Are alcoholics born or made?

When one parent is staunchly teetotal and the other a full-blown alcoholic, it is difficult, says Ronnie Joice with delicate understatement, "to work out how to drink safely."

The 30-year-old says he "very rarely drink[s] now, but I used to drink to excess with no cut-off point. Alcohol certainly set off the right endorphins. I could never just enjoy a glass with a meal."

Not surprisingly, his greatest concern was - and is - that, one day, Joice, a comedian from Storrington, west Sussex, would - and still could - morph into his father Kevin, now 65, who has been sober for just four years, reports Telegraph UK.

"I don't want to be my dad," he says. "I don't want to live his life." Whether alcoholism is a genetic or even learned inevitability is the stuff of much academic and medical investigation.

The death last week of comedian Sean Hughes at 51, who was suffering cirrhosis of the liver following years of heavy drinking, is a point in case. Hughes's father had been an alcoholic.

The former Never Mind the Buzzcocks team captain may have joked of a childhood where he was left in the car outside pubs for hours - "We would while away the hours by nodding at the other kids parked up in other cars as we all looked to the warm glow of the pub" - but he also talked of disliking his father for his behaviour.

And although Hughes had spent a few years teetotal in his forties, friends had reported he was drinking heavily in the more recent past. According to the UK Collaborative Study on the Genetics of Alcoholism (UK-COGA), alcoholism is about 50-60 per cent heritable.

Well-known names including Charlie Sheen, Demi Moore, Kelly Osbourne and Calum Best have suffered from addiction issues as their parents did before them; Best, the son of footballer George, last year described his predilection for booze as akin to "a demon inside of me", adding that his excessive drinking "ruined my health, cost me my career and my reputation."

Some of the influences of alcohol misuse come from social and family attitudes - so-called environmental effects - though alcoholism runs even more commonly in blood relatives adopted away.

Scientists at UK-COGA are presently trying to establish which genes modify the risk of alcohol dependence and related problems such as depression, bipolar disorder, attention deficit disorder, and dissocial (antisocial) personality disorder.

Dr Niall Campbell, a consultant psychiatrist based at Priory's Roehampton Hospital who specialises in addiction, says that those with a family member who has an addiction are more at risk.

"It's tough," he says, "you need to be more observant. But many often are: I meet patients who are not addicts but who know that the disease runs in the family and are already careful. They tell me it is a tendency they need to watch."

However, learned behaviour can be to blame too. Typical environmental triggers might be having parents who drink a lot, or the patient drinking from an early age.

Childhood trauma, post-traumatic stress disorder, relationship and work difficulties can also be to blame.

Dr Campbell adds: "I also see plenty of alcoholics whose parents don't drink excessively, who have not suffered any traumas or have a genetic predisposition. So, one size does not fit all."

Joice is unable to unpick what might be genetic versus learned behaviour in his own family. "We were not a family that grew up around alcohol but an absence of it.

Alcohol was talked of as an 'evil thing', by my mother. I associated it with darkness and aggression.

We never had any in the house that I was aware of, and I would be scared if I was walking past a pub." As the eldest of five children, Joice realises he was witness to behaviours that not all his siblings saw.

"When I was young, I remember Dad coming home drunk and smashing up furniture. We had to leave that house. That must have been quite scarring."

But on some level Kevin Joice was determined to do the right thing: he cooked evening meals for his children - albeit at 5pm, because he worked a night shift as a paint sprayer from 5.30pm.

"I think of that line from Nirvana's Serve the Servants, says Joice: " 'I tried hard to have a father/ But instead I had a dad'." His mother tried to shield her children, getting up early to hide any evidence of her husband's drinking.

"It was secrets and lies," Joice says. "It didn't teach me the essence of alcohol. I didn't have a glass of wine with my mum until I was 21. She just didn't want to bring this darkness into our world."

Four signs you may be alcohol dependent

1.

You worry about where your next drink is coming from and plan social, family or work events around alcohol.

2.

You have a compulsive need to drink and find it hard to stop once you've started.

3.

You wake up and drink - or find you want to have a drink in the morning.

4.

You suffer from withdrawal symptoms, such as sweating, shaking and nausea, which stop once you have a drink.

If you're worried you have any symptoms of these alcohol dependence, contact your GP.

Source: drinkaware.co.uk

This lack of education left Joice "envying" his peers, who understand how to drink moderately.

Perhaps no wonder then that when Joice moved to London at 18 and became involved in music, he also started to drink heavily.

"I was in a band and DJ-ed. It is an excessive culture. I didn't seek it out but that lifestyle is catered for; there are always free drinks, and your tolerance builds."

