Running Head: AUD:NATURE VS.

NURTURE 1

Alcohol Use Disorder: The Debate of Nature Versus Nurture

Lauren Yerry

Hudson Valley Community College

July 29, 2019

AUD:NATURE VS. NURTURE !2

Abstract

Alcohol Use Disorder (AUD) is a complex disorder that effects many individuals. In order to

gain an understanding of AUD it is essential to examine the internal and external factors that

contribute to the manifestation of the disorder. These factors include: (1) biological factors, (2)

environmental factors and (3) psychological factors. Through a clear understanding of the

individual influences that may impact the development of AUD, the possibility of recovery from

AUD increases. While the debate of nature versus nurture seems to be ongoing, it seems that

there may never be a definitive answer. Through extensive examination of three separate case

studies, internal and external factors are weighed to compare significant influences contributing

to AUD. The case studies reveal the possibility that contributing factors can combine from a

nature and a nurture viewpoint. This indicates that AUD is a disorder that develops through

individual circumstance without a general emphasis on any one specific factor.

Keywords: AUD, biological, environmental, nature, nurture, psychological

AUD:NATURE VS. NURTURE !3

Alcohol Use Disorder: The Debate of Nature Versus Nurture

The prevalence of Alcohol Use Disorder (AUD) in the United States raises many

questions as to the origins of its manifestation in an individual. While AUD is a chronic disorder

that effects the quality of life for many people, there is widespread debate on whether it is

developed through a nature or nurture perspective. It appears that there may not be a generalized

definitive answer to this important discussion. Some research shows that biological influence

may significantly contribute to AUD, however, several contrasting studies conclude that

psychological and environmental factors primarily impact the progression of the disorder.

Perhaps, AUD evolves through individualized circumstance that cannot be assigned to either a

nature or nurture viewpoint. The complexities of AUD indicates that both internal and external

factors affect individual behavior. It appears that causal variables contributing to the inception

and progression of the disorder cannot be clearly identified in respect to one definitive answer.

Through close examination of three alcoholic individuals, questions pertaining to nature versus

nurture arise. The candid answers provide insight into what seems to be a nearly impossible

question. AUD culminates from many variables without a known set equation. Each

circumstance of AUD derives from an individualized recipe that blends, biological,

environmental, psychological, and behavioral influences through various combinations that

rarely reflect either the nature or nurture debate.

AUD Origin and Diagnosis

The origin of AUD and its diagnosis as a mental disorder can be traced back to the

Diagnostic and Statistical Manual of Mental Disorders, first edition (DSM-I) in 1952 (NIAAA,

2016). However, through extensive research and continued examination, the understanding of
AUD:NATURE VS. NURTURE !4

AUD has evolved in order to develop and implement effective treatment for individuals who

suffer from the disorder in present times (NIAAA, 2016). The criteria and thresholds for

diagnosis have changed over the last 70 years through gained knowledge of AUD. They can be

found in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). The

DSM-5 defines the diagnosis of AUD by the presentation of at least two of 11 standards that

must be met by an individual in order to be diagnosed (APA, 2013). Furthermore, these standards

need to be considered active within the individual at some point within the last 12 month period

of time (APA, 2013). One of the biggest changes that exists in the DSM-5 is the severity index

that was added to signify the number of standards met by an individual (NIAAA, 2016). For

instance, individuals considered to have mild AUD can have two or three symptoms, while those

that identify with six or more symptoms can be diagnosed with severe AUD (APA, 2013). In

addition, a moderate severity index can be applied to an individual that has four to five

symptoms (APA, 2013). The implementation of the severity index may have assisted with the

idea that AUD is an individualized disorder that cannot be diagnosed or treated with a broad

theory that supports a generalized definition. With this in mind, the development of AUD in each

individual needs to be thoroughly examined to determine the biological, environmental and

psychological impacts associated with each case. Thereby offering the possibility that AUD can

manifest through many internal and external factors. A closer examination of the nature versus

nurture debate in AUD is explored through three separate interviews of individuals that have

been diagnosed with AUD. Three interviews reveal three very different case studies. While

Frank, Jason and Tina provide in depth descriptions of their individual experiences leading up to
AUD:NATURE VS. NURTURE !5

their diagnoses of AUD, there are interesting contrasts and correlations that support both the

nature and nurture debate.

Case Study - Frank

Frank is a recovering alcoholic, diagnosed with AUD, that has been in sustained recovery

for close to 26 years. Frank was born into a low-income family and was raised by his biological

mother. He states that his mother was a “drinker” and had a tendency to date and marry men that

were abusive alcoholics (F. Yerry, personal communication, July 15, 2019). While this may

indicate a genetic predisposition to AUD from his mother, the environmental and psychological

factors that Frank experienced cannot be overlooked.

