Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-14T01:31:26.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Social and economic consequences of alcohol use disorder: a longitudinal cohort and co-relative analysis

Published online by Cambridge University Press:  05 December 2016

K. S. Kendler ,
H. Ohlsson ,
K. J. Karriker-Jaffe ,
J. Sundquist  and
K. Sundquist
K. S. Kendler*
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
H. Ohlsson
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden
K. J. Karriker-Jaffe
Affiliation:
Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
J. Sundquist
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden
K. Sundquist
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden
*
*Address for correspondence: K. S. Kendler, M.D., Virginia Institute for Psychiatric and Behavioral Genetics of VCU, Box 980126, Richmond, VA 23298-0126, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Although alcohol use disorder (AUD) is associated with future risk for psychosocial dysfunction, the degree to which this arises from a direct causal effect of AUD on functioning v. from correlated risk factors (also known as confounders) is less clearly established.

Method

AUD was assessed from Swedish medical, criminal and pharmacy registries. In a large general population cohort, using Cox proportional hazard and regression models, we predicted from the onset of AUD four outcomes: early retirement, unemployment, social assistance, and individual income. We then examined the degree to which these associations were attenuated by relevant confounders as well as by the use of discordant cousin, half-sibling, full-sibling, and monozygotic twin pairs.

Results

In males, AUD most strongly predicted social assistance [hazard ratio (HR) 8.27, 95% confidence interval (CI) 7.96–8.59], followed by early retirement (HR 5.63, 95% CI 5.53–5.72) and unemployment (HR 2.75, 95% CI 2.65–2.85). For income at age 50, AUD was associated with a decrease in income of 0.24 s.d.s (95% CI −0.25 to −0.23). Results were similar in females. Modest to moderate attenuation of these associations was seen in both sexes after the addition of relevant covariates. These associations were reduced but remained robust in discordant co-relative pairs, including monozygotic twins.

Conclusions

Our results suggest that AUD has a causal impact on a range of measures reflective of psychosocial dysfunction. These findings provide strong support for the drift hypothesis. However, some of the associations between AUD and dysfunction appear to be non-causal and result from shared risk factors, many of which are likely familial.

