Using Alcohol Abuse to Understand Risk for Alcohol Use Disorders

Using Alcohol Abuse to Understand Risk for Alcohol Use Disorders

Family history is a critical factor in understanding both the environmental and genetic risks that can create the perfect storm for an alcohol use disorder. In addition to genetic causes, the frequent misuse of alcohol in family networks may influence risky behaviors related to alcohol.


The diagnosis of an alcohol use disorder is largely concerned with determining the symptoms that may direct the clinician to focus on either alcohol abuse or alcohol dependence. Historically they have been treated as two distinct syndromes, but increasingly research is demonstrating that alcohol abuse is a precursor for alcohol dependence.

A recent study examined how alcohol abuse and alcohol dependence might impact the risk of developing alcohol use disorders in families. The results of the study appear in a recent issue of the journal Alcoholism: Clinical & Experimental Research.

The study’s findings surprised the researchers because they found that contrary to their expectations, the symptoms of alcohol abuse were more accurate predictors for alcohol use disorders than alcohol dependence.

Corresponding author for the study, Kenneth S. Kendler, is a professor of psychiatry at the Virginia Commonwealth University School of Medicine. Kendler explains that the researchers focused on the symptoms of alcohol abuse and alcohol dependence related to familial liability to alcohol use disorders because the risk of illness in the family is a core diagnostic tool used by psychiatrists.

Kendler points to the changing perceptions about alcohol abuse and alcohol dependence in their diagnostic criteria as an example of this. Alcohol abuse is increasingly believed to share one underlying risk factor with alcohol dependence.

The researchers utilized the Virginia Twin Study of Psychiatric and Substance Use Disorders, identifying 1,200 twins who met criteria for lifetime alcohol use disorders according to the DSM-IV. The researchers analyzed whether alcohol use disorders, including individual symptoms of alcohol dependence and alcohol abuse, were predictors of alcohol use disorders in twins and in parents.

The analysis showed that the criteria for alcohol abuse and alcohol dependence were different in their reliability as predictors for a familial liability to alcohol use disorders. The familial risk was better linked to symptoms of alcohol abuse and the negative consequences associated with alcohol use disorders than it was to the age of initiation of alcohol use or experiences of tolerance or withdrawal symptoms.

The most reliable predictor for familial risk was legal problems associated with alcohol use disorder. The symptom is the single criterion expected to be removed when the DSM-5 is finalized.

The removal is linked to the influence of international standards, as set forth in the International Classification Diseases 11th Revision (ICD-11). The authors of the DSM-5 are removing the symptom from the criteria in the DSM-5 because legal standards vary widely when considering an international set of criteria.

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