Caroline Cassels

May 19, 2016

ATLANTA ― Marriage is associated with a very large reduction in the risk for alcohol use disorder (AUD), new research suggests.

A large population-based study of more than 3.2 million individuals showed that compared with being single, marriage was associated with a 60% reduction in risk for AUD for men and a 70% reduction in risk for women.

The investigators found that that this protective effect is even greater in individuals with a strong family history of alcoholism.

Although the findings do not prove causality, principal investigator Kenneth Kendler, MD, professor of psychiatry and human and molecular genetics, Virginia Commonwealth University School of Medicine, in Richmond, said the size and rigor of the study suggest there is a direct protective effect of marriage on the risk for alcohol problems.

Dr Kenneth Kendler

"We don't prove causality because, in the absence of double-blind trials, you can't, but this is very strong evidence that causal properties are actually going on, and that [finding] has a whole range of social implications," Dr Kendler said at a press briefing here at the American Psychiatric Association (APA) 2016 Annual Meeting, where the results were released.

The study was also published online May 16 in the American Journal of Psychiatry.

Greatest Benefit

Dr Kendler said that many epidemiologic studies show that in comparison with married people, single individuals, both men and women, drink much more.

Previous studies, the authors note, have shown a robust relationship between marital status and alcohol consumption, problem drinking, and, in particular, AUD risk. However, research has been limited by small, sometimes unrepresentative samples.

"Understanding the causal processes underlying this robust association could provide important insights into the etiology of alcohol use disorder and elucidate potential avenues for prevention," the authors write.

To clarify the relationship between first marriage and subsequent risk for alcohol problems, the investigators used Swedish registry data on 3,220,628 individuals born between 1960 and 1990.

A total of 72,252 individuals met the criteria for AUD. The prevalence of AUD was 3.3% in men and 1.1% in women. Results also showed that for fewer than half of affected individuals, one or more close relatives were similarly affected.

The investigators controlled for several confounding variables, including socioeconomic status, early criminal behavior or drug abuse, and family history of AUD. These variables did not explain the reduced risk.

Results showed that first marriage was associated with a substantially reduced risk for the onset of AUD in men (hazard ratio [HR] = 0.41; 95% confidence interval [CI] = 0.40 - 0.42) and women (HR = 0.27; 95% CI = 0.26 - 0.28).

Interestingly, this protective effect was even greater in individuals at high familial risk for alcoholism (HR = 0.89; P < .001).

"It is really the people with the greatest vulnerability to the problem that have the greatest benefit from this kind of spousal interaction," said Dr Kendler.

Potent Social Influence

In contrast, the investigators found that marriage to a spouse with AUD increased the risk for AUD beyond the risk associated with unmarried status in both men (HR = 1.29; 95% CI = 1.16 - 1.43) and women (HR = 1.18; 95% CI = 1.06 - 1.30).

Dr Kendler added that these findings strongly suggest that the influence of marriage, both positive and negative, on AUD risk is likely directly related to spousal influence.

Much of AUD research focuses on the underlying neurobiology, but these findings, said Dr Kendler, show that "strong causal effects are occurring at the level of culture and relationships.

"When we are thinking about the causes of alcohol problems, yes, we want to know a lot about the biology and what's going on in the GABA system and all these other features, but these social influences are very potent.

"As we develop treatment and prevention mechanisms and funding patterns, we really have to balance [and recognize] that these disorders have quite strong social components that are very profound aspects of human life. Having long-term, enduring, loving relationships also can be very important for the risks of these conditions," he said.

Commenting on the findings for Medscape Medical News incoming APA president Maria Oquendo, MD, said the study reminds her of principals central to 12-step programs.

"Chances are you're not as lonely if you're married. It means that you have built-in social support and companionship in your home, and we know that that does a lot to counteract loneliness, which oftentimes is behind some addictions," she said.

Dr Kendler and Dr Oquendo report no relevant financial relationships.

American Psychiatric Association (APA) 2016 Annual Meeting: Presented May 16, 2016.

Am J Psychiatry. Published online May 16, 2016. Abstract

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