Throughout our blogs so far we have looked at who the vulnerability to later alcoholism is transmitted genetic via family members.

The task for science is answering the question – “What exactly is inherited in this vulnerability?”

Again via various blogs we have looked at certain vulnerabilities that we believe contribute to the aetiology of alcoholism (and possible other addictive disorders). These relate to specific emotional processing and regulation problems which we feel not only make alcohol more rewarding for various reasons but also seem to create a decision making profile whereby the inability to properly use emotions to guide decisions making, via not properly recruiting the goal-directed, reflective and evaluative areas of the brain – areas of the prefrontal cortex – and instead recruiting, reactionary, sub-cortical parts of the brain such as the amgydala and dorsal striatum in decision making, to relieve emotional unpleasantness rather than guide adaptive behaviour.

This may be a fundamental difference between those vulnerable to later alcoholism and those who are not, even those in the same family.

If there is a fundamental deficit in decision making this will have numerous knock on effects  obviously and right from the beginning of alcohol use.

So is this borne out in studies? Do studies suggest emotional processing deficits are linked to a family  history of alcoholism. In other words, is this emotional processing deficit, which may lead to later alcoholism, inherited?

One study in particular (1), high alexithymic (50%) patients suffering alcohol use disorders (AUDs)  were more likely to have fathers with alcohol problems…

” Sifneos first described the notion of alexithymia in 1973 [1] as the inability to express emotions or feelings. Alexithymia is mostly seen as a personality construct characterized as a deficit in the ability to cognitively process and regulate emotions [2]. Whereas the prevalence of alexithymia in population-based studies varies between 8% and 15% [3], rates of up to 67% have been reported in patients with alcohol use disorders (AUD) [4] and up to 50% in patients with other substance use disorders (SUD) [5] and [6].

Based on genetic and familial influence, a higher percentage of alexithymia is expected in parents and other family members of alexithymic patients. As alexithymia and alcohol use disorders are related, this could be a reason for more alcohol problems in the relatives of alexithymic patients [4] and [15]. However, in alexithymic patients with SUD or AUD, other genetic, environmental or familial mechanisms could of course have an important role in the alcohol problems of their relatives [19].

As part of an often shared environmental or familial mechanism, problems with alcohol in parents could result in neglecting their child’s emotional states, leading to emotional self-regulation deficits, such as alexithymia. The latter has been shown in a recent meta-analysis on parental bonding and alexithymia [20].

In line with this, a disturbed family functioning has been found to relate to the development of alexithymic characteristics [21]. Similar finding was observed for a history of neglect or sexual abuse, regardless of whether it occurred within the family [22], [23] and [24].

We found that high alexithymic SUD-patients were more likely to have fathers or both fathers and mothers  with alcohol problems compared to low alexithymic SUD-patients. Next, we found that especially paternal family history of alcoholsim (FHA) relates to the degree of alexithymia, independent of disturbed family functioning. The high degree of alexithymia in our abstinent SUD sample is consistent with previous reports [4],[10] and [34]. The relationship between alexithymia and these symptoms suggests that the high baseline alexithymia score can at least partially be interpreted as a state phenomenon [4] and [34].

References

de Haan, H. A., Joosten, E. A., de Haan, L., Schellekens, A. F., Buitelaar, J. K., van der Palen, J., & De Jong, C. A. (2013). A family history of alcoholism relates to alexithymia in substance use disorder patients. Comprehensive psychiatry, 54(7), 911-917.