing an alcohol dependence.
Dopamine
When you drink alcohol, it stimulates the release of dopamine, which is why it feels drinking feels enjoyable. Variations in your dopamine receptor gene, DRD2, can affect how sensitive you are dopamine hit that comes from drinking alcohol. For example, you may have a DRD2 variant that causes you to experience weaker pleasure from alcohol, which makes you drink more.
Serotonin
Similarly, drinking alcohol affects your serotonin levels in way that reduces your anxiety and improves your mood. It’s why many people turn to alcohol to calm their nerves when they’re stressed or to feel something when they’re depressed. Variants in your serotonin transporter gene, 5-HTT, affects how your body processes serotonin. 5-HTT is associated with novelty and impulsivity, which are linked increased cravings in alcoholics.
But even though genetic factors have a 50 percent impact on whether you develop an addiction, having certain genes doesn’t guarantee it. There’s also no alcohol addiction gene because social and environmental factors significantly influence the outcome. Other factors, such as your environment, play a significant role in developing an AUD.
Can Prenatal Alcohol Exposure Increase My Risk of Developing AUD?
Consuming alcohol during the gestation period has harmful effects on the developing fetus, though heavy drinking is especially damaging. Prenatal exposure to alcohol leads to a higher risk of developing fetal alcohol spectrum disorders. These are lifelong cognitive, behavioural, and physical impairments that fall under different categories: fetal alcohol syndrome, partial FAS, alcohol-related birth defects, and alcohol-related neurodevelopmental disorder.
Additionally, researchers have found a link between alcohol exposure during early pregnancy and an increased risk of AUDs. The study showed that having 3 or more drinks per occasion during early pregnancy increased the risk of developing an AUD by 2.95 times.
Risk Factors of AUD
Experts assess your risk of developing AUD by looking for specific risk factors. Here are some of the most common ones:
- A history of inadequate parental supervision
- Limited bonding with parents
- Experiencing a traumatic event during childhood
- Having a pre-existing mental health disorder
- History of poor self-control or impulsive behaviour
- Alcohol consumption during childhood or adolesence
- Facing neglect from parents or caregivers
- Having unhealthy social relationships
Adolescent Alcohol Use
Additionally, how soon you begin drinking can also lead to a higher risk of addiction. If you start drinking alcohol earlier, you have a greater likelihood of experiencing alcohol-related issues in adulthood. This is especially the case if you start drinking in adolesence, because it’s when your brain is still developing and much more sensitive to the effects of alcohol.
Gender
Besides genetics, another biological risk factor to consider is your gender. For example, men in the US usually consume alcohol more frequently. They also tend to drink more heavily compared to women. It’s why men are diagnosed with AUD at a higher rate than women.
Pre-Existing Mental Disorder
When you have a pre-existing mental disorder like PTSD or major depression, you’re more vulnerable to developing alcohol addiction than someone who doesn’t have a disorder. That’s because as many as 22 percent of people struggling with mental health difficulties self-medicate using alcohol and other substances to cope with symptoms.
The number of risk factors you have can predict your likelihood of developing alcohol use disorder. Suppose you identify with some of these above-mentioned risk factors. In that case, you can take steps to change them, reducing your vulnerability to alcohol dependence.
Alcoholism and Epigenetics
Remember how we mentioned that your genes and environment need to interact in order for a disorder to develop? It’s even more complex, because your genes don’t stay the same throughout your life. Just as your genes and environment affect your behavior, your behavior and environment can lead to changes in how your genes function.
This is what scientists call ‘epigenetics’ and it helps explain why alcoholism is such a complex condition to understand. Epigenetics discusses changes in how your genes work, which is affected by thinks like your drinking behaviors and stress levels. Researchers have found that alcohol can alter gene expression in certain brain areas, affecting traits like alcohol sensitivity and tolerance. These alterations are linked to other mental health concerns like anxiety.
Tests To Diagnose Alcoholism
If you feel like you or a loved one may be struggling with addiction, a medical professional or addiction specialist will need to assess your symptoms. Since theren’t any specific blood tests, genetic tests, or brain imaging scans that guarantee the presence of an AUD, they use other methods. Specifically, they use tools and instruments to get a clear picture of your symptoms. Here are some of the tests commonly used:
DSM-5 Criteria
The most common way to diagnose an alcohol use disorder is using the APA’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Diagnostic criteria by the APA includes symptoms such as:
- You drink alcohol in larger amounts and over a longer period than was intended.
- You want to cut down on alcohol consumption or have tried to control alcohol use and were unsuccessful.
