Editor’s Remarks

This week's offerings are keyed to a variety of interests, as always. There is an elliptical orbit around two particular foci, alcohol and development; and opioid use disorders.

Those whose practice encompasses recovering adults with children will be familiar with an anxious topic: will our child develop alcoholism, and what can we do to prevent that?

Expressed in those two questions is the search for the Philosopher's Stone of addiction medicine. It is what we all wish that we knew, and it is what so many earnest researchers seek. What are the probabilities of development of an alcohol use disorder in the offspring of those with the disorder? And, of course, that begs the question, what is an effective intervention? Together, what can one do to avert the onset; and, failing that, what can one do to minimize the impact on those young adults? The basis for the concern is intensified, ironically, by a commonplace and happy event during recovery: two people meet in the course of treatment or participation in a community recovery group; identify more than the usual common interests as a result of them both participating in a recovery program, AA or other; and decide that they can support each other in remaining abstinent in the decades ahead. As interventions occur earlier than was common in the middle of the last century, and enjoy a good rate of success, it means a greater probability of the couple meeting up while still fertile. They choose to create children. And then, or even before then, having correctly heard that alcohol use disorders are the product of an interaction of multiple forces including heredity, they begin to worry. 

Interestingly, their concern helps further define the field of addiction medicine, because it extends the range of responsibility from the designated patient with alcohol use disorder, beyond the dyad of husband and wife, to a family, and to generations following. It means that treatment has a legacy.

As we survey the progress of understanding about environmental, social, and heredo-familial influences on the development of this illness group, we are not without some good advice to give our patients. From sources as varied as Mark Schuckit and George Vaillant, we have learned that the longer we can stave off the onset of an alcohol use disorder, the greater is the opportunity for developing a mature personality upon which to predicate a future recovery. Said differently, delay the initial exposure as long as possible, and use the time to train the kids. There is every reason to impart this information with the spirit of cheerfulness. After all, among the many chronic, progressive illnesses with a heredo-familial component, this group at least has the opportunity for complete arrest, followed by a resumption of normal human development. It is arguably a darker path for many other illnesses, whether Huntington's disease or diabetes or schizophrenia.

This week's issue includes a full-text article relating to risks and impact of genetics and environment in a Swedish adoption study and a description of current parental trends in managing their children's alcohol use.

Aloha, Bill
(Wm. Haning, MD, FASAM, DFAPA, Region 8 Director)