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

Abstract

Objective: The purpose of this study was 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), the authors 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 (hazard ratio=5.98, 95% CI=5.65-6.33) and women (hazard ratio=7.29, 95% CI=6.72-7.91). The hazard ratio was estimated for AUD onset given divorce among 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 (hazard ratio=3.85, 95% CI=2.81-5.28) and women (hazard ratio=4.10, 95% CI=2.98-5.64). Among divorced individuals, remarriage was associated with a large decline in AUD in both sexes (men: hazard ratio=0.56, 95% CI=0.52-0.64; women: hazard ratio=0.61, 95% CI=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 noncausal 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 following divorce or widowhood, and the protective effect of remarriage against subsequent AUD, speaks to the profound impact of marriage on problematic alcohol use.

Keywords: Alcohol Abuse; Epidemiology.

Figure 1

a – The temporal relationship between divorce and the moving yearly prevalence of first onset of AUD in males (red dots) who were married between the ages of 18 and 25. For each pair, the time of divorce was given the value of zero. The figure also shows (blue dots) the rate of AUD onsets in stably married males whose average age at the zero point matches the age of the divorced sample. All date points, except at age zero, represent a three year rolling average. Therefore, the plotted risk at one time point is the weighted average of the observation at that time point plus the one before and one after. The exception is the estimate at time 1 or −1 which is the weighted average only of time 1 (or −1) and 2 (or−2) and does not include the value at time 0. b – The temporal relationship between divorce and the yearly prevalence of first onset of AUD in males (red dots) who were married between the ages of 26 and 35. See legend to figure 1a for further methodological details.

Figure 1

a – The temporal relationship between divorce and the moving yearly prevalence of first onset of AUD in males (red dots) who were married between the ages of 18 and 25. For each pair, the time of divorce was given the value of zero. The figure also shows (blue dots) the rate of AUD onsets in stably married males whose average age at the zero point matches the age of the divorced sample. All date points, except at age zero, represent a three year rolling average. Therefore, the plotted risk at one time point is the weighted average of the observation at that time point plus the one before and one after. The exception is the estimate at time 1 or −1 which is the weighted average only of time 1 (or −1) and 2 (or−2) and does not include the value at time 0. b – The temporal relationship between divorce and the yearly prevalence of first onset of AUD in males (red dots) who were married between the ages of 26 and 35. See legend to figure 1a for further methodological details.

Figure 2

a – The temporal relationship between divorce and the yearly prevalence of first onset of AUD in females (red dots) who were married between the ages of 18 and 25. See legend to figure 1a for further methodological details. b – The temporal relationship between divorce and the yearly prevalence of first onset of AUD in females (red dots) who were married between the ages of 26 and 35. See legend to figure 1a for further methodological details.

Figure 2

a – The temporal relationship between divorce and the yearly prevalence of first onset of AUD in females (red dots) who were married between the ages of 18 and 25. See legend to figure 1a for further methodological details. b – The temporal relationship between divorce and the yearly prevalence of first onset of AUD in females (red dots) who were married between the ages of 26 and 35. See legend to figure 1a for further methodological details.