Meanwhile, he had cut his father out of his life: "I had ostracised him. I didn't even want the idea of him around. Eventually he was drinking a bottle of vodka a day."

Finally, on insistence from one of his daughters, Kevin Joice went into rehab four years ago and is now sober, and he and his eldest have partly reconciled. But his son points out that much damage has been done.

"He's needed hip operations, he has a huge hernia. It puts me in a predicament about my opinion on alcohol. I look at the destruction it has caused my father and what it has done to me and my family with horror.

"But then I think maybe I am alcoholic, that this is deep rooted, that I can't help myself."

He worries, too, about his siblings. Although most don't drink at all, he admits looking at one of his younger brothers when the two were at a festival enjoying a beer together and thinking, "What if he ends up like Dad?" Joice may feel he is hyper-aware but perhaps that is no bad thing.

Dr John Kelly, Director of the Recovery Research Institute at Harvard Medical School and Massachusetts General Hospital, says experts are learning that, like many other illnesses, early intervention has benefits.

"If we intervene early and often," he says, "when patients are showing first signs - in the teen years for example - then we can destabilise patterns of behaviour. This means we can get them into remission earlier and results improve dramatically."

Treatment of alcoholism is quite successful, he says. "It takes on average (from when people seek help) four to five treatment episodes before they get one year's remission.

But 60 per cent will get to full remission; it is a good prognosis disorder." Attitude is important too, says Dr Campbell.

"Yes, it is more difficult if you have a family member already affected but I tell those patients "susceptibly does not mean inevitability". I would challenge the idea that one can't change things very robustly.

Just because Dad didn't get on top of it, doesn't mean you can't." For Joice, that desire to be in charge has been helped by moving out of London and adjusting his attitudes.

"I try to drink only on special occasions. I don't want to be completely teetotal but I approach alcohol with caution.

"I understand everyone will feel differently and for some full-blown abstinence is the answer."

He continues to struggle with Kevin's belief that in being sober, he has earned forgiveness.

"Dad is going to spend his life regretting it - but addicts think when they are cleaned up, they should get an instant second chance. But they've already broken your heart once, and if your second chance heart breaks, you worry you will never recover."

A history of advice on alcohol

1947 - Medicinal drinking

Along with the famous "Guinness is good for you" slogan, this advert from 1947 gives us a little insight into attitudes towards alcohol at the time.

1981 - Drinking Sensibly

The government publishes a pamphlet called Drinking Sensibly, introducing the concept to the public for the first time, following rising concern about the dangers of heavy drinking in the 1970s

1984 - 56 drinks a week: 'too much'
A new pamphlet from the then Health Education Council outlines safe limits for drinking for the first time: 18 "standard drinks" a week for men, and nine for women. "Too much" alcohol was defined as 56 standard drinks a week for men and 35 for women

1987 - Alcohol units are born
A new 1987 leaflet outlines the concept of alcohol units and reduces the 1984 guidelines to 21 units a week for men and 14 for women, to avoid damaging health. "Too much" is defined in this new pamphlet as 36 units a week for men and 22 for women. The guidance is endorsed by the three medical Royal Colleges and officially adopted by the government.

1995 - New daily guidelines
Following reports about the health benefits of moderate drinking in the early 1990s, a government working group publishes new daily guidelines - entitled Sensible Drinking - that effectively increase the recommended weekly limit from the 1987 guidelines: 3-4 units a day for men and no more than 2-3 for women. Everyone is advised to stay off the booze for two days after a heavy drinking session

1995 - Advice for pregnant women
For the first time, the Sensible Drinking report also includes advice for pregnant women: they are warned against it, especially in the first three months of the pregnancy, and advised to consume no more than 1-2 units a week if they continue to drink.

2006 - More advice for pregnant women
This time, even women trying to conceive are advised to avoid drinking alcohol. But the new guidelines state that if they do choose to drink, to stick to no more than one to two units of alcohol once or twice a week

2009 - Guidance for children
For the first time, the Chief Medical Officer (CMO) for England advises that no children under the age of 15 years should consume alcohol. Between 15 to 17-year-olds were also advised not to drink, and to stick to once a week, supervised by parents or carers, if they did

2012 - New review commissioned
Following a government committee report, the coalition commissions a thorough review of the medical evidence concerning the links between alcohol and health, to tackle poor public understanding of - and adherence to - the current drinking guidelines

2016 - Three pints 'binge drinking'
Chief Medical Officer Dame Sally Davies publishes the UK's first major revision of alcohol guidelines since 1995. The report says even a sherry a week could increase the risk of cancer, and that three pints is "binge drinking"

- Telegraph UK