“The pronounced elevation in AUD risk following divorce or widowhood, and the protective effect of both first marriage and remarriage against subsequent AUD, speaks to the profound impact of marriage on problematic alcohol use and the importance of clinical surveillance for AUD among divorced or widowed individuals,” lead author Kenneth Kendler, M.D., of Virginia Commonwealth University and colleagues wrote.
The researchers assessed the records of nearly one million married individuals in Sweden to identify the association between divorce or widowhood and AUD occurrences (identified using medical, criminal, and pharmacy registries). The researchers controlled for potential confounding factors such as age, education, and family history of alcohol use.
Divorce was strongly associated with both a risk of a first AUD occurrence (hazard ratio of 5.98 in men and 7.29 in women) and AUD relapse (hazard ratio of 3.20 in men and 3.56 in women). These risks were higher in people with a family history of AUD or who had prior externalizing behaviors. Remarriage following a divorce was associated with a large decline in first AUD occurrence in both sexes (hazard ratio of 0.56 in men and 0.61 in women)
Widowhood also increased AUD risk in both sexes (hazard ratio of 3.85 in men and 4.10 in women). In women, widowhood had a stronger association with risk for future AUD if the spouse did not versus did have a lifetime history of AUD (hazard ratio of 3.69).
“We found, in both sexes, a much larger effect on risk for AUD of divorce when the spouse did not versus did have a history of AUD. We saw a similar effect with widowhood but only in females,” the authors wrote. “These results suggest that it is not only the state of matrimony and the associated social roles that are protective against AUD. Rather, they are consistent with the importance of direct spousal interactions in which one individual monitors and tries to control his or her spouse’s drinking. A non-AUD spouse is likely to be much more effective at such control than a spouse with AUD.”
For related information, see the American Journal of Psychiatry study “Effect of Marriage on Risk for Onset of Alcohol Use Disorder: A Longitudinal and Co-Relative Analysis in a Swedish National Sample” and Psychiatric News article “Marriage May Decrease Future Risk of Alcohol Use Disorder.”
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