He did not know his biological father and struggled with the notion that his “self-

understanding was half missing” (F. Yerry, personal communication, July 15, 2019). He also

suffered from feelings of abandonment due to the fact that he did not know his father (F. Yerry,

personal communication, July 15, 2019). Frank moved from school to school as a young child

because his mother was always running from one bad situation to the next. His studies suffered

and his anger grew (F. Yerry, personal communication, July 15, 2019). In a rare jurisdictional

decision, Frank was emancipated from his mother at the age of 16 (F. Yerry, personal

communication, July 15, 2019). His schoolwork continued to suffer and he began hang around

with the wrong crowd (F. Yerry, personal communication, July 15, 2019). His drinking increased

and his anger continued to grow (F. Yerry, personal communication, July 15, 2019). As time

passed, he found himself in many physical altercations that were a direct result of his increased

alcohol intake and mounting displaced anger (F. Yerry, personal communication, July 15, 2019).
AUD:NATURE VS. NURTURE !6

It seems that Frank had many internal and external factors that contributed to his diagnosis of

AUD.

Biological Factors of Frank’s AUD

The genetic possibility of transference of his mothers alcoholism could indicate a

biological factor. While biological evidence exists, it is hard to understand, based on research, if

the genetic predisposition is a primary influencer for Frank’s AUD (Tawa, Hall & Lohoff, 2016).

In addition, the intricate understanding of AUD through the influence of several internal and

external factors to each individual lends to the doubt that AUD is purely based upon biological

predisposition (Tawa, Hall & Lohoff, 2016). In Frank’s case, it is especially difficult to

understand his genetic make-up given the fact that he does not know biological father.

Environmental Factors of Frank’s AUD

The dynamics of Frank’s childhood, most likely had a significant impact on his AUD.

Throughout his childhood, Frank’s understanding of proper alcohol consumption may have been

skewed by the constant misguided representation of alcohol in his family’s daily life (Galbicsek,

n.d.). While Frank’s daily environment was flooded by the negative effects of alcohol, it is likely

that his childhood observations significantly impacted his sense of acceptable drinking patterns.

Galibicsek (n.d.) emphasizes the correlation between early exposure to alcohol in childhood and

the development of AUD. While Frank’s exposure to alcohol was early and consistent, it is

reasonable to believe that this may have had a considerable impact on Frank’s AUD. However, in

order to further understand Frank’s AUD, the psychological factors involved also require

examination.
AUD:NATURE VS. NURTURE !7

Psychological Factors of Frank’s AUD

It appears that psychological factors that may have contributed to Frank’s AUD

developed at an early age. During his interview, Frank placed great emphasis on the idea that he

never knew his biological father. This seems to have weighed heavily on Frank throughout his

life. It may also explain the source of his anger. In order to dull his painful thoughts, Frank used

alcohol as a numbing agent. According to Galibicsek (n.d.), alcohol can become a coping

mechanism to avoid feelings. This can often develop into AUD through repeated use and habit

(Galibicsek, n.d.).

Case Study - Tina

Tina is a recovering alcoholic who has been in sobriety for nearly 26 years (T. Gay-Yerry,

Personal Communication, July 17, 2019). She grew up in her paternal-grandparent’s home with

her mother and father. Tina’s parents had her when they were 17 (T. Gay-Yerry, Personal

Communication, July 17, 2019). She grew up in an Italian family home where it was considered

normal to drink wine at lunch and dinner as a child (T. Gay- Yerry, Personal Communication,

July 17, 2019). Although this behavior was typical for Italian families, it never affected her

parents development of AUD. Due to her parents conceiving her at a young age and being forced

to marry, Tina was exposed to a volatile environment (T. Gay-Yerry, Personal Communication,

July 17, 2019). This led to an unstable childhood that was rarely consistent. At the age of 10, her

parent’s divorced and she lived with her mother. By age 13, she was enrolled in a boarding

school 30 minutes away from her home as a day student. Midway through her sophomore year,

she became a boarder in order to distance herself from her home life where her parents were

mostly absent (T. Gay-Yerry, Personal Communication, July 17, 2019). Tina expresses her need
AUD:NATURE VS. NURTURE !8

to achieve perfection during her high school years to gain approval (T. Gay-Yerry, Personal

Communication, July 17, 2019). This constant need for perfection and validation would send her

into binge drinking episodes where she would want to forget her obsessive need to be perfect (T.

Gay-Yerry, Personal Communication, July 17, 2019).

Environmental Factors of Tina’s AUD

From early childhood to her teenage years, Tina had direct environmental influences that

contributed to her AUD. Her exposure to alcohol at an early age certainly may have had a

significant impact. In addition, the instability of her daily life, most likely, prompted stress and

pressure for her to be noticed by her mother and father. Her early exposure to alcohol coupled

with the constant turmoil in her family combined to increase her risk for AUD (Galibicsek, n.d.).

