Familial clustering and relapse patterns in alcohol dependence syndrome: a case series of four sibling groups

Abstract

Alcohol dependence syndrome (ADS) is a chronic relapsing disorder resulting from a complex interaction of genetic, environmental, and psychosocial factors, with a positive family history being a strong predictor of early onset, greater illness severity, and recurrent relapse. This case series describes four sibling groups diagnosed with alcohol dependence syndrome (ICD-10: F10.2), all of whom initiated alcohol use during their early twenties, with an age difference of two to six years between siblings. Despite variations in psychosocial background and family structure, all groups demonstrated recurrent relapses following multiple treatment attempts. Common contributing factors included shared environmental exposure, family history of alcohol dependence, permissive attitudes towards alcohol use, impulsivity, psychosocial stressors, poor motivation for abstinence, and mutual reinforcement of drinking behaviour. In one sibling pair, relapse episodes occurred almost simultaneously following similar stressors, while other families illustrated the influence of parental alcohol use, impulsivity, and differing motivations with similar relapse trajectories. These findings highlight that familial influences extend beyond genetic vulnerability to include behavioural modelling, shared stressors, and environmental reinforcement, underscoring the importance of incorporating family-centred assessment and relapse prevention strategies in the management of ADS.