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Is Alcoholism due to Nature or Nurture

Why can some people have a glass of wine or beer with their meal without feeling compelled to drink more, whereas others can’t seem to stop drinking? Can some people “hold” their liquor better than others? Does alcoholism tend to run in families? Does genetics hold the key to developing medications to treat alcoholism and its effects on the body? Researchers have been trying to find answers to questions such as these for several decades, seeking to identify the factors that influence a person’s risk of becoming alcohol dependent.

Research, to date, indicates that both your genetic makeup (i.e., the information stored in the DNA that you inherited from your parents) and your environment (i.e., how you live) influence your risk for alcohol abuse and alcoholism.

Your genes certainly play an important role, influencing how your body responds to alcohol, how sensitive you are to its effects, and how likely you are to have a problem with alcohol. However, environmental factors—such as being surrounded by people who are heavy drinkers and who encourage you to drink—also can raise your risk for drinking too much.

The next question then becomes just how much of this risk is determined by our genes—that is, how much can be attributed to factors beyond our control. By studying large families with alcoholic and non-alcoholic members, comparing identical and fraternal twins, and studying adopted children and their biological and adoptive families, researchers found that about half of our risk for alcoholism is influenced by genetics. The remaining risk is related to the influence of environment—where and how we live. The two factors also work together in complex ways.

Unlike for some other diseases, there is no single gene that determines whether you will develop a problem with alcohol; instead, many genes influence your risk for developing alcoholism, each of which only has a small impact.

Understanding how genetics influences alcoholism also is important for another reason. Knowing the genes involved in this disease could help researchers and clinicians identify those who are most at risk of becoming alcoholic and understand how alcohol affects the body. These individuals then could be targeted more effectively for prevention and treatment efforts.

This Alcohol Alert describes how research is helping to identify the genes involved in alcoholism. In examining this research, one thing becomes clear: Unlike for some other diseases, there is no single gene that determines whether you will develop a problem with alcohol; instead, many genes influence your risk for developing alcoholism, each of which only has a small impact. Further, environmental influences may override or blunt the effects of the genes that increase risk. This overview describes how researchers are trying to tease apart which of the thousands of genes and millions of gene variants that make up your DNA play a role in alcoholism, how some of these genes act, and how these genes interact with your environment to determine how you and your body respond to alcohol.

Genes v’s Environment

As described above, researchers are learning more and more about how your genetic makeup can influence your drinking behavior and its consequences and which genes may put you at increased risk of alcoholism. But does this mean that if you inherit a certain combination of genes from your parents, you are destined to become an alcoholic? The answer to this is a clear “no” because how you live also plays an important role. People with the same genetic makeup may be more or less likely to develop alcoholism depending on their environment and life circumstances.

Researchers can study the interactions between genes and the environment and the relative impact of each through a variety of direct and indirect approaches.38 These approaches have helped identify several environmental factors that either protect us from or place us at increased risk for alcoholism; for example, marital status and religiosity have been found to be protective factors, lessening the impact of genetic risk factors on drinking in women. For adolescents in particular, drinking seems to be influenced strongly by environmental factors in addition to genetic makeup. Adolescents who carry high-risk genes and whose parents do not monitor their activities and/or who have friends that use alcohol and other drugs are more likely to develop alcohol problems than those with a similar genetic makeup whose behavior is monitored more closely. Modifying the environment also can help adolescents avoid risky drinking behavior. Participants in one prevention program designed for youth were less likely to engage in high-risk behavior, such as drinking, even though they had a high-risk genetic background.

The bottom line is that genes alone do not determine our destiny—lifestyle choices and other environmental factors have a substantial impact. In addition, many other individual and psychosocial variables influence when and how much we drink, both in the short and long term, and how this influences our risk of alcoholism.

1. Addiction is a complex but treatable disease that affects brain function and behavior. Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences.

2. No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.

3. Treatment needs to be readily available. Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.

4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.

5. Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.

6. Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment. Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.

