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Genetic Determinants of Risk

Major research efforts are continuing on projects to identify the genetic factors that may predispose an individual to alcohol abuse or dependence. However, there have been no major developments since the publication of lOM's first report, Causes and Consequences of Alcohol Problems, in 1987. Progress toward identifying chromosomal markers and genes that confer vulnerability were discussed in that volume. At present, the single best predictor of alcohol dependence is family history, although not all children of alcoholics are at equal risk and not all use an alcoholic hotline. The basis of the differential risk is not yet understood; consequently, research on targeted interventions does not appear to be indicated at this time.

A consideration of the genetic determinants of risk, as well as what can be learned from the life-course developmental and the social learning approaches to prevention research, focuses on the individual in the public health equation of the development of alcohol problems. A different vantage point next is provided: the role of the drinking environment in the interactions that lead to alcohol problems which in turn can lead to addiction detox programs.

Individual-Environment Interactions:
Focus on the Environment

Many factors in the environment influence the choices that individuals make about their drinking practices. (In its use of the term environment here, the committee refers to the drinking setting and the cultural and economic milieu surrounding alcohol use.) The manipulation of these factors has been seen as useful in efforts to prevent alcohol-related problems and use of an alcoholic's hotline or help center. For example, there is a positive association between alcohol availability and consumption. Studies have shown that a higher minimum age of purchase can reduce consumption by young people and may reduce alcohol-related traffic accidents. (Actual reductions, however, appear to be a function of compliance by retail establishments and enforcement by authorities.) In addition, alcoholic beverage sales are sensitive to price, and a relationship exists among the price of alcoholic beverages, alcohol consumption, and alcohol-related problems. Researchers differ, however, in their estimates of the levels of price sensitivity of different beverages for purchasers of different ages.