Most of us are aware that a family history of alcoholism increases a person’s risk of addiction. While having a family history of drug and alcohol problems does not doom one to addiction, the history increases the probability (Hesselbrock, Hesselbrock & Epstein, 1999). This is just one of many potential family variables that can increase the risk. Among several well-known family predisposition variables, one in particular may not have received the press it deserves. It is called density.

Before discussing density, it is important to review what we know about familial alcoholism. This review illustrates how density fits into the overall familial risk factors.

Past research has established several notable contributors to familial alcoholism. First, genetics plays a role. Depending on what you read, the influence factor ranges from 40 to 60 percent (NIDA, 2007). Second, family interactions have been shown to be significant. For instance, males in particular, who continue to interact with alcoholic parents tend have increased levels of alcoholism themselves. In a similar vein, individuals with drug and alcohol problems, far from being estranged from family members, often live in or have a network of relationships with family members (McCrady, 2006).

Third, there seems to be some association with family income and heavy drinking. Households with income below the national median income have twice as many heavy drinking episodes as those above the median (Kinney, 2008). Intact family rituals, however, such as dinnertime or celebrations seem to be a protection factor (Hesselbrock & Hesselbrock, 2006). There are certainly many other contributing factors to alcohol abuse (e.g., temperament, pathology, peer influences), but those variables don’t quite fall into the family realm proper. What is sometimes forgotten in listing familial dispositional variables is density.

Familial density

Density recently hit the college scene, and provided resurgence to the concept. It was the core variable in a new research project (Capone & Wood, 2008), in which 408 undergraduates were asked to complete a behavior health survey. The researchers found that those subjects who reported a higher density of family members with alcohol problems had a greater risk of developing alcohol problem themselves.

Density refers to the number of family members affected by alcoholism; basically, the greater number of family members affected with alcohol problems, the greater the density. Typically, the probability of alcoholism risk increases if a son has a father who was alcoholic. This father to son association has been known for a long time. However, density looks beyond the immediate family for potential indications and includes the extended blood related family, such as grandparents, cousins, uncles and aunts. If many of those relatives have alcohol problems, then the potential risk for someone else in that family increases even more. Again, the greater number of relatives affected with alcoholism, the greater the density, and hence the greater risk.

This college survey identified two other risk variables that were interrelated to higher density, including: behavioral undercontrol, which is a personality construct that includes the characteristics of impulsivity, aggressiveness and extraversion (Sher, 1991); and cigarette smoking. While these factors should be considered, for the most part, we are interested in the density variable proper, and how you it may be applied to your daily work.

Try it: treatment suggestions

Looking at all the places density might clinically fit it seems a natural for the assessment phase of treatment. Why? Because it’s so quantifiable. Not that quantity will determine a sure fire diagnosis, but if someone came to your program with an assortment of nebulous alcohol-related problems, investigating density could serve to clarify a screening or even assessment process. For example, determining if a client had many (quantity) close and extended relatives with alcohol problems might inspire an array of additional questions. You could, as an illustration:

• inquire about family rituals and alcohol associations for the client
• ask who gave the client alcohol at such family gatherings
• ask if the client ever became intoxicated with relatives
• ask if the client felt he or she fit in with such a family

On the other hand, you could inquire how the client might have avoided such family influences and maintained a sober and healthy lifestyle, in spite of such influences. This concept also is an ideal educational tool. For example, this is useful information to present to clients via lectures, often within an inpatient program. As for prevention strategies, you could easily utilize such information in an assortment of brochures, newsletters or even local newspaper articles directed at families and social groups.

Lastly, envision a Power Point presentation for a parent- teacher group, or even Rotary Club where density could be presented graphically spiraling out from nuclear family to one’s extended family. A colorful diagram like this would illustrate density nicely. That graphic could signal a warning to certain audience members who just might heed such a warning, and begin to carry out certain protective behaviors to assuage this influence (i.e., maintain family rituals, create clear limits on child behavior).

Research you can do

As an introductory project that could provide some interesting data and usefulness to your program, you could conduct a broad survey of clients to associate density variables, as well as track possible density patterns coming into your program. With the next set of clients entering your program, ask them a few extra questions in addition to your usual bio-psychosocial questionnaire.

These questions would essentially be the same as those asked by Capone and Wood (2008):

• Do you think your mother, father or siblings has a problem with alcohol, or is alcoholic?
• Do you think other blood relatives such as grandparents, aunts, uncles, great-grandparent, great uncles or aunts have problems with alcohol, or is alcoholic?
Sort the clients answers into the following family history of alcoholism (FHA) categories:
• FH (family history alcoholism) = No alcoholism in any biological relative
• FH1 = alcoholism in second relatives such as grandparents, uncles, aunts, or third degree relatives such as great-grandparents, great-uncles and aunts
• FH2 = alcoholism in first degree relatives such as father, mother or siblings
• FH3 = alcoholism reported in first-, second- and third-degree relatives

Notice the FH3 classification is the high-density classification, meaning there is a large number of affected relatives in a family, which indicates a greater risk for developing an alcohol use disorder.

Now, what would you do with this information? If a high density finding were discovered from a reluctant client, one could easily use such results to add evidence of problematic alcohol use for that client to contemplate. In terms of your overall program aspirations, tracking the percent of high-density clients being admitted to your program could be used in a grant application or state contract negotiations to sway a reviewer’s favorable opinion. Lastly, discovering a flux of high-density clients or low-density clients in your program might give you ideas to modify treatment strategies to meet the specific needs of such clients, or promote ideas for marketing strategies.

There are certainly other possibilities. This column just wanted to dust off an old but useful concept.

References

Capone, C. & Wood, M.D. (2008). Density of familial alcoholism and its effects on alcohol use and problems in college students. Alcoholism, Clinical and Experimental Research. 32, 8, 1451-1458.
Hesselbrock, M.N, Hesselbrock, V.M. & Epstein, EE. (1999). Theories of etiology of alcohol, and other drug use disorders. In B. S. McGrady & E.E. Epstein (Eds.) Addictions: A comprehensive guidebook. (pp. 50-72) New York: Guilford.
McCrady, B.S. (2006). Family and other close relationships. In W.R. Miller & K.M. Carroll (Eds.) Rethinking substance abuse: What the science shows, and what we should do about it. (pp. 166-181). New York: Guilford.
Kinney, J. (2008). Loosening the grip: A handbook of alcohol information (9th ed). Boston: McGraw Hill.
National Institute of Drug Abuse (NIDA). The science of addiction. (2007). Washington, DC: National Institutes of Health. NIH Publication No. 07-5605.
Sher, K.L., Walitzer, K.S., Wood, P.K., & Brent, E.E. (1991). Characteristics of children of alcoholics: Putative risk factors, substance use and abuse, and psychopathology. Journal of Abnormal Psychology, 100, 427-448.

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