Keywords

Alcohol use disorderco-relative designdriftearly retirementincomesocial assistanceunemployment
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 5 , April 2017 , pp. 925 - 935
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akaike, H (1987). Factor analysis and AIC. Psychometrika 52, 317–332.Google Scholar
Alm, S (2015). What happened to the Swedish problem drug users of the 1960's and 1970's? Nordic Studies on Alcohol and Drugs 32, 109–132.CrossRefGoogle Scholar
Bacon, SD (1944). Sociology and the Problems of Alcohol: Foundations for a Sociologic Study of Drinking Behavior. Quarterly Journal of Studies on Alcohol: New Haven.Google Scholar
Braun, BL, Hannan, P, Wolfson, M, Jones-Webb, R, Sidney, S (2000). Occupational attainment, smoking, alcohol intake, and marijuana use: ethnic-gender differences in the CARDIA study. Addiction Behaviors 25, 399–414.Google Scholar
Buu, A, Mansour, M, Wang, J, Refior, SK, Fitzgerald, HE, Zucker, RA (2007). Alcoholism effects on social migration and neighborhood effects on alcoholism over the course of 12 years. Alcohol Clinical and Experimental Research 31, 1545–1551.Google Scholar
Compton, WM, Gfroerer, J, Conway, KP, Finger, MS (2014). Unemployment and substance outcomes in the United States 2002–2010. Drug Alcohol and Dependence 142, 350–353.CrossRefGoogle ScholarPubMed
Faris, RE & Dunham, HW (1939). Mental Disorders in Urban Areas: An Ecological Study of Schizophrenia and Other Psychoses. University of Chicago Press: Chicago, IL.Google Scholar
French, MT, Maclean, JC, Sindelar, JL, Fang, H (2011). The morning after: alcohol misuse and employment problems. Applied Economics 43, 2705–2720.Google Scholar
Gauffin, K, Hemmingsson, T, Hjern, A (2013). The effect of childhood socioeconomic position on alcohol-related disorders later in life: a Swedish national cohort study. Journal of Epidemiology and Community Health 67, 932–938.CrossRefGoogle ScholarPubMed
Gerster, M, Madsen, M, Andersen, PK (2014). Matched survival data in a co-twin control design. Lifetime Data Analysis 20, 38–50.CrossRefGoogle Scholar
Grant, BF, Goldstein, RB, Saha, TD, Chou, SP, Jung, J, Zhang, H, Pickering, RP, Ruan, WJ, Smith, SM, Huang, B, Hasin, DS (2015). Epidemiology of DSM-5 alcohol use disorder: results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry 72, 757–766.Google Scholar
Johnson, TP, Freels, SA, Parsons, JA, Vangeest, JB (1997). Substance abuse and homelessness: social selection or social adaptation? Addiction 92, 437–445.Google Scholar
Kendler, KS, Ji, J, Edwards, AC, Ohlsson, H, Sundquist, J, Sundquist, K (2015). An extended Swedish National adoption study of alcohol use disorder. JAMA Psychiatry 72, 211–218.Google Scholar
Kendler, KS, Ohlsson, H, Sundquist, K, Sundquist, J (2014). The causal nature of the association between neighborhood deprivation and drug abuse: a prospective national Swedish co-relative control study. Psychological Medicine 44, 2537–2546.Google Scholar
Kerr, NS (1894). Inebrity; Or, Narcomania; Its Etiology, Pathology, Treatment, and Jurisprudence. H.K. Lewis: London.Google Scholar
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.CrossRefGoogle ScholarPubMed
Kringlen, E, Torgersen, S, Cramer, V (2001). A Norwegian psychiatric epidemiological study. American Journal of Psychiatry 158, 1091–1098.CrossRefGoogle ScholarPubMed
Leifman, H (2002). A Comparative analysis of drinking patterns in six EU countries in the year 2000. Contemporary Drug Problems 29, 501–548.Google Scholar
McVicar, D, Moschion, J, van Ours, JC (2015). From substance use to homelessness or vice versa? Social Science & Medicine 136, 89–98.CrossRefGoogle ScholarPubMed
Room, R, Palm, J, Romelsjö, A, Stenius, K, Storbjörk, J (2006). Women and men in alcohol and drug treatment: an overview of a Stockholm County Study. In The Social Ecology of Alcohol and Drug Treatment: Client Experiences in Context (ed. Storbjörk, J.), pp. 221–232. Centre for Social Research on Alcohol and Drugs (SoRAD): Stockholm.Google Scholar
SAS Institute I. (2011). SAS/STAT User's Guide, Version 9.3. SAS Institute Inc: Cary, NC.Google Scholar
Stenius, K (2015). Down and out in Norden. Nordic Studies on Alcohol and Drugs 32, 107–108.CrossRefGoogle Scholar
Stenius, K, Witbrodt, J, Engdahl, B, Weisner, C (2010). For the marginalized, or for the integrated? Acomparative study of the treatment systems in Sweden and the US. Contemporary Drug Problems 37, 417–448.Google Scholar
Storbjork, J, Room, R (2008). The two worlds of alcohol problems: who is in treatment and who is not? Addiction Research & Theory 16, 67–84.Google Scholar
Tsai, J, Rosenheck, RA, Kasprow, WJ, McGuire, JF (2013). Risk of incarceration and clinical characteristics of incarcerated veterans by race/ethnicity. Social Psychiatry and Psychiatric Epidemiology 48, 1777–1786.Google Scholar
Supplementary material: File

Kendler supplementary material

Appendix

Download Kendler supplementary material(File)
File 14.4 KB