Psychological Factors of Tina’s AUD

The lack of support of her parents both physically and mentally took a toll on Tina.

Leaving her to constantly strive toward perfection in order to get noticed by her family. When

that failed, she turned to alcohol to relieve her sorrows and frustration. Unable to face or feel

emotional pain, Tina’s AUD progressed through repeated periods of inebriation (Galibicsek,

n.d.).

Case Study - Jason

Jason is a 42 year old active alcoholic. Jason was given up for adoption when he was born (J.

Rushforth, Personal Communication, July 18, 2019). He was adopted by a stable family and

childhood was very “normal” (J. Rushforth, Personal Communication, July 18, 2019). He grew

up in a two-parent household where his father taught him how to hunt and fish (J. Rushforth,

Personal Communication, July 18, 2019). Jason’s adoptive parents were very open in telling
AUD:NATURE VS. NURTURE !9

Jason he was adopted and conveyed so in a healthy manner (J. Rushforth, Personal

Communication, July 18, 2019). Although Jason came from a healthy environment he ultimately

knew “nothing” about where or whom he came from (J. Rushforth, Personal Communication,

July 18, 2019). Later in his life Jason decided to join Ancestry.com and have his DNA tested to

see if he could find any blood relatives and find out more about his biological parents (J.

Rushforth, Personal Communication, July 18, 2019). DNA matches concluded that Frank, from

the first case study, is Jason’s half-brother. When Jason had his first phone call with Frank it was

emotional. Frank was the first blood relative to whom Jason had spoken (J. Rushforth, Personal

Communication, July 18, 2019). One of the first questions Jason asked Frank was if he had

problems with alcohol (J. Rushforth, Personal Communication, July 18, 2019). Jason has been

arrested for driving under the influence on three separate occasions, however, he continues to

drink (J. Rushforth, Personal Communication, July 18, 2019).

Biological Factors of Jason’s AUD

Interestingly Jason may be biological predisposed to AUD given the fact that he and

Frank grew up in two entirely different environments, but are related. They both have been

diagnosed with AUD. Past twin studies that support biological genetic evidence of AUD may

explain this influence for Jason and Frank (Tawa, Hall & Lohoff, 2016). Although this evidence

could be a biological link to Jason’s AUD, psychological effects may also be contributing

factors.

Psychological Effects of Jason’s AUD

The psychological factor of not knowing his biological origins may have contributed to

Jasons AUD in such a way that he may have become fearful of the unknown. This influence may
AUD:NATURE VS. NURTURE !10

have created a vulnerability which may have led to increased drinking habits for Jason. It has

been evidenced that vulnerable feelings can lead to increased alcohol intake in order to overcome

inferiority (Galibicsek, n.d.). Due to the ongoing nature of Jason’s active AUD, further

exploration of factors leading to his AUD should be examined.

Conclusion

After interviewing Frank, Tina and Jason, it seems that there are not definitive answers to

the nature versus nurture debate. In comparing and contrasting all three individual histories,

evidence supports the influence of AUD through various factors. The biological, psychological,

and environmental impacts in each case are very different. It appears that individual

circumstance and reaction to individual are forefront in the manifestation of AUD. Each

individual is different, the only commonality is the diagnosis of AUD. Biological, environmental

and psychological factors influence people in different ways. The nature versus nurture debate

believes it is one of these factors over the other that contributes to AUD. However, this seems to

be untrue as each case study exhibits different culminating factors leading to the outcome of

AUD. While studies continue to further explore the underpinnings of AUD, it is important to

remain cognizant that research should be treated as a tool to understand the individualities

associated with AUD. Research should not be generalized as a broad interpretation on this

disorder. Furthermore, AUD is an immensely intricate disease that is far more complicated than

nature versus nurture.

AUD:NATURE VS. NURTURE !11

References

Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5. (2019, June 26).

Retrieved July 21, 2019, from https://www.niaaa.nih.gov/publications/brochures-and-

fact-sheets/alcohol-use-disorder-comparison-between-dsm

Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Arlington, VA: American

Psychiatric Association.

Gay-Yerry, T. (2019, July 17). Personal Experiences of Alcoholism [Personal interview].

Galbicsek, C. (n.d.). Alcoholism Causes and Risk Factors. Retrieved July 19, 2019, from https://

www.alcoholrehabguide.org/alcohol/causes/

Rushforth, J. (2019, July 18). Personal Experiences of Alcoholism [Telephone interview].

Tawa, E. A., Hall, S. D., & Lohoff, F. W. (2016). Overview of the Genetics of Alcohol Use

Disorder. Alcohol and Alcoholism, 51(5), 507-514.

Yerry, F. S. (2019, July 15). Personal Experiences of Alcoholism [Personal interview].