Divorce Fosters Alcohol Use Disorder

Summary and Comment |
January 23, 2017

Divorce Fosters Alcohol Use Disorder

  1. Joel Yager, MD

In divorcing individuals, rates of onset of alcohol use disorder increase, independent of usual risk factors, and decrease with remarriage.

  1. Joel Yager, MD

Complex relationships exist between alcohol use disorder (AUD) and marriage. In a study using Swedish registry data, marriage to nonalcoholic spouses reduced AUD risk (NEJM JW Psychiatry Jul 2016 and Am J Psychiatry 2016; 173:911). Now, the same researchers examine divorce and AUD onset. Study data concerned 942,366 individuals (women, 53%) born between 1960 and 1990, without AUD before marriage (mean age at marriage, 30). Follow-up continued through 2008.

At a mean of 7 years after marriage, 16% of men and 17% of women divorced; overall, initial AUD was noted in 1.1% of men and 0.5% of women (mean age, 39). In analyses adjusting for independent AUD risk predictors (low parental education, prior deviant/externalizing behavior, and family AUD history), hazard ratios for postdivorce AUD risk increased significantly (hazard ratios [HRs]: men, 5.09; women, 6.31). HRs were even higher if spouses had no lifetime AUD.

Based on analyses of monozygotic twin pairs discordant for divorce, divorce per se elevated the risk for AUD by about 3.5 times. New AUDs started increasing several years before divorce, peaked in the divorce year, and remained elevated for the entire study period among people who did not remarry. In analyses of 13,039 individuals (29% women) with past AUD before marriage, divorce was associated with increased risk for AUD relapse (HRs: men, 3.20; women, 3.56). Remarriage after divorce substantially reduced risks for first AUD in both sexes.

Comment

Registry ascertainment methods yield lower AUD rates than interviews. Still, these findings underscore risks for initial AUD associated with divorce. Clinicians should attend to how AUD onset might herald or contribute to divorce in the first place and how added stresses (plus disinhibiting effects) of divorce generate additional vulnerabilities, particularly among those with other independent risk factors.

Editor Disclosures at Time of Publication

  • Disclosures for Joel Yager, MD at time of publication Editorial boards Bulletin of the Menninger Clinic; Eating Disorders Review (Editor-in-Chief Emeritus); International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.