Environmental factors such as stress influence both the predisposition to and  development of alcoholism, as well as have significant implications for  alcoholism relapse. 
One predominant biological response to acute stress is the  release of norepinephrine, which activates the peripheral stress response and  also the hypothalamic–pituitary–adrenal axis. 
We aimed to examine the role of  two genes of the adrenergic system (SLC6A2 and ADRA2A) in  alcoholism by genotyping 21 SNPs in 785 adult alcohol-dependent patients and  1237 controls. Two single nucleotide polymorphisms (SNP) (rs36020 and rs36029)  in SLC6A2 were significantly associated with alcoholism [false  discovery rate corrected P-value (FDR) P = 0.007]. Two SNPs in  ADRA2A (rs521674 and rs602618) were associated with a positive family  history of alcoholism (FDR P ≤ 0.05). 
A combined SNP-set analysis was  also carried out to determine the risk of harbouring multiple alcohol risk  alleles across SLC6A2 and ADRA2A. 
Logistic regression analysis  revealed that an increase in the number of alcohol risk alleles increased the  risk for alcoholism (P = 0.000567, odds ratio = 1.75, 95% confidence  interval 1.26–2.44).
 A three-SNP haplotype consisting of rs187715, rs36020 and  rs40147 alleles, AGC, was also found, which was significantly over-represented  in cases compared with controls (61% versus 56%). 
We therefore demonstrate an  association of SLC6A2ADRA2A with adult alcoholism. 
These  data confirm the relevance of the adrenergic stress system when considering  genetic predisposition to alcohol dependence and suggest that SLC6A2  and ADRA2A should be studied in additional alcohol-dependent  cohorts.
Request Reprint E-Mail:   ctoni@mail.med.upenn.edu  

 
