All of the following statements regarding the epidemiology and genetics of alcoholism are true EXCEPT:
ExplanationIn the most recent ffth edition of Diagnostic and Statistical Manual of Mental Disorders, the term alcohol use disorder replaced the two terms used to describe problem areas with alcohol use: alcohol abuse and alcohol dependence. Under the new terminology, alcohol use disorder is defned as repeated alcohol-related difculties in at least 2 of 11 life areas that cluster together in the same 12-month period, and this disorder combines many of the criteria of dependence and abuse into a single diagnosis. The diagnosis of alcohol use disorder is further characterized as mild, moderate, or severe based on how many criteria a person fulflls. Examples of these criteria include failure to fulfll obligations, drinking in hazardous situations, tolerance, withdrawal, craving, and inability to control drinking behaviors. The lifetime risk of an alcohol use disorder in most Western countries is about 10%–15% in men and 5%–8% in women. However, there may be higher rates in Ireland, France, and Scandinavian countries. In addition, native cultures appear to be especially susceptible to problems with alcohol use. This has been seen in Native Americans, Maoris, and the aboriginal tribes of Australia. About 60% of the risk for alcohol use disorders is attributed to genetic influences. Children of alcoholics do have a higher risk of an alcohol use disorder; however, this risk is about 4 times higher, not 10 times higher. This risk is conferred even when the children are adopted early and raised by nonalcoholics. Identical twins also exhibit a higher risk of concurrent alcoholism when compared to fraternal twins. The genetic factors that appear to be most strongly linked to alcohol use disorders include genes that are linked to impulsivity, schizophrenia, and bipolar disorder. In addition, genes that affect alcohol metabolism or sensitivity to alcohol also contribute to the genetics of alcoholism. A mutation in aldehyde dehydrogenase that is more common in individuals of Asian descent results in intense flushing when alcohol is consumed and confers a decreased risk of alcohol dependence. Conversely, genetic variants that lead to a low sensitivity to alcohol increase the risk of a subsequent alcohol use disorder as higher doses of alcohol are required to achieve the same effects. It is estimated that 20% of all patients have at least mild alcohol use disorder. The age at first drink is similar between alcoholics and nonalcoholics. However, alcoholics report a slightly earlier onset of regular drinking and drunkenness. In most individuals with alcoholism, the course of the disease is one of remissions and relapse, but most individuals do require treatment to be able to sustain abstinence. The chance of spontaneous remission is about 20%. If drinking continues without remission, the lifespan will decrease by about 10 years, with leading causes of death including heart disease, cancer, suicide, and accidents.
