as adequate employment opportunities, financial stability, adequate housing, and responsibility for health care, they (a) are more likely to pursue the reinforcement associated with heavy drinking and (b) have fewer disincentives for such heavy drinking. We theorized that the high level of negative health consequences found among African Americans may be due to two factors. The first is that the heavy drinking characteristic of some members of this group is sustained into late middle age. If findings suggesting an association between the ADH1B*3 allele and negative health complications are accurate, then the subset of these individuals who have the genetic vulnerability to alcohol are a significantly high risk of liver disease and cirrhosis (Ehlers et al., 2007). The second is that, overall, African Americans are less likely to have health care or utilize health services, such that if problems were to develop from use, they would be less likely to get needed treatment, resulting in higher severity and frequency of health problems from use (Schmidt et al., 2007). Overall, there appear to be several social, biological, and behavioral factors that place African Americans at higher risk of more severe consequences from drinking than European Americans, and for some the consequences
