Thursday, October 22, 2009

Predicting alcoholism; then what do you do?

What would you do if you could say from a simple test that this group of kids over here is 8 times more likely to become alcoholics or drug addicts than the rest of the kids? As a matter of public policy or child development, what would you do for them differently than you would do for kids without the bad gene?

A bunch of kids were followed for 11 years to track potential risk factors for alcoholism. The study, published in Biological Psychiatry and described on Science Daily,  chose
children with either high or low familial risk for developing alcohol dependence and followed them annually over an eleven-year span. During this time, they repeatedly evaluated a series of thirteen predictors that are thought to influence familial risk, including educational achievement scores, personality variables, self-esteem, and anxiety, along with specific neurobiological variables (P300 amplitude, a brain neuroelectric potential, and postural body sway).
They found that children with increased body sway and reduced P300 amplitude had an 8-fold increase in their likelihood of developing a substance use disorder by young adulthood, indicating that neurobiological variables are among the most important in predicting outcome. "The P300 is a brain signal that is associated with the significance of events in our environment and may reflect an individual's ability to make optimal use of such information to guide future behavior. It is both interesting and important that the long-term risk for developing alcohol dependence can be connected to this relatively basic feature of brain wiring," explained Dr. John Krystal, Editor of Biological Psychiatry.
So when we start testing kids' posture and P300 amplitude in grade Pre-K as part of normal screening, what will we do with the kids we find who have "an 8-fold increase in their likelihood of developing a substance use disorder by young adulthood"?

What can you do with information that this group of kids over here is where we will draw our biggest young alkies and druggies from? You can't have different alcohol availability rules for them. (As in, kids with high P300 amplitude can drink starting at 18, but low P300 at 21.) Do you have them take extra DARE classes? Send home extra handouts in backpacks for parents to know their kids might become druggies? Restrict the movies and TV shows they can watch?

Or maybe we can require them to take Antabuse.

Be careful what you wish for here in finding a way to help this batch of people. If we identify a group of people who (probably genetically) are predisposed to abuse alcohol or drugs, and if we mandate some precautionary treatment, then what will we do when we find that some particular string of codons makes people susceptible to type 2 diabetes. Do we restrict their sugar intake as kids, so we don't have to pay for their diabetes treatment as adults? What about aggression? There is a gene that makes people fly off the handle sometimes. (Lost the link to it.) Will we mandate Prozac for them? What if we find a gene set that makes people like whatever it is you like? First they came for the alkies, but I wasn't an alkie. ...

Of course that doesn't mean we have to abandon them, but I'm not sure what we can do. The parents should know and not model excessive drinking (yes, yes, true for all parents) and develop trusting relationships and, in general, be better parents.

Ideally, I suppose, we could teach the kids about their susceptibility and persuade them to avoid alcohol and drugs. We know how well this is likely to work from current anti-drug programs.

I went into this post just going to talk about the research. Then I thought about the implications and figured I'd outline a problem and show how to solve it. Then I thought about it and don't see a solution. We can now identify some percent of kids who have a greatly increased likelihood of becoming druggies, and good luck to them. The only things I can think of that might work require powers I don't want the government to have.

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