- You spend large amounts of time in activities to obtain alcohol, consume alcohol, or recover from alcohol consumption.
- Your drinking habits are affecting your ability to fulfill obligations at school, work, or home.
- You keep drinking its effects causing and worsening interpersonal and social problems.
- You drink alcohol in physically hazardous situations like operating machinery.
- You have a high tolerance for and are dependent on alcohol.
According to the DSM-5, addiction severity is determined by how many criteria you meet. Meeting two to three criteria indicates a mild addiction, while six or more means a severe AUD.
You can take an online self-assessment to determine whether you have a drinking problem. Another option is to see an addiction professional so they can assess you.
The Alcohol Use Disorders Identification Test (AUDIT)
The WHO developed AUDIT, a 10-item screening test to assess an individual’s drinking habits. It looks at three core areas: your alcohol intake, the possibility of dependence, and if you’ve experienced harm because of alcohol consumption. If you answer ‘yes’ to ten or more questions, it indicates the presence of an AUD.
When answering questions about how many drinks you have on average,
There’s also a shorter version of the AUDIT, the AUDIT-C. It only has three questions instead of the usual 10, with each one worth four points. Having more points indicates a higher probability of an AUD.
CAGE Assessment
The CAGE questionnaire is an initial test that’s used to quickly screen you for possible signs of alcohol related problems. The letters C-A-G-E stand for Cut Down, Annoyed, Guilty and Eye-Opener, and they’re based on the assessment’s questions. These questions are designed to show a drug alcohol depend by asking about:
- Feeling like you need to cut down on your alcohol use.
- People getting annoyed by and criticising your alcohol use.
- Feeling guilty or bad about your alcohol use.
- Taking alcohol as an eye-opener, first thing in the morning.
Your answers to questions will suggest a possible alcohol abuse problem. Usually, answering ‘yes’ to two or more questions points to an alcohol dependence.
However, it doesn’t give a final diagnosis and could indicate alcohol misuse instead of an addiction. If your results suggest a problem, you’ll need to undergo further evaluation to know if you have an AUD.
Carbohydrate-Deficient Transferrin (CDT) Test
Physicians use the CDT test to determine if you’ve been binge drinking in the past few days or drink heavily on a daily basis. That’s because carbohydrate-deficient transferrin is a marker of chronic alcohol abuse and can detect an alcohol consumption of 40 to 60 grams of ethanol per day.
If your CDT levels are 2.6 percent or higher, it’s marked positive for alcohol use. It takes about two weeks of heavy drinking for your CDT level to appear as positive. With abstinence, your CDT levels can normalize in about 2 weeks.
Remember that a positive CDT level isn’t indicative of an addiction, but heavy or binge drinking behavior. To determine that you’re struggling with an AUD, further assessments are needed.
Electroencephalography (EEG)
This method uses EEG to detect whether someone has a possible AUD. It works by measuring your brain’s electrical activity and checking it for abnormal patterns. Chronic alcohol abuse can change your brain waves so they appear vastly different from normal brain waves.
Physicians look for changes like reduced alpha wave activity and increased theta or delta waves. Examples like these indicated alterations in your brain’s function which are typically linked to alcohol dependency.
Stopping The Family Cycle of Alcohol Addiction
As a parent who’s aware that alcohol misuse runs in the family, you can take different steps to prevent or delay alcohol use in your children. The same applies to discouraging alcohol use in adult children. Here are some strategies that professionals recommend:
- Sharing age-appropriate information about the dangerous of alcohol use, such as alcohol induced medical diseases.
- Keeping track of how your children spend their time and recommending ways to have fun without alcohol.
- Establishing family rules like abstaining from alcohol use
- Encourage activities that promote communication, listening, and problem-solving.
- Improving your children’s confidence and sense of responsibility by being a good role model.
Being aware of your family history with regard to drug abuse or acoholism is a motivator for change. It encourages you to find a solution that stops the cycle of addiction and improves quality of life.
Protective Factors For AUD
Though some factors can increase your risk of developing alcohol dependence, others can help you counteract negative influences. These are protective factors and they can be anything that benefits you socially, emotionally, or physically. Even academic and professional strengths can be protective factors that reduce the risk of developing an addiction. These include:
- Receiving social support from positive relationships among friends and family members.
- Seeking counselling from an addiction specialist
- Living in a low-stress environment
- Building connections with other people in the community, at school, or at work.
- Having positive role models as mentors
When you implement protective factors like the ones mentioned above, they can outweigh risk factors to help you experience a better life.
What if I’m at Risk of Becoming Addicted?
