Divorce and the Onset of Alcohol Use Disorder: A Swedish Population-Based Longitudinal Cohort and Co-Relative Study

Abstract

Objective-To clarify the magnitude and nature of the relationship between divorce and risk for alcohol use disorder (AUD).Method-In a population-based Swedish sample of married individuals (n=942,366), we examined the association between divorce or widowhood and risk for first registration for AUD. AUD was assessed using medical, criminal and pharmacy registries.Results-Divorce was strongly associated with risk for first AUD onset in both men (HR=5.98, 95% CI,). We estimated the HR for AUD onset given divorce in discordant monozygotic twins to equal 3.45 and 3.62 in men and women, respectively. Divorce was also associated with an AUD recurrence in those with AUD registrations before marriage. Furthermore, widowhood increased risk for AUD in men (HR=3.85, 2.81-5.28) and women (HR=4.10, 2.98-5.64). Among divorced individuals, remarriage was associated with a large decline in AUD in both sexes: males 0.56, 0.62-0.64 and females 0.61, 0.55-0.69. Divorce produced a greater increase in first AUD onset in those with a family history of AUD or with prior externalizing behaviors.Conclusions-Spousal loss through divorce or bereavement is associated with a large enduring increased AUD risk. This association likely reflects both causal and non-causal processes. That the AUD status of the spouse alters this association highlights the importance of spouse characteristics for the behavioral health consequences of spousal loss. The pronounced elevation in AUD risk HHS Public AccessAuthor manuscript Am J Psychiatry. Author manuscript; available in PMC 2017 November 01. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript following divorce or widowhood, and the protective effect of remarriage against subsequent AUD, speaks to the profound impact of marriage on problematic alcohol use.In epidemiological samples, divorce is consistently associated with levels of alcohol consumption and risk for alcohol use disorder (AUD) (1-3). Divorced individuals consume more alcohol (4) and in more harmful patterns (5) than married individuals. Compared to married individuals, divorcees are more likely to have a lifetime or last-year AUD diagnosis (1), to engage in alcohol-related risky behaviors (5), and to have higher alcohol-related mortality (6).However, the causes of the divorce-AUD association are likely complex and remain poorly understood. The association could result from confounding factors including social class, genetic liability, and personality traits which predispose to both AUD (1;7;8) and divorce (9)(10)(11). This association could also arise from a causal pathway from AUD -> divorce as suggested by longitudinal studies showing that heavy drinking individuals have an increased risk for divorce (12;13). Finally, a range of prior evidence suggests a causal divorce -> AUD pathway. For example, marriage is associated with a many benefits including spousal monitoring and moderating of one another's health-related behaviors (14). Divorce prospectively predicts increases in drinking (4;15;16). A recent Swedi...

The Origin of Spousal Resemblance for Alcohol Use Disorder

“…Alcohol use disorder in one spouse, through a range of psychosocial mechanisms, appears to directly increase the risk for AUD in the partner. Although genetic and biological factors contribute strongly to the predisposition to alcohol dependence, these findings complement our prior work on marriage 35 and divorce 36 in showing how close social bonds such as marriage can also powerfully influence, for better or worse, the risk for AUD.…”

Parental alcohol use disorder and offspring marital outcomes

“…Only the first marriage was considered for the current analyses. Methods for identifying individuals with AUD are detailed elsewhere [19]. Briefly, individuals were classified as having a lifetime history of AUD if they received an alcohol-related primary or secondary medical diagnosis, at least 2 alcohol-related registrations in the Crime and Suspicion register (e.g., drunk driving), or had a record of a prescription for a drug used to treat AUD (e.g., disulfiram, acamprosate).…”

Marriage and reductions in men's alcohol, tobacco, and cannabis use

“…In a series of prior studies using quasi-causal designs in Swedish population registers, we found that marriage protected against the development of alcohol use disorder (AUD) (Kendler et al ., 2016), while the loss of marriage through divorce/widowhood increased the risk for AUD (Kendler et al ., 2017). A limitation of this work is that registry-based measures of AUD (which come from medical, legal, and pharmacy records) represent an extreme clinical endpoint of a disease process that develops over time.…”