Are there identifiable causal factors to problem drinking?

One of the anxieties about alcopops is that by encouraging children to drink they may increase the risk of problem drinking later in life.

Yet there are clearly other factors involved besides the age of starting to drink.
Ian Sutherland of the Centre for Substance Abuse examines the issue.

Within the context of our society, drinking alcohol is a perfectly normal activity, indeed the adult who does not enjoy the occasional glass is often viewed, at the very least, with a degree of suspicion. Indeed, even though the legal public drinking age is eighteen, it seems fair to say that a very large

number of young people from about the age of twelve upwards also drink on a fairly regular basis. As we all know, for most people drinking a moderate amount of alcohol can be a pleasurable, not to say, fairly beneficial experience that can facilitate sociability and provide an antidote to a stress filled life. However, for a minority of people drinking alcohol is an activity that is fraught with danger and, for a very few, is akin to taking a poison that will almost inevitably ruin their lives and those of their family and friends.

What makes these two groups so different? At one end of the spectrum we have people who enjoy using the drug in a responsible manner and at the other those who alcohol seems to inevitably kill, having reeked years of havoc along the way. Surely there must be some way to differentiate these people from each other and , in so doing, be able to identify those at risk from the downside of alcohol use before the inevitable occurs?

In the not too distant past, researchers from various different disciplines sought to pin down a single cause for alcoholism and problem drinking. There was the concept of the addictive personality whereby it was suggested that anyone with this particular personality type was almost inevitably doomed to alcoholism as soon as the first pint passed their lips.

In a similar way, the presence of a close family member with a drink related problem was also considered to be a danger of almost epic proportions with various people suggesting that their lifestyle would undoubtedly rub off on anyone unfortunate enough to live near them. There was also the genetic lobby who proposed that the presence of an alcoholic gene predestined a person from birth. None of these individual theories have really provided an answer and yet, from the three areas a concept known as the BioPsychoSocial theory has arisen that has, in the past decade or so begun to make more and more sense.

As the name implies the BioPsycho -Social model is an amalgamation of the theories mentioned above and does, on the surface at least, appear to make intuitive sense.

One of the reasons that the other, single entity models, have fallen down is that clearly there can be no single cause of addictive behaviours. We live extraordinarily complex lives and we are acted upon by a myriad of variables affecting all aspects of our activities so it really does appear nonsensical to suggest that a single factor can cause problem drinking. On the other hand, the BioPsychoSocial model seeks to take into account all of these variables.

The Bio part of the theory suggests that whilst there may not be an alcoholic gene, certain individuals may have a genetic predisposition to alcoholism. Extensive work has been done on the DRD2 gene which indicates that aspects of the gene may have a role to play in the development of severe alcoholism. However, at this juncture anyway, it is not possible to carry out a test and proclaim an individual to be at risk because of a biological factor.

The Psycho part of the model stems from the concept of the addictive personality mentioned earlier and although it is not suggested that such a personality exists, there may be aspects of a persons psychological makeup that puts them at risk. For instance, people low in personal self-esteem are at greater risk from alcohol problems than those with high levels. In the same way, people with a tendency towards being generally over anxious seem to be at greater risk than those who take everything in their stride and people who tend towards a depressive outlook on life also seem at increased risk.

Possibly of most interest at the moment is the Social component of the model. There has been a lot of work in this area, particularly in relation to adolescent alcohol/substance use and it appears there are various aspects of young people's lives that can be considered to be pointers to later problems. One of the most important is the age at which they began to use alcohol, essentially the earlier they begin drinking the more likely it is they will encounter problems further down the track.

Reasons for early initiation are extremely complex, but may include peer group pressure and abnormal levels of alcohol use within the household. Another area which may be a factor is religiosity, a person who does not believe in some form of deity appears to be at greater risk than a person with religious convictions. Academic achievement and academic expectations can also be pointers, a person with low expectations may often be drinking more heavily than a person who intends to go onto higher education. Finally, amongst the more obvious examples, is a person's history of trouble either at school or with the law. A far higher proportion of young drinkers have been suspended from school and have had encounters with the police than non-drinkers.

The key to understanding the BioPsychoSocial theory is that one particular risk factor on its own does not mean that a person is liable to have a drink problem. For instance, if a person does have a genetic predisposition they may also need to be in an appropriate (or rather, inappropriate) social setting before they start to notice a problem. Alternately, they could be genetically predisposed, live in a pub and still not develop any sort of problem until a particular turn of events makes them particularly depressed and therefore vulnerable.

I believe that we will never be able to say with one hundred percent certainty that a particular person will become a problem drinker in the same way that we can never say definitely that a two pack a day smoker will develop lung cancer (after all, we all know of people who say they have a granny of 103 who smoked since she was twelve and still runs five miles a day). However, I believe that what may be possible is to assess the risk factors within a person, particularly an adolescent - and, at the very least, make them aware that they are potentially more at risk than their friends.

For instance, we may be able to say that a person is at risk because they have a history of alcoholism within the family, they appear to be genetically prone, they spend time with a heavy drinking peer group, they started drinking at a very young age and appear to have a tendency towards depression. While there may be little they can do about their family and genetic predisposition, they could, if they wished, do something about some of the other risk factors.

Whilst it would not be desirable to attempt to prevent people from drinking alcohol, we can at least make them aware of the dangers in their particular cases and allow them to make an informed choice based on knowledge of their circumstances.

Perhaps if people were aware they were at special risk, they might take more care in their drinking activities.