Michael Windle, Ph.D.
University of Alabama at Birmingham
Alcoholism: Clinical & Experimental Research
Researchers know that both genetic and environmental influences contribute to the development of alcohol-use disorders (AUDs). One pivotal environmental force in the life of an individual with an AUD may be their spouse. A study in the September issue of Alcoholism: Clinical & Experimental Research examines women who are married to alcoholics to determine if they possess unique characteristics that may influence their partners' AUDs and/or have an impact on the risk for problems in their offspring.
"I'm in the business of trying to understand genetic and environmental contributors to alcoholism," said Marc A. Schuckit, director of the Alcohol Research Center, Veterans Affairs San Diego Healthcare System, professor of psychiatry at the University of California, San Diego, and corresponding author for the study. "I can't interpret what happens to the offspring of male alcoholics - I can't understand their childhood, environment or even their genetic background - without understanding as much about the mother as I do about the father."
Researchers conducted personal interviews with 327 women who were the original spouses of 453 subjects of the 20-year-old San Diego Prospective Study (97% of the families continue to participate). Characteristics of the 235 women (71.9%) whose husbands had never developed alcoholism were compared with the 92 women (28.1%) whose husbands had developed alcoholism.
The women who had married alcoholic men were less likely to be homemakers, were more likely to meet criteria for alcoholism themselves, reported more use of illicit drugs, and were more likely to be current smokers. These women, however, had no higher risk for other major psychiatric disorders, and did not report a higher rate of AUDs or psychiatric conditions in their parents.
"I think this study is important for at least four reasons," said Schuckit. "One, there are women out there who marry alcoholic men, divorce them, and then marry another alcoholic man ... why does that happen? Additionally, prior studies have shown that daughters of alcoholics are more likely to marry alcoholic men even if these women are not themselves alcoholic. Does this mean that some women have to take double care as to who they set up a relationship with, because they may be a little more vulnerable to pick somebody who has a problem? Two, a clinician treating an alcoholic man should ask himself or herself 'what is the social life/home life of this guy like, are there any special characteristics I have to worry about regarding his spouse in any kind of a systematic way?' Three, I'm doing research on causes of alcoholism. When you do such studies, you need to look at multiple subjects, including potential spousal influence. If that's at all systematically different, you really have to interpret that in how you put your data together. Finally, in order to understand what causes alcoholism in children, and what causes people to grow up to be alcoholics, you need to know as much as you can about both parents."
Examining alcoholism within the broader context of family is key to understanding the disease, added Michael Windle, director of the University of Alabama at Birmingham's Center for the Advancement of Youth Health and the Comprehensive Youth Violence Center. "A broader conception of the family as a 'system' is important for understanding the dominant roles that alcoholism may play in structuring the daily activities and adjustments of families," he said. "All families have assets and liabilities; alcoholism among both parents often weighs the ledger very strongly toward the liability end of the spectrum."
Windle said that the Schuckit study clearly places alcoholism within the family context of influences where spouses may not only select one another based on their patterns of alcohol abuse, but may also contribute to maintaining these patterns across time. "For children who have parents who are both alcoholics, the risks are manifold as this increases both genetic risk and reduces potentially protective factors, such as having at least one non-alcoholic parent. Parenting among alcoholic parents is often marked by inconsistency, lower monitoring - that is, knowing where their children are, setting fewer rules for curfew - and harsher punitive practices. Certainly health professionals who work with alcoholics need to view the fuller picture of the family in terms of assets and liabilities and to provide appropriate couples and/or family interventions."
Windle also noted the importance of the "highly functional nature" of the population studied. "Sometimes there is a public stereotype of the 'skid row' alcoholic," he said, "largely isolated and disconnected from society. Conversely, and by design, this sample was based on a non-treatment, relatively high functioning group. In many instances, with treatment samples or low functioning individuals, it is difficult to conclude if alcoholism is contributing to many of the poor health outcomes, or if it is co-occurring with high levels of dysfunction in other domains such as aggression, violence, and/or depression. In this study, it is evident that alcoholism is central in accounting for the findings."
Results in this paper were collected 15 years after the San Diego Prospective Study began. Schuckit and his colleagues plan to duplicate their examination of this group at 20 years. "We're as interested in what happens to these women - how does it relate to her family history or her prior diagnoses - we're as interested in that as we are in our original subjects," he said. They will also be closely following, and eventually interpreting, developments in the lives of the women's offspring.
Co-authors of the Alcoholism: Clinical & Experimental Research paper included Tom L. Smith, Mimy Y. Eng, and Jelena Kunovac of the Veterans Affairs San Diego Healthcare System. The study was funded by the National Institute on Alcohol Abuse and Alcoholism, Veterans Affairs Research Service, and the University of California, San Francisco.
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