special subjects
Alcohol Use Disorder and Rehabilitation
Etiology of Alcohol Use Disorder
The maladaptive pattern of drinking that constitutes alcohol abuse may begin with a desire to reach a state of feeling high. Some drinkers who find the feeling rewarding then focus on repeatedly reaching that state. Many who abuse alcohol chronically have certain personality traits: feelings of isolation, loneliness, shyness, depression, dependency, and hostile and self-destructive impulsivity. Societal factors—attitudes transmitted through the culture or child rearing—affect patterns of drinking and consequent behavior. Alcohol use disorder can occur in anyone, regardless of their age, sex, background, ethnicity, or social situation. Thus, clinicians should screen for alcohol problems in all patients. As much as 45to 65% of risk variance is thought to be due to genetic factors. The incidence of alcohol use disorder is higher in biologic children of people with alcohol problems than in adoptive children in a given family (and also higher than in the general population). There is evidence of genetic or biochemical predisposition, including data that suggest some people who develop alcohol use disorder are less easily intoxicated (ie, they have a higher threshold for central nervous system effects). 