Sex differences in the sources of genetic liability to alcohol abuse and dependence in a population-based sample of U.S. twins

Genetic Correlational Analyses of Ethanol Reward and Aversion Phenotypes in Short-Term Selected Mouse Lines Bred for Ethanol Drinking or Ethanol-Induced Conditioned Taste Aversion

Short-term selective breeding created mouse lines divergent for ethanol drinking (high drinking short-term selected line [STDRHI], low drinking [STDRLO]) or ethanol-induced conditioned taste aversion (CTA; high [HTA], low [LTA]). Compared with STDRLO, STDRHI mice consumed more saccharin and less quinine, exhibited greater ethanol-induced conditioned place preference (CPP), and showed reduced ethanol stimulation and sensitization under some conditions; a line difference in ethanol-induced CTA was not consistently found. Compared with LTA, HTA mice consumed less ethanol but were similar in saccharin consumption, sensitivity to ethanol-induced CPP, and ethanol-induced locomotor stimulation and sensitization. These data suggest that ethanol drinking is genetically associated with several reward-and aversion-related traits. The interpretation of ethanol-induced CTA as more genetically distinct must be tempered by the inability to test the CTA lines beyond Selection Generation 2.

Sweet liking, novelty seeking, and gender predict alcoholic status

BACKGROUND

The relationship between a hedonic response to sweet taste and a propensity to excessive alcohol drinking is supported by both animal and human studies. There is evidence indicating that the tendency to rate more concentrated sweet solutions as the most pleasurable (i.e., sweet liking) is associated with the genetic vulnerability to alcoholism. However, sweet liking by itself is insufficient to predict the alcoholic status of the individual. Our previous study indicated that alcoholic status can be predicted by a combination of hedonic response to sweet taste and personality profile as measured by the Tridimensional Personality Questionnaire (TPQ). This study was designed to further test this hypothesis.

METHODS

Participants were 165 patients admitted to a residential treatment program for the treatment of alcoholism, drug dependence and/or interpersonal problems secondary to substance-abusing family members. In addition to a routine medical examination, on the 24th day after admission, patients completed the TPQ, the standard sweet taste test was conducted, and paternal family history of alcoholism was evaluated.

RESULTS

Sweet liking was strongly associated with a paternal history of alcoholism. The odds of receiving an alcohol dependence diagnosis were shown to increase, on the average, by 11% for every one-point increase in the TPQ novelty-seeking score in sweet-liking but not in sweet-disliking subjects. Gender contributed independently to the probability of alcohol dependence, with males exhibiting higher rates of alcoholism than females.

CONCLUSIONS

These findings support the hypothesis that a hedonic response to sweet taste is associated with a genetic risk for alcoholism. Alcoholic status may be predicted by a combination of sweet liking, the TPQ novelty-seeking score, and gender in a mixed group of alcoholic, polysubstance-dependent, and psychiatric patients.

Trajectories of Alcohol Use and Electrophysiological and Morphological Indices of Brain Development: Distinguishing Causes from Consequences

Alcoholism is a major public health problem. Patterns of drinking during adolescence can influence the likelihood of this outcome. Both environmental variation and familial/genetic susceptibility play important roles in this process. While there is some evidence to suggest that metabolic factors play a role in whether some individuals are protected from developing alcohol problems, there is substantial reason to look for cognitive factors that are associated with increased susceptibility. Developmental trajectories for information processing that can be reflected in P300 amplitude changes over time, as well as trajectories describing acquisition of postural control when compared in offspring from families with multiple cases of alcoholism or those with none or few, suggest that brain development provides a clue to why some individuals are more susceptible to becoming alcoholic. Finally, differences seen in amygdala volume between high- and low-risk adolescents suggest that functional differences seen in electrophysiological responding or neuropsychological test performance may have anatomical correlates.

Resting EEG in offspring of male alcoholics: beta frequencies

This study examines the differences in beta (12-28 Hz) band power in offspring of male alcoholics from densely affected alcoholic families. We have attempted to investigate if the increase in beta power is a 'state' or 'trait' marker for alcoholism. This study also explores the gender differences in the expression of this potential risk marker. Absolute beta power in three bands-beta 1(12-16 Hz), beta 2 (16-20 Hz), and beta 3 (20-28 Hz)-in the eyes closed EEG of 171 high risk (HR) subjects who were offspring of male alcoholics and 204 low risk (LR) subjects with no family history of alcoholism, were compared for each gender separately using a repeated measures analysis of variance design. Alcoholic and non-alcoholic subjects within the high risk group were compared using a repeated measures design as a follow-up analysis. The present study demonstrated increased beta power in the resting EEG of offspring of male alcoholics. Male HR subjects had higher beta 1 (12-16 Hz) power and female HR subjects had increased power in beta 2 (16-20 Hz) and beta 3 (20-28 Hz) as compared with low risk participants. Female HR subjects also showed significantly increased beta 2 and beta 3 power if they had two or more alcoholic first-degree relatives when compared with HR females having only an affected father. Risk characteristics are expressed differentially in males and females and may be an index of differential vulnerability to alcoholism. The results indicate that increased EEG beta power can be considered as a likely marker of risk for developing alcoholism and may be used as a predictive endophenotype.

