February 4, 2013
(Chicago Tribune) -- At age 17 in the 1970s, Marvin Seppala dropped out of high school and became the first adolescent admitted at Hazelden, when treatment for alcoholism was in its infancy.
Afterward, he returned to his Minnesota town and finished high school in the homes of merciful teachers. Between relapses, he applied for a job as a janitor at the Mayo Clinic and somehow landed one as a lab tech. The work inspired him to get straight at age 19, go to college, then move ahead to medical school.
Now a renowned expert on addiction treatment and psychiatry, Seppala returned to Hazelden (hazelden.org) a few years ago -- as chief medical officer.
His recovery shows that predisposition to alcohol abuse isn't doom or destiny. But people with alcoholism in their backgrounds, whether they or close family members have struggled, often worry they or their children will inherit it, for good reason: Genetic history of alcoholism is the biggest risk factor for alcoholism.
"Having an alcoholic parent, especially, tremendously raises the risk, by as much as six times the general population," Seppala said. "Honestly, when I got married, I didn't want children. I was so scared they'd go through the same thing I did."
More has been learned about risk factors for alcoholism in the years since Seppala decided that having children was worth the risk. (He has two healthy children in their 20s.) Awareness can't guarantee someone won't fall into alcoholism. But it can't hurt.
We asked Seppala and Sarah Allen Benton, author of "Understanding the High-Functioning Alcoholic" (Rowman & Littlefield), to shed light on a few of the more shadowy risk factors and red flags. They were game.
Early onset of alcohol use: "If you start drinking before age 15, you increase the risk of alcoholism by 40 percent regardless of family history," said Benton, a therapist specializing in substance abuse and dual diagnosis treatment at McLean Hospital in Waltham, Mass. Just postponing the use of alcohol can significantly reduce the risk of alcoholism, Benton said, partly because the part of the brain that understands risk and inhibits problematic behaviors hasn't completely developed before age 21.
"The more we learn about the neuroscience of addiction, the more we realize that the brain can be molded by our experience, particularly by substances we use," Seppala said. "Early on, substance use could be molding people's brains in a manner that they could be more at risk. It's not absolutely proven."
Benton, who has been in recovery from alcoholism since 2004, said she started drinking when she was 14. "Most people I know who are alcoholics started drinking at age 14 or before," she said.
High tolerance to alcohol: High tolerance to alcohol can be a red flag. One longitudinal study of people who had an alcoholic mother or father tested the fine motor coordination of the study participants at a young age, before and after drinking one shot.
"Those who tolerated alcohol without much change at all in their coordination, suggestive of high tolerance, were a lot more likely to wind up alcoholic than those who were remarkably affected by alcohol and couldn't perform well on the test after the shot," Seppala said.
Some experts say it helps explain why children of alcoholics often end up marrying one, despite their best efforts. In their young dating years, they are drawn to mates who seem to be able to "hold their liquor," unlike what they may have witnessed in their alcoholic parent. Alas, alcoholism is progressive and looks different at different stages.
Compulsive tendencies: Experts suggest that one compulsive or addictive behavior often begets another.
One early clue of an alcohol compulsion is a lack of recognition of consequences to use, Seppala said. "You see the consequences mounting and the individual doesn't alter the behavior," Seppala said. "I did all kinds of crazy things. Dropping out of high school was a big one. But before that I dropped out of sports and band and choir, all these things I enjoyed. And it never occurred to me it was because of the drugs and alcohol."
Brain scans of addicts show damage to the prefrontal cortex.
In recovery, people often talk about being compulsive about other things. "Early in my own recovery, all of a sudden I would go off and do one thing and one thing only," Seppala said. "It wasn't pure compulsivity driving me, but that was part of it. I also can be prone to overworking. ... Compulsivity is an ongoing feature that people in recovery really do have to deal with."
Benton has found dialectical behavior therapy, which involves building mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation, to be particularly helpful to recovering alcoholics. "Learning ways to take care of yourself, to calm the nervous system, even if you don't have an addiction, is going to help you," Benton said.
Another mental health disorder. "It's very common for alcoholics to have an underlying mood issue," Benton said. What came first? It's hard to say. "Someone who suffers anxiety may drink to feel calmer, but when it leaves their system, they get rebound anxiety. The system is stimulated and anxiety symptoms are worsened, so then they drink again. It becomes a cycle. If they're just getting sober and not dealing with the underlying mental health issue, it's a recipe for relapse."
Genetics. It bears repeating that genetics accounts for 50 percent of the chance of alcoholism, Benton said. "It's not a guarantee, but ... people underestimate the power of genetics in alcoholism. A majority of alcoholics will say they grew up in an alcoholic home. Again, do your drinking patterns happen because of genetics or because of what they saw when they were younger or the family culture? It's probably all of that. But again, the genetics are loaded on this one."
That said, Benton doesn't want to obsess over drinking as she raises her young daughter.
"I plan to have an open dialogue with her, and I want her to feel she can talk to my husband and me," Benton said. "I know my first drinking experiences, I blacked out, and I thought that was normal. I hid it from my parents. It's not that I want to condone it. I want to find a balance between condoning it and openness."
"The main thing," Seppala said, "is raising your children to the best of your ability, providing a really loving environment for them. There are so many limits to what we can do. But those two things are powerful."
KNOW THE FACTS
About 8.5 percent of Americans suffer from alcohol-use disorders, and 25 percent of children have been exposed to alcohol-use disorders in their family. For more information on alcoholism awareness, including insights for parents and young adults, go to the website of The National Council on Alcoholism and Drug Dependence, ncadd.org.
(c)2013 Chicago Tribune Distributed by McClatchy-Tribune News Service.