7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone, buprenorphine, and naltrexone (including a new long-acting formulation) are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (available as patches, gum, lozenges, or nasal spray) or an oral medication (such as bupropion or varenicline) can be an effective component of treatment when part of a comprehensive behavioral treatment program.

8. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person’s changing needs.

9. Many drug-addicted individuals also have other mental disorders. Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both (or all), including the use of medications as appropriate.

10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement.

11. Treatment does not need to be voluntary to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.

12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.

13. Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary. Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness. Moreover, engaging in substance abuse treatment can facilitate adherence to other medical treatments. Substance abuse treatment facilities should provide onsite, rapid HIV testing rather than referrals to offsite testing—research shows that doing so increases the likelihood that patients will be tested and receive their test results. Treatment providers should also inform patients that highly active antiretroviral therapy (HAART) has proven effective in combating HIV, including among drug-abusing populations, and help link them to HIV treatment if they test positive.

Anesthesiologists – the doctors who keep patients alive during surgery, who essentially take over our breathing – make up just three per cent of all doctors, but account for 20 to 30 per cent of drug-addicted MDs. Experts say anesthesiologists are overrepresented in addiction treatment programs by a ratio of three to one, compared with any other physician group, an occupational hazard that could pose catastrophic risks to their patients.

Their drugs of choice are most frequently fentanyl and sufentanil, opioids that are 100 and 1,000 times more potent than morphine. They “divert” a portion of the doses meant for their patients to themselves, slipping syringes into their pockets.

And later, alone in the bathroom or the call room, when the drug hits their own bloodstream, the relief, the sense that all is well in the world, the mild euphoria, is immediate.

ISLAMABAD, Dec 26 (APP): The Model Addiction Treatment and RehabilitationCenters have provided treatment to 6,725 drug addicts from different parts of thecountry till November 30 this year.Efforts are also being made for the job placement of addicts,being providedtreatment at the Centres, established at Quetta,Karachi and Islamabad. These are45 bedded hospitals and provide free treatment, food, boarding and rehab to drugaddicts.

At least once during the daytime, she says she thinks about killing herself.

“Perhaps I had better die,” the woman muttered. “But I want to die in Hirono.”

Cases of depression and alcoholism are rising in number among evacuees of the March 11 Great East Japan Earthquake, tsunami and the nuclear accident.

A team of mental care specialists from Kyoto Prefecture treated 262 people at seven evacuation centers, including one in Aizuwakamatsu in Fukushima Prefecture, until July.

The team said 51 evacuees, or 19.5 percent, were suffering from reactive depression.

Toru Ishikawa, president of the Tohokukai Medical Hospital in Sendai, says the survivors of disasters have become more susceptible to depression and alcoholism since moving into temporary housing from evacuation centers. That’s because many of them now live alone.

An epidemic of prescription painkiller abuse has led to another growing problem — newborns exposed to the addictive drugs their mothers use.

At the Catholic Health System in Buffalo, which operates the state’s largest methadone clinic outside of New York City, physicians used to see one to three babies a month with symptoms of withdrawal from narcotic pain pills. Now, the number approaches 10 a month, said Dr. Paul Updike, director of chemical dependency at Sisters Hospital.

The number of cases has grown enough that the hospital network is reorganizing services to standardize the care of addicted moms-to-be and their newborns.

“We can’t control the influences on a child’s environment, but withdrawal is quite treatable. We can give a child a chance for a reasonable life,” said Updike.

Thousands of West Australians have become addicted to dangerous prescription drugs while waiting to see a doctor, but a lag in illicit drug use statistics has left the escalating problem largely undetected, a scathing parliamentary inquiry has found.

General practitioners are concerned that about 22,000 West Australians are now addicted to opioids such as morphine and oxycodone, prescribed to them to manage chronic pain while they waited up to 12 months to see a specialist, the Education and Health Standing Committee said in an interim report tabled in parliament yesterday.

“The misuse of prescription opioids has become a significant problem within Western Australia and the number of people misusing them is now at a similar level to the number consuming heroin,” the report says.