Gene-environment interplay in alcoholism and other substance abuse disorders: expressions of heritability and factors influencing vulnerability

Factors that confer predisposition and vulnerability for alcoholism and other substance abuse disorders may be described usefully within the gene-environment interplay framework. Thus, it is postulated that heritability provides a major contribution not only to alcohol but also to other substances of abuse. Studies of evoked potential amplitude reduction have provided a highly suitable and testable method for the assessment of both environmentally-determined and heritable characteristics pertaining to substance use and dependence. The different personal attributes that may co-exist with parental influence or exist in a shared, monozygotic relationship contribute to the final expression of addiction. In this connection, it appears that personality disorders are highly prevalent co-morbid conditions among addicted individuals, and, this co-morbidity is likely to be accounted for by multiple complex etiological relationships, not least in adolescent individuals. Co-morbidity associated with deficient executive functioning may be observed too in alcohol-related aggressiveness and crimes of violence. The successful intervention into alcohol dependence and craving brought about by baclofen in both human and animal studies elucidates glutamatergic mechanisms in alcoholism whereas the role of the dopamine transporter, in conjunction with both the noradrenergic and serotonergic transporters, are implicated in cocaine dependence and craving. The role of the cannabinoids in ontogeny through an influence upon the expression of key genes for the development of neurotransmitter systems must be considered. Finally, the particular form of behaviour/characteristic outcome due to childhood circumstance may lie with biological, gene-based determinants, for example individual characteristics of monoamine oxidase (MAO) activity levels, thereby rendering simple predictive measures both redundant and misguiding.

Is Risk for Alcoholism Mediated by Individual Differences in Drinking Motivations?

BACKGROUND

Individual differences in motivations to drink have been proposed as a mechanism that mediates risk for alcoholism. We investigated the genetic and environmental sources of variation in motivations for drinking, as assessed by four scales of the Alcohol Use Inventory (AUI), and then examined the extent to which genetic and environmental variations in risk for alcoholism are mediated by individual differences in drinking motives.

METHODS

Data on four AUI scales (assessing drinking to manage mood states, to relieve social anxiety, in social situations, and to improve mental functioning) and lifetime DSM-IV alcohol abuse and/or dependence (AAD) were obtained from 2529 female and 3709 male adult twins, including 2229 complete twin pairs, from the population-based Virginia Twin Registry.

RESULTS

Logistic regression analyses indicated that higher scores on each of the four AUI variables were significantly associated with AAD, with increases in risk for diagnosis of 40% to 141% per standard deviation increase in AUI score. Structural modeling analyses conducted using Mplus indicated that individual differences in AUI scores were in part due to genetic variation, particularly among women. Among males, genetic factors were substantial for drinking to alter mood but small for other measures. A substantial portion of the genetic variation in AAD overlapped with drinking to manage mood states. Results from bivariate twin models of AAD and the AUI scales were consistent with the mediation hypothesis for the social anxiety and social interaction scales but not drinking to manage mood or to enhance mental functioning.

CONCLUSIONS

Genetic contributions to variation in risk for alcoholism may be mediated in part by individual differences in motivations related to drinking in social settings. Drinking to manage mood indexes genetic risk for alcoholism but does not appear to act as a direct cause of alcoholism.

Genetics and drug use as a complex phenotype

Drug use is a complex behavior influenced by multiple biological, family, and sociocultural factors. The concurrent use/misuse of multiple drugs is often seen and drug use also co-occurs with other psychiatric conditions. Behavior and molecular genetic studies support an important posited role of genes in drug use. This posited genetic risk does not appear to be conferred by one or two major genes manifesting large effects, but rather by a number of genes manifesting smaller effects. Genetic factors explain, on average, only about half of the total variability in drug use, with the remaining variability influenced by environmental factors. Also, genetic risk may be differentially expressed in the presence vs. absence of particular environmental conditions. Thus, investigation of environmental factors and their interaction with genetic risk is a necessary component of genetic research. While the full potential of genetic investigations for the prevention of drug misuse has yet to be realized, an example of the impact of risk factor modification under various conditions of gene-environment interaction is provided, and the implications for use of genetic information in drug-misuse prevention are discussed. The multifactorial nature of drug use necessitates coordinated investigation from multiple disciplines and timely dissemination of scientific findings. In addition, this work demands adherence to the highest standards of confidentiality and ethical use of genetic information to best inform future prevention efforts.

