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People begin drinking socially for a myriad of reasons, including, most notably, peer pressure. But the answer to one question remains elusive: Why do people become alcoholics? In the continuum from a few too many drinks at a party to loss of control over drinking, where is the trigger point? Vaillant says that it is impossible to say, but at some level the casual drinker becomes physiologically and psychologically addicted to liquor. "You are an alcoholic," says Vaillant, "when you're not always in control of when you begin drinking and when you stop drinking."
But why do some people become addicted to alcohol if most do not? The reasons, says Vaillant, are as complex as people. Once hooked, argues Vaillant, an alcoholic drinks from habit and not to resolve conflict.
Although no one is predisposed by personality to become an alcoholic, Vaillant believes that a person is likely to drink too heavily—and find himself some day addicted—if he is demoralized, feels that he is a social outcast, is "susceptible to heavy-drinking peers," or can seemingly "handle" his liquor well, drinking everyone under the table. People who drink for a specific reason, such as a death or illness in the family, are more likely to be able to control the practice than those who use liquor for unknown reasons. Vaillant claims that a serious drinker does not proceed automatically down the path to alcoholism and, indeed, may be able to lead a remarkably stable and happy life. The study shows that moderate drinkers (who do not exceed an average of four drinks per day) often turn out to be better adjusted socially than total abstainers.
Recognizing alcoholism is simpler than pinpointing its causes. Says Vaillant: "The warning signs of alcoholism are when a person finds himself doing things when drinking that he regrets afterward, or if he has ever gone on the wagon, or tried to change brands to control his drinking." Some other danger signals: five or more drinks daily; problems with family or friends or at work over drinking; two or more blackouts while drinking.
Is an alcoholic predetermined by his genes? Vaillant believes there is a connection, noting that one out of three victims has a close relative who is alcoholic. But he doubts that researchers will ever find the biochemical marker. "I think it would be as unlikely as finding one for basketball playing," he says. "The best analogy is most coronary heart disease, which is not due to twisted genes or to a specific disease. There is a genetic contribution, and the rest of it is due to maladaptive lifestyle: too much fat, too little exercise. One gets alcoholism not because one does something terrible over the past week, but because, over time, one has done a lot of maladaptive things."