Many factors influence alcohol consumption during adulthood. Individuals who experience early adversity (EA) in their lives tend to be more vulnerable to stress-related drinking or other stress-related addiction. This vulnerability can be exacerbated by an existing genetic predisposition. These findings and others will be shared at the 42nd annual scientific meeting of the Research Society on Alcoholism (RSA) in Minneapolis, MN, on June 22–26, 2019.

“I think genetic and environmental factors both play significantly in alcohol use disorders (AUDs),” said Dongju Seo, assistant professor of psychiatry at Yale University. “For example, not all traumatized individuals develop addiction or AUDs even if they have a family history of alcoholism. In addition, environmental protectors such as a strong family, social support, a high socioeconomic status, less stress, or belonging to a spiritual community can all help reduce the incidence of AUDs." Seo will discuss her research at the RSA meeting on Wednesday, June 26.

“The ventromedial prefrontal cortex (VmPFC) is crucially involved in emotion and stress regulation,” explained Seo. “Early adversities interrupt prefrontal development, which can subsequently disrupt VmPFC function. Individuals with VmPFC dysfunction likely have difficulties with emotion regulation and stress-related adaptive coping. Under stress, an individual who experienced EA may become overwhelmed and lose control over their stress system, becoming vulnerable to maladaptive stress coping and alcohol addiction.”

Seo examined neuroimaging data belonging to AUD patients with and without early life trauma during a sustained emotion provocation task. Patients with early trauma showed impaired dynamic VmPFC response to stress cues, indicating increased vulnerability to early relapse. In contrast, patients without trauma showed a hyperactive striatal response to alcohol cues, suggesting vulnerability to reward-driven, alcohol-seeking behaviors.

“My results show that alcoholism with and without early trauma could be different types of AUDs,” said Seo. “Thus, they should be treated differently in the treatment phase. Following treatment, they may be vulnerable in different ways to relapse, so their aftercare instructions and follow-up care should also be different. AUDs with EA are likely to benefit from stress management during and after alcoholism treatment.”

Seo said her research helps to show that alcoholism is a disease. “We often think that alcoholism is solely a reward-driven or sensation-seeking behavior,” she observed. “However, substantial evidence indicates that alcohol is also used as a maladaptive coping strategy to overcome a challenging stress state by individuals with emotional difficulties or early adversities. It is important that the public see alcoholism as a disease state that needs clinical help and systematic public health support, rather than stigmatizing the disorder.”