Pharmacogenomics of alcohol response and addiction

Alcoholism is a complex psychiatric disorder that has high heritability (50-60%) and is relatively common; in the US the lifetime prevalence of alcohol dependence is 20% in men and 8% in women. Current psychosocial and pharmacological therapies have relatively modest effects. Treatment is complicated by the fact that alcoholism is often co-morbid with other disorders, including anxiety, depression, and antisocial personality disorder. Approximately 80% of alcoholics smoke cigarettes and there is considerable genetic overlap between nicotine and alcohol addiction. Convergent evidence supports the classification of alcoholics into two broad categories: type 1 - later onset with feelings of anxiety, guilt, and high harm avoidance; and type 2 - early age of onset, usually men, impulsive, antisocial, and with low levels of brain serotonin. The pharmacogenomics of alcohol response is well established; genetic variants for the principal enzymes of alcohol metabolism influence drinking behavior and protect against alcoholism. Vulnerability to alcoholism is likely to be due to multiple interacting genetic loci of small to modest effects. First-line therapeutic targets for alcoholism are neurotransmitter pathway genes implicated in alcohol use. Of particular interest are the 'reward pathway' (serotonin, dopamine, GABA, glutamate, and beta endorphin) and the behavioral stress response system (corticotrophin-releasing factor and neuropeptide Y). Common functional polymorphisms in these genes are likely to be predictive (although each with small effect) of individualized pharmacological responses. Genetic studies, including case-control association studies and genome wide linkage studies, have identified associations between alcoholism and common functional polymorphisms in several candidate genes. Meanwhile, the current pharmacological therapies for alcoholism are effective in some alcoholics but not all. Some progress has been made in elucidating the pharmacogenomic responses to these drugs, particularly in the context of the type 1/type 2 classification system for alcoholics.

Family History of Alcoholism and Response to Sweets

BACKGROUND

The relationship between a hedonic response to sweet tastes and a propensity to excessive alcohol drinking is supported by both animal and human studies. This study was designed to test the hypothesis that the genetic risk for alcoholism as measured by a paternal history of alcoholism in young social drinkers is associated with sweet-liking, defined as rating the strongest offered sucrose solution (i.e., 0.83 M) as the most palatable during the standard sweet test.

METHODS

Participants were 163 subjects (39% male) without a lifetime history of alcohol or drug abuse or dependence. Eighty-one subjects had a paternal history of alcoholism (FH+), and 82 did not (FH-). Each subject rated a series of sucrose solutions for intensity of sweetness and palatability. Subjects were categorized as sweet-likers if they rated the highest sucrose concentration as the most pleasurable.

RESULTS

The estimated odds of being a sweet-liker were 2.5 times higher for FH+ than for FH- subjects. FH+ subjects disliked the tastes of the two weakest offered sucrose concentrations (0.05 and 0.10 M), whereas FH- subjects reported these tastes to be neutral.

CONCLUSIONS

The results of this study support the hypothesis that sweet-liking is associated with a genetic vulnerability to alcoholism.

D2 dopamine receptor gene in psychiatric and neurologic disorders and its phenotypes

The D2 dopamine receptor (DRD2) has been one of the most extensively investigated gene in neuropsychiatric disorders. After the first association of the TaqI A DRD2 minor (A1) allele with severe alcoholism in 1990, a large number of international studies have followed. A meta-analysis of these studies of Caucasians showed a significantly higher DRD2 A1 allelic frequency and prevalence in alcoholics when compared to controls. Variants of the DRD2 gene have also been associated with other addictive disorders including cocaine, nicotine and opioid dependence and obesity. It is hypothesized that the DRD2 is a reinforcement or reward gene. The DRD2 gene has also been implicated in schizophrenia, posttraumatic stress disorder, movement disorders and migraine. Phenotypic differences have been associated with DRD2 variants. These include reduced D2 dopamine receptor numbers and diminished glucose metabolism in brains of subjects who carry the DRD2 A1 allele. In addition, pleiotropic effects of DRD2 variants have been observed in neurophysiologic, neuropsychologic, stress response, personality and treatment outcome characteristics. The involvement of the DRD2 gene in certain neuropsychiatric disorders opens up the potential of a targeted pharmacogenomic approach to the treatment of these disorders.

