The Genetics of Alcoholism:
A Review of the Evidence and Ethical Implications

    Jennifer N. Guggenheim
    Medical Student, University of Colorado Health Sciences Center 
 Executive Summary 

Consider a time in the future when a hard-working bus driver with a perfect driving record is fired after his company tests his DNA and finds that he has a genetic predisposition for alcoholism. Although he is not an alcoholic and never has been, his DNA indicates that he has genes that make him vulnerable to alcohol dependence. Despite the fact that he has been a dependable driver who has never abused alcohol, his company terminates him. He loses his job not because of his behavior, but because of his DNA.  

Now consider the fact that on May 14, 1988, a repeat drunk-driving offender sped the wrong way down the highway in his pickup truck and slammed head on into a school bus. The bus burst into flames killing twenty-four children and three adults while injuring thirty others (MADD 1998). Perhaps the driver of the pickup truck also had a genetic predisposition to alcoholism. If a DNA test had been available to him so that he had known of his vulnerability before he developed a problem with alcohol, maybe this tragedy could have been prevented. These two scenarios demonstrate the ethical dilemma of DNA testing that society may soon face. It is unfair that the hard-working bus driver be discriminated against for something he has never done; but it is also unfair for a drunk driver to destroy the lives of others.  

Several lines of evidence lead us to believe that there is a genetic component to the risk for alcoholism (Cloninger, Bohman, Sigvardsson 1981; Pickens et al 1991; Kendler et al 1992; Schuckit 1994). Most recently the Collaborative Study on the Genetics of Alcoholism (COGA) reported "highly suggestive" evidence of a genetic vulnerability for alcohol dependence (Long et al 1998). This study points to specific chromosomes that predispose individuals to become alcoholics. As researchers further delineate the biological basis of alcoholism, they will be able to develop more effective treatment programs and initiate preventative programs. This in turn would benefit the millions of people who are affected by alcoholism and its devastating effects.

At the moment, DNA tests for vulnerabilities to alcoholism do not exist. However, such a test may become available in the not-too-distant future. DNA testing is complicated, not only because of the scientific methodology, but also because of problems like health care discrimination, job discrimination and stigmatization. To better understand the ethical issues of the genetics of alcoholism, this paper will discuss important information about alcoholism: First, it will define alcoholism. Second, it will demonstrate how society is affected by it. Third, it will outline the scientific research and discoveries that have been made about alcoholism. And finally it will discuss the ethical implications of the genetics of alcoholism. There are five main ethical issues: autonomy, privacy, justice, equity and quality (Knoppers, Chadwick 1994). By sensitively educating health care workers, policy makers and the general public about these issues, the quality of life will be improved for individuals suffering from alcoholism and those who are affected by it. 

Division of Substance Dependence