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Marriage reduces risk for alcohol use disorder, particularly in those at highest risk

ATLANTA — First marriage had protective effects on risk for alcohol use disorder, especially among individuals with high familial risk for alcoholism, according to a new study released at the American Psychiatric Association Annual Meeting.

“While clinicians have long been aware of the potentially important protective effects of marriage on alcohol problems, our study puts this observation on a firm scientific footing,” Kenneth S. Kendler, MD, of Virginia Commonwealth University School of Medicine, said in a press release. “Although causal relationships can never be definitively shown for such a relationship, our large sample prospective population-based study complemented by our co-relative analyses strongly suggest that marriage does indeed directly and substantially reduce risk for onset of alcohol use disorder. It is also especially intriguing that this effect is largest in those at highest risk.”

Kenneth S. Kendler

To assess the association between marriage and risk for alcohol use disorder, researchers analyzed data from medical, criminal and pharmacy registries for a population-based Swedish cohort of 3,220,628 individuals.

First marriage was associated with a significant decrease in risk for onset of alcohol use disorder in men (HR = 0.41; 95% CI, 0.4-0.42) and women (HR = 0.27; 95% CI, 0.26-0.28).

This association was slightly greater when a spouse had no lifetime alcohol use disorder.

However, marriage to a spouse with lifetime alcohol use disorder increased risk for subsequent alcohol use disorder registration in men (HR = 1.29; 95% CI, 1.16-1.43) and women (HR = 1.18; 95% CI, 1.06-1.3).

The protective effect of marriage was significantly stronger in individuals with a family history of alcohol use disorder, compared with those without a family history.

Associations between marriage and risk for alcohol use disorder in cousins, half siblings, full siblings and monozygotic twins discordant for marital status was comparable to that observed in the general population.

Although these findings do not directly translate to clinical practice, Kendler believes they inform clinicians who treat individuals with alcohol use disorder.

“For clinicians, these findings indicate that quality of intimate social relations in people with alcohol problems is very critical. Think about how 12-step Alcoholic Anonymous works with the whole idea of the buddy system. That’s kind of recreating what a good marriage should do. I think this reinforces that in a very firm search base,” Kendler told Healio.com/Psychiatry. “So when service providers and clinicians think about developing programs, if you’re only going to concentrate on [the neurobiological side], I think that this study suggests otherwise. These social relations can be very important. Any integrative planning has to pay attention to that.” – by Amanda Oldt

Reference:

Kendler KS, et al. Am J Psychiatry. 2016;doi:10.1176/appi.ajp.2016.15111373. Presented at: American Psychiatric Association Annual Meeting; May 14-18, 2016; Atlanta.

Disclosure: The researchers report no relevant financial disclosures.