Neurodevelopmental liabilities in alcohol dependence: central serotonin and dopamine dysfunction

Alcoholism is a complex disorder with symptoms ranging from abuse to dependence, often comorbid with depression, antisocial personality, or anxiety. Neurodevelopmental causes of the disorder are unknown but inferences are possible from current knowledge. Neurobiological studies implicate multiple brain changes, which may be characterized as premorbid or morbid. These studies have also examined specific aspects of the alcohol dependence syndrome, including alcohol reinforcement and craving. Here, we review the evidence for vulnerability factors in alcohol dependence, with an emphasis on central serotonin (5-HT) and dopamine (DA). Serotonin dysfunction likely contributes to the development of alcoholism since studies of alcohol-preferring rodents show decreased 5-HT function on many measures. We have shown that serotonin-enhancing drugs reduce consumption and craving in mild to moderate alcoholics, yet similar studies in severely dependent individuals remain inconclusive. Studies indicate that serotonin dysfunction may contribute to the development of dependence via impaired impulse control and/or mood regulation. The mesocorticolimbic dopamine pathway represents another important pathophysiological target in alcoholism. Differences in D(2) receptor density, dopamine sensitivity, and gene expression have been linked to consumption, reinforcement, craving, and relapse. However, while DA agonists reduce self-administration in animals, we found no effect in humans with long-acting bromocriptine, a D(2) agonist. Dopamine may contribute differentially to the development of dependence via its effects on alcohol wanting, reinforcement, and reward memory. Although animal experiments show consistent roles for serotonin and dopamine in alcohol dependence, human studies are not always concordant. Such discrepancies highlight the complexity of dependence-related behaviors in humans and of identifying vulnerabilities to alcoholism.

D(2) dopamine receptor (DRD2) polymorphism is associated with severity of alcohol dependence

The A(1) allele of the D(2) dopamine receptor (DRD2) gene has been associated with alcohol dependence. However, the expression of this allele risk on the severity of drinking behavior in patients with alcohol dependence has not been systematically explored. The present study examines the association between DRD2 A(1)(+) (A(1)/A(1) and A(1)/A(2) genotypes) and A(1)- (A(2)/A(2) genotype) allele status and key drinking parameters in alcohol-dependent patients. A sample of Caucasian adults was recruited from an alcohol detoxification unit. A clinical interview and the Alcohol Dependence Scale (ADS) questionnaire provided data on consumption, dependence, chronology of drinking and prior detoxification. A(1)(+) allele compared to A(1)- allele patients consumed higher quantities of alcohol, commenced problem drinking at an earlier age, experienced a shorter latency between first introduction to alcohol to the onset of problem drinking and had higher ADS scores. Moreover, A(1)(+) allele patients had more detoxification attempts than their A(1)- allele counterparts. In sum, alcohol-dependent patients with the DRD2 A(1) allele compared to patients without this allele are characterized by greater severity of their disorder across a range of problem drinking indices. The implications of these findings are discussed.

Estado atual e perspectivas da genética e epidemiologia do alcoolismo

O alcoolismo é um problema de saúde pública de escala mundial. O abuso e dependência combinados afetam aproximadamente 8% da população brasileira, gerando um grande custo social. O reconhecimento da existência de uma herdabilidade significativa contribuiu para o entendimento do problema como uma doença específica com origem biológica. Os avanços no conhecimento da neurobiologia da dependência permitiram delimitar uma série de genes candidatos para a predisposição. Atualmente, iniciam-se os estudos sobre o papel de polimorfismos genéticos na resposta ao tratamento. A integração de abordagens clínicas, epidemiológicas e de genética molecular pode identificar grupos clínicos mais responsivos a abordagens terapêuticas específicas.

Detecting and addressing alcohol abuse in women

In the primary care setting, 20% to 25% of patients experience alcohol-related problems; however, clinicians often treat the symptoms of alcoholism and fail to identify the disease itself. Unlike men, women commonly seek help for alcoholism from primary care clinicians. Further, the development and progression of alcoholism is different in women than in men. Women with alcohol problems have higher rates of dual diagnoses, childhood sexual abuse, panic and phobia disorders, eating disorders, posttraumatic stress disorder, and victimization. Early diagnosis, brief interventions, and referral are critical to the treatment of alcoholism in women.

