Alcoholism in Spouse Directly, Markedly Raises Partner's Risk

Batya Swift Yasgur, MA, LSW

February 14, 2018

Being married to an individual with alcohol use disorder (AUD) directly increases the risk for alcoholism in the other partner, results of a large, longitudinal study show.

Using data from a large Swedish registry spanning 30 years, investigators led by Kenneth Kendler, MD, professor of psychiatry, Virginia Commonwealth University School of Medicine, Richmond, found "large and rapid" increases in the risk for first-onset AUD in a married person after the onset of AUD in his or her spouse.

In people married to serial partners, the risk for AUD was substantially increased when the partner had AUD; it was decreased when the partner did not have AUD, regardless of whether it was a first or second marriage.

"A marriage partner can have a very substantial and causal effect on each other's risk for AUD," Kendler told Medscape Medical News.

This is important information for clinicians because, "in treating one married individual, you need to take their spouse into account," he added.

The study was published online February 7 in JAMA Psychiatry.

Highest Risk in Early Marriage

Spouses resemble one another in the amount of alcohol they consume and in their risk for AUD, but "the degree to which this resemblance results from assortative mating or spousal interaction remains unclear," the authors write.

Prior longitudinal studies show evidence for partner selection and spousal interaction, and prior modeling studies for alcohol consumption and dependence have found evidence for assortative mating, the authors note.

"Our study was motivated by wanting to understand why spouses resemble one another in their risk for AUD," said Kendler.

To investigate, the researchers used data from several nationwide Swedish registers to evaluate individuals born in Sweden between 1960 and 1990 who were married before the end of follow-up on December 31, 2013. Spouses had to reside together to be included in the study.

The researchers took two "novel approaches" with respect to the data.

The first approach involved analysis of AUD registration in Swedish married couples to determine how the first registration for AUD in one spouse was associated with the risk for a first registration for AUD in his or her marital partner.

For this analysis, the researchers identified 8562 couples (mean age at marriage, 29.2 years; SD, 5.7) in which neither had a history of AUD prior to marriage and the other developed AUD during their first marriage.

The couples were then sorted into female and male probands (n = 5883 and n = 2679, respectively). Individuals who were not exposed to a spouse with AUD served as control participants.

The risk for onset of AUD was much greater in pairs in which the spouse experienced the onset of AUD than in pairs in which the spouse did not.

Moreover, there were sex differences. The hazard ratio (HR) of AUD registration in wives immediately after the first AUD registration in their husbands was 13.82. HR declined rapidly during the first 2 years, to a fourfold excess of 3.75, and then remained relatively constant from 2 to 6 years after the husband's first registration for AUD.

The researchers found similar patterns when they examined the effect of wives' first AUD registration on the subsequent risk for husbands' first AUD registration.

In men, the short-term increase was somewhat smaller (HR, 9.21), and the risk also declined more slowly in men than in women, stabilizing at an approximately threefold increase (HR, 3.09) after 3 years.

Direct Causal Influence

In the second approach to the data, the investigators employed a within-person design to analyze the risk for AUD registration in people who had multiple marriage partners in which at least one spouse had a lifetime history of AUD and the other did not.

In this analysis, the researchers identified 4891 individuals with multiple marriages (1439 women and 3452 men; mean age at first marriage, 25.5; SD, 4.2 years).

They found that in husbands whose first wife had AUD and whose second wife did not, the risk for AUD was reduced by half (HR, 0.50; 95% confidence interval [CI], 0.42 - 0.59).

However, in men whose first wife did not have AUD but whose second wife did, the risk for AUD was increased sevenfold (HR, 7.02; 95% CI, 5.34 - 9.23).

More individuals with multiple marriages went from having a spouse without AUD to a spouse with AUD than vice versa.

When the researchers investigated the effects of transitioning from a second marriage in which the woman did not have AUD to a third marriage in which the woman did have AUD, they found a similar, although weaker, effect.

The risk remained largely unchanged after controlling for AUD registration prior to the first marriage or between the first and second marriages.

The patterns were very similar for wives with multiple marriages to husbands with vs without a history of AUD.

In women who transitioned from a first husband with AUD to a second husband without AUD, the HR was 0.51 (95% CI, 0.44 - 0.59), vs an HR of 7.02 (95% CI, 5.34 - 9.23) in women who transitioned from a first husband without AUD to a second husband with AUD.

"Our study suggests that at least part of the connection between AUD in one spouse and the development of AUD in the other spouse is due to the heaving drinking in one spouse influencing the other spouse to also drink heavily and risk developing AUD," Dr Kendler said.

Treat Both Partners

Commenting on the study for Medscape Medical News, Kenneth Leonard, PhD, director, Research Institute on Addictions, University at Buffalo, New York, who was not involved with the study, called it "unique and important," because it "adds to a growing literature showing that alcohol use and alcohol use disorders can be causally influenced by the behavior of one's spouse."

He said that the "most powerful comparison" was "in terms of second and third marriages," because the researchers "are comparing the same person married to two different people, so the person's genetic and psychological risk factors cannot explain the results."

Additionally, "unlike many other studies, this study is also able to show the protective effect of marrying a person without an AUD, as well as the increased risk of marrying a person with an AUD."

The study has important take-home messages, he said.

"Close relationships are a critical element that can facilitate or undermine recovery from AUD and need to be systematically addressed in treatment and prevention — in many instances, by involving both members of the couple in treatment."

The authors add that their findings demonstrate how "close social bonds such as marriage can also powerfully influence, for better or worse, the risk for AUD."

The study was supported by the National Institutes of Health, the Swedish Research Council, and the Swedish Research Council for Health, Working Life and Welfare. The researchers also received Avtal om Läkarutbildning och Forskning funding from Region Skåne. The investigators and Dr Leonard have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online February 7, 2018. Abstract

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