Even though alcoholism susceptibility genes affect your likelihood of becoming addicted to alcohol, you can still mitigate risks. You can do this by recognising possible scenarios that could lead to problematic drinking, like going to a bar with your co-workers, and modifying how you behave.
Alcohol addiction is a complex genetic disease, so there’s no one-size-fits-all solution for treatment and avoiding alcohol issues. The key is to be persistent, so that if one approach doesn’t work, you can choose another one. The National Institute on Alcohol Abuse and Alcoholism recommends abstaining from alcohol consumption and offers different types to lower your risks of developing alcohol misuse problems. For example:
Setting Goals
Think about realistic changes you’ll make to your drinking habits. If you’re not going to quit drinking alcohol, decide these 2 things:
- On how many days will you drink per week
- How many drinks will you have per day
Keeping specific days for drinking is important because it helps to have days when you don’t have any alcohol. The sooner you plan your alcohol consumption, the faster you’ll learn to stick to the plan. With time, you’ll have established guidelines when it comes to drinking. These guidelines can help you tell when your drinking habits are changing.
Tracking Your Number of Drinks
You’ll want to ensure that you’re sticking to the plan and not drinking more. A simple way to track your consumption is to make tick marks on a calendar or a dated notebook, or use an application.
Many people end up drinking more than they think because they don’t know what makes a standard drink. In the UK, a standard drink or unit of alcohol is any beverage with 8 grams of pure alcohol. Knowing how much alcohol is in your average glass of beer, wine, or whiskey is a good way to count your drinks properly.
Look For Alternatives
According to the Substance Abuse and Mental Health Services Administration, a large proportion of people develop alcohol problems because several of their activities involve alcohol. If that’s the case for you, it helps to find alternative sources of rewarding social interactions that don’t involve drinking alcohol.
It’s also common for people to use alcohol as a way to cope with stressful situations or feel less nervous in social situations. If you feel like that applies to you, start seeking other coping strategies or professional guidance to build your coping skills.
Avoid Triggers
Sometimes, the best way to reduce your risk of alcohol misuse is to avoid triggers. Triggers include events, people, and places that influence you to drink. If you’re trying to reduce how much you drink or want to stop drinking entirely, find out what those triggers look like for you. Once tiu do that, make plans to sidestep them before they occur.
Remember Why You Want To Reduce Alcohol
There will be plenty of times when you feel the urgent to drink more or drink on a day that’s outside your plan. On these days, remember why you’ve set these guidelines. Maybe you’ve seen a loved one struggle with alcohol addiction or are aware of your family history. Either way, keeping these reasons close to you, like in your wallet or phone can help you look at them when you need to.
Can My Genetics Affect Alcohol Addiction Treatment?
Your genetics can affect your response to alcoholism treatment to a certain extent. For example, there may be clear differences in how well you respond to treatment programs versus someone else. Part of the reason for this is due to genetic factors like your brain chemistry and how quickly your body metabolises medications.
If you have a faster metabolism, you may need more frequent dosing to ensure consistent levels of medication in your system. Fortunately, treatment for AUD isn’t one-size-fits-all. Your clinician will tailor the treatment program to your specific needs.
Most, if not all, treatment plans for alcohol addiction include two main aspects: pharmacological and behavioural interventions.
- Pharmacological treatment includes medication for AUD. These aren’t addictive and are formulated to relieve withdrawal symptoms. Taking them can help you reduce alcohol use, improve abstinence, and prevent you from relapsing.
- Behavioural treatment includes a combination of individual, family, and group therapy sessions. These span a range of approaches like CBT, motivational interviewing, and mindfulness. The goal of implementing behavioural treatment is to learn coping skills to better deal with stress.
Reahab centres can provide both inpatient and outpatient care developing on the severity of your addiction. Treatment professionals can design individualised programs while delivering evidence-based care in a relaxing environment. Some centres also specialise in dual diagnosis treatment, which includes addressing co-occurring mental disorders along with your alcohol addiction.
If you’re unsure about what kind of treatment is the right choice for you, you can start by approaching an addiction expert. They can assess your symptoms and recommend the right treatment plan for your needs.
Seek Professional Help For AUD
If you’re concerned about your drinking habits and feel as though you have a higher risk of developing an AUD, there are certain steps you can take to reduce that risk. You can start by monitoring your drinking habits and taking a self-assessment to know how your alcohol use can affect your well-being.
Whether you or a loved one are struggling with addiction or alcohol abuse, just know that help is available. Your healthcare provider can recommend inpatient or outpatient treatment centers based on the severity of your symptoms. These programs are designed to give you support, help you achieve sobriety, and encourage recovery.