The genetics of alcoholism and alcohol abuse

Twin studies have established that there are substantial genetic influences on alcoholism (0.5-0.6) in both men and women. Our knowledge of behaviors predisposing to alcoholism, including anxiety and impulsivity, is advancing rapidly through animal and human studies. Although alcoholism is often comorbid with other substance abuse and psychiatric disorders, recent studies have shown that, with the exception of nicotine, the heritability of alcoholism is largely substance-specific. Increasing understanding of the neurobiology of addiction has identified neural pathways in which genetic variation at candidate genes could influence vulnerability. Some functional variants of these genes have been identified. Recent linkage analyses in humans and rodents have pointed to genomic regions harboring genes that influence alcoholism. Refinement of clinical phenotypes and use of intermediate phenotypes will improve chances of gene identification. All these advances in the understanding of the genetics of alcoholism should facilitate the development of more accurately targeted therapies using molecular diagnostic approaches.

P300 event-related potential amplitude as an endophenotype of alcoholism--evidence from the collaborative study on the genetics of alcoholism

There is substantial information supporting the role of genetic factors in the susceptibility for alcohol dependence. However, the identification of specific genes that contribute to this predisposition has proven elusive, although several theoretically relevant candidates, e.g. DRD2 or 5-HT(1B), have been considered. The difficulty in identifying specific genes may be related to the clinical heterogeneity of the disorder resulting in a poorly defined phenotype for genetic analysis. An alternative approach to the use of a diagnostic phenotype for identifying alcoholism susceptibility genes may lie in the examination of the neurobiological correlates of the disorder, the so-called endophenotypes. One possible endophenotype of alcohol dependence may be related to the P300 waveform of the event-related brain potential (ERP). Using data obtained from the Collaborative Study on the Genetics of Alcoholism (COGA), a multi-site family-based study, the utility of P300 amplitude as an endophentype was examined. Differences in P300 amplitude were found between alcoholics and nonalcoholics, between unaffected relatives of alcoholics and relatives of controls, as well as between unaffected offspring of alcoholic fathers and offspring of controls. A genetic analysis indicated that attributes of the P(3) ERP waveform are heritable, and a quantitative trait locus analysis found linkage to several chromosomal regions. These data provide significant support for P300 as an endophenotype for alcohol dependence.

The DRD2 gene in psychiatric and neurological disorders and its phenotypes

The TaqIA D2 dopamine receptor (DRD2) minor (A1) allele was first associated with severe alcoholism a decade ago. Since then, studies both confirming and not confirmnning this finding were reported. However, a meta-analysis of a large number of Caucasian alcoholics (both more severe and less severe) and controls (both assessed and unassessed for substance use disorders) revealed a significantly higher frequency (p < 10(-6)) and prevalence (p < 10(-8)) of the DRD2 A1 allele in the alcoholics. Further analysis showed that the more severe alcoholics had a 3-fold higher prevalence of the DRD2 A1 allele than the assessed controls (p < 10(-10)), whereas no difference was found between the less severe alcoholics and the unassessed controls. DRD2 exonic or promoter mutations have not yet been associated with alcoholism, although two intronic variants at the TaqIB and intron 6 sites, which are in linkage disequilibrium with the TaqIA site, were associated with this disorder. Variants of the DRD2 gene have also been associated with cocaine, nicotine and opioid dependence, obesity and gambling. It is hypothesised that the DRD2 is a reinforcement or reward gene. Although less intensively studied than substance use disorders, the DRD2 gene has been implicated in Tourette's syndrome (TS), post-traumatic stress disorder (PTSD) and certain symptoms associated with affective disorders and schizophrenia. Further, DRD2 variants have been implicated in Parkinson's disease (PD) and in iatrogenically-induced movement disorders, as well as in certain migraineurs. Phenotypic differences have been associated with DRD2 variants. These include reduced D2 dopamine receptor numbers and diminished glucose metabolism in the brain of subjects who carry the DRD2 A1 allele. In addition, phenotypic differences have been found in neurocognitive and personality characteristics, and in treatment outcome of DRD2 variants. The involvement of the DRD2 gene in certain neuropsychiatric disorders opens up the potential of a targeted pharmacogenomic approach to the prevention and treatment of these disorders.

Segregation analysis of drinking problem in elderly men and their first-degree relatives from the Western Collaborative Group Study

PURPOSE

The purpose of this study is to determine the mode of inheritance of alcohol-related drinking problems.

METHODS

Family history was collected by interview from 493 elderly male participants (probands) in a follow-up cardiovascular exam of healthy white men living in the San Francisco Bay Area and Los Angeles. Segregation analysis was used to test for the presence of a major gene effect underlying the liability to develop an alcohol-related drinking problem.

RESULTS

The results showed that the liability to drinking problem is due, in part, to a single major gene with no residual effects from shared familial influences.

CONCLUSIONS

These results suggest that at least one major gene is involved in the genetic predisposition to develop drinking problem in late adulthood.