Natalie Frank, a Ph.D in clinical psychology, specializes in pediatrics, health psychology, and behavioral medicine.
The Psychology Query is back after a short hiatus due to illness. Actually, this brings me to a point I’d like to make related to a number of questions I have received. Many questions I get from week to week ask for either advice related to medical conditions and treatment or recommendations for medications to take for different types of mental health conditions. I will not be writing on medical issues for an important reason.
Each professional has their own areas of expertise, their own background and their own type of training. Just like you wouldn’t hire a plumber to rewire your house, you shouldn’t ask someone who is not a medical professions such as a physician or nurse to make medical recommendations. There are many people out there who will answer such questions despite not being qualified to do so and this can lead to serious problems in terms of using a treatment that is not correct or is based on personal opinion, limited evidence or anecdotal support.
With the technological advances we have made in recent decades especially in regard to the Internet, it can seem easier to ask questions online and receive answers without the need to make an appointment with a qualified health care provider or put in a call about a particular problem. However, while there are licensing and credentialing laws for health care providers that can be checked, the internet has no overall vetting system for those who upload content or answer questions. Yet many people perceive the material on the Internet to be in some way official, safe or otherwise reliable. The fact is practically anyone anywhere can write what they choose to on the internet with little to no over site.
Basic Guidelines for Evaluating Online Health Information
The Office of Dietary Supplements (ODS), which is a part of the National Institutes of Health has put together a fact sheet of useful information about evaluating online sites and sources of health information. Some of their main points include the following:
• Any Web site should make it easy for you to learn who is responsible for the site and its information.
• If the person or organization in charge of the Web site did not write the material, the Web site should clearly identify the original source of the information.
• Health-related Web sites should give information about the medical credentials of the people who have prepared or reviewed the material on the site.
• Any Web site that asks you for personal information should explain exactly what the site will and will not do with that information.
• The U.S. Food and Drug Administration and Federal Trade Commission are federal government agencies that help protect consumers from false or misleading health claims on the Internet.
Always remember that while there is a wealth of information online, much of it is not accurate, is simply a trend, is based on someone’s personal agenda or is trying to sell you something. Similarly, just because someone says they are a physician or pharmacist doesn’t mean they actually are one, and even if they may be this doesn’t automatically mean they are well trained, ethical or providing good information. Please always make sure to check out any sources whether they are sites or individuals and only take medical advice from properly trained and credentialed professionals who have fully evaluated you, your problem or concern and have obtained all the necessary information to allow them to make an informed decision. I have listed a number of good sites for basic health information below.
Reliable Online Sites for Health Information
Question: I’ve recently heard that there are two types of alcoholics having to do with when the problem starts. I’ve also heard that the earlier someone develops the disorder the better the outcomes which doesn’t make sense to me. Are there subtypes of alcoholism and if so does one type do better than the other?
This is a complicated question with equally complex answers. The complexity of the issue in question is largely due to the heterogeneity in both heritability and environmental factors that are related to the disorder. This just means that there are a lot of different characteristics that can contribute to alcohol use disorder some of which are inherited, some of which are physiological and develop over time such as dependence and withdrawal, and some of which are environmental.
Studies have supported the classification of two types of alcohol abuse based on heritability or the degree to which genetics plays a role in the disorders development (Please see the previous article for a discussion of heritability). As with most disorders, results of research have indicated that there are both genetic and environmental influences on the development of alcohol abuse. The strength of these factors however, differs by type (e.g. Enoch, 2012).
Gender differences, age of onset, associated personality characteristics, course of the disorder have also been described through several well-known adoption studies carried out in Sweden (e.g. Sigvardsson, Bohman, & Cloninger, 1996). Subsequent research has been summarized and examined in many reviews and books which include descriptions of the two types of disorders as presented below (e.g. Vaillant 2009; Meier, Caspi, Houts, Slutske, Harrington, Jackson, & Moffitt, 2013).
Type 1 and Type 2 Alcohol Abuse
Those with Type 1 alcohol abuse usually begin drinking in their mid-twenties to thirties but don't develop alcohol problems until middle age. Tolerance and dependence generally develops rapidly due to the anti-anxiety effect of the alcohol and the fact these individuals frequently develop psychological addiction. This means they do not believe they can function properly without the alcohol. This results in high rates of relapse even after successful treatment and the absence of physical dependence.
The Type 1 Subtype is characterized by anxious, passive-dependent personality traits. These traits are associated with the loss of control over the ability to resist consumption and the inability to stop binges once they start. This type usually begins after exposure to socially encouraged alcohol use. The social aspect may be direct through reassurance that the behavior is perfectly normal, even desirable, through peer pressure or indirectly through modeling by popular or enviable individuals.
Compared to Type 2 alcoholics, those with Type 1 alcoholism show little antisocial behavior and fewer social and occupational problems. Severe medical complications are common in this subtype including serious liver disease. Mostly found in males and females who were the biological offspring of female alcoholics. Heritability in the Type I subgroup for both males and females has been estimated at 21%.
Type 2 alcohol abuse is characterized by antisocial personality traits and drinking alcohol for the euphoric effects. This pattern has an earlier onset than Type 1 and is typified by the inability to abstain completely almost from the onset. Criminal behavior, violence and arrests are common when the person is drinking. Those with Type 2 alcoholism experience profound social and occupational problems but few medical difficulties.
Type 2 alcoholism is most often found in males who are the biological sons of male alcoholics. Biological sons of Type 2 alcoholics are nine times more likely to become alcoholics compared to the sons of all other fathers. Low rates of medical complications are found in this group. Heritability in the Type 2 subgroup has been estimated at 88% for males. This type of alcohol abuse has been termed male limited.
The answer to your question then, is that there are different subtypes of alcohol abuse disorders. These types can be differentiated by genetic and environmental factors related to its development. The groups can also be identifies through different patterns of behavior, personality characteristics, other psychopathology including co-occurring drug abuse, mood and anxiety disorders, and medical problems.
I think however, a more important question is what implications this have for treatment. Sometimes researchers get caught up in finding evidence for their theories without keeping in mind the fact that they are dealing with real people who need help to get their lives back on track. Classification in terms of psychological disorders is only useful in so far as it provides implications for treatment.
While the evidence regarding different types of alcoholism has been available since the 1950’s or earlier there is a lack of associated research looking at treatment approaches that take this into account. I point this out only to underscore the importance of keeping in mind that psychological research of this type should include something other than the ability to categorize. Psychological research examining characteristics of disorders should provide some type of recommendations or implications for treatment that can contribute to the research participants’ well-being.
I would argue it is unethical to simply identifying the variety of legal, psychosocial and medical problems related to alcohol abuse only in order to publish the findings without paying attention to the need of the individuals who were the source of the data, Giving back to those who are identified as having difficulties of some kind or another in psychological research may or may not provide an additional source of publication credit. However, I think this is the only way to conduct research in a morally responsible manner.
Thank you, reader for your question and thank you to all of you who have tuned in for another edition of the Psychology Query. Keep your questions coming!
Enoch, M. A. (2012). The influence of gene–environment interactions on the development of alcoholism and drug dependence. Current psychiatry reports, 14(2), 150-158.
Meier, M. H., Caspi, A., Houts, R., Slutske, W. S., Harrington, H., Jackson, K. M.& Moffitt, T. E. (2013). Prospective developmental subtypes of alcohol dependence from age 18 to 32 years: implications for nosology, etiology, and intervention. Development and psychopathology, 25(03), 785-800.
Sigvardsson, S., Bohman, M., & Cloninger, C. R. (1996). Replication of the Stockholm Adoption Study of alcoholism: Confirmatory cross-fostering analysis. Archives of General Psychiatry, 53(8), 681-687.
Vaillant, G. E. (2009). The natural history of alcoholism revisited. Harvard University Press.
© 2017 Natalie Frank