Spousal concordance for alcohol dependence: evidence for assortative mating or spousal interaction effects?

Working With the Suicidal Client Who Also Abuses Substances

Substance use disorders and suicidal thoughts and behaviors commonly co-occur in adolescent and adult psychiatric populations and are often functionally interrelated. Although the evidence base for treatment of this population is sparse, integrated cognitive behavioral treatment (CBT) protocols, or those that rely heavily on CBT techniques, hold promise. In this paper, we provide an overview of the evidence-based literature for interventions that target suicidal behavior and substance use disorders with adults and adolescents. We then discuss the manner in which these behaviors may be functionally interrelated and offer a conceptual framework (S-O-R-C) to guide case conceptualization and treatment planning for clients with co-occurring suicidality and substance use disorders. Next, we provide a case example of a client with suicidal behavior and an alcohol use disorder and demonstrate how to apply an integrated CBT treatment protocol to this case. This case example is followed by a more general discussion about the potential advantages of integrated CBT protocols for suicidality and substance use disorders, guidelines for prioritizing treatment targets and skill selection for each individual client, and other important treatment considerations. We conclude with recommendations for future research in this area.

Non-random mating and convergence over time for alcohol consumption, smoking, and exercise: the Nord-Trøndelag Health Study

Spouses tend to have similar lifestyles. We explored the degree to which spouse similarity in alcohol use, smoking, and physical exercise is caused by non-random mating or convergence. We used data collected for the Nord-Trøndelag Health Study from 1984 to 1986 and prospective registry information about when and with whom people entered marriage/cohabitation between 1970 and 2000. Our sample included 19,599 married/cohabitating couples and 1,551 future couples that were to marry/cohabitate in the 14-16 years following data collection. All couples were grouped according to the duration between data collection and entering into marriage/cohabitation. Age-adjusted polychoric spouse correlations were used as the dependent variables in non-linear segmented regression analysis; the independent variable was time. The results indicate that spouse concordance in lifestyle is due to both non-random mating and convergence. Non-random mating appeared to be strongest for smoking. Convergence in alcohol use and smoking was evident during the period prior to marriage/cohabitation, whereas convergence in exercise was evident throughout life. Reduced spouse similarity in smoking with relationship duration may reflect secular trends.

A quantitative-trait genome-wide association study of alcoholism risk in the community: findings and implications

BACKGROUND

Given moderately strong genetic contributions to variation in alcoholism and heaviness of drinking (50% to 60% heritability) with high correlation of genetic influences, we have conducted a quantitative trait genome-wide association study (GWAS) for phenotypes related to alcohol use and dependence.

METHODS

Diagnostic interview and blood/buccal samples were obtained from sibships ascertained through the Australian Twin Registry. Genome-wide single nucleotide polymorphism (SNP) genotyping was performed with 8754 individuals (2062 alcohol-dependent cases) selected for informativeness for alcohol use disorder and associated quantitative traits. Family-based association tests were performed for alcohol dependence, dependence factor score, and heaviness of drinking factor score, with confirmatory case-population control comparisons using an unassessed population control series of 3393 Australians with genome-wide SNP data.

RESULTS

No findings reached genome-wide significance (p = 8.4 × 10(-8) for this study), with lowest p value for primary phenotypes of 1.2 × 10(-7). Convergent findings for quantitative consumption and diagnostic and quantitative dependence measures suggest possible roles for a transmembrane protein gene (TMEM108) and for ANKS1A. The major finding, however, was small effect sizes estimated for individual SNPs, suggesting that hundreds of genetic variants make modest contributions (1/4% of variance or less) to alcohol dependence risk.

CONCLUSIONS

We conclude that 1) meta-analyses of consumption data may contribute usefully to gene discovery; 2) translation of human alcoholism GWAS results to drug discovery or clinically useful prediction of risk will be challenging; and 3) through accumulation across studies, GWAS data may become valuable for improved genetic risk differentiation in research in biological psychiatry (e.g., prospective high-risk or resilience studies).

Developmental trajectories of marijuana use from adolescence to adulthood: personality and social role outcomes

Longitudinal trajectories of marijuana use from adolescence into adulthood were examined for adverse life-course outcomes among African-Americans and Puerto Ricans. Data for marijuana use were analyzed at four points in time and on participants' personality attributes, work functioning, and partner relations in adulthood using growth mixture modeling. Each of the three marijuana-use trajectory groups (maturing-out, late-onset, and chronic marijuana-users) had greater adverse life-course outcomes than a nonuse or low-use trajectory group. The chronic marijuana-use trajectory group was highly associated with criminal behavior and partners' marijuana use in adulthood. Treatment programs for marijuana use should also directly address common adverse life-course outcomes users may already be experiencing.

Psychiatric comorbidity in couples: a longitudinal study of 202,959 married and cohabiting individuals

PURPOSE

To examine whether partner's psychiatric and somatic disorders are risk factors for incidence of psychiatric disorders among non-psychiatric individuals at baseline.

METHODS

Register-based 6-year follow-up on Finns (106,935 men and 96,024 women aged 40 and over), living with a married or cohabiting partner at the end of 1997. The outcome measures included non-psychotic major depressive disorder (MDD), substance use disorder (SUD), and severe psychiatric disorder, evaluated using information on reimbursement for drug costs, purchases of prescription medication, and principal causes of hospitalization.

RESULTS

Among persons whose partner had any psychiatric disorder, the incidence rate ratio (IRR) for own MDD, controlling for own age at baseline, was 1.58 (95% confidence interval 1.48-1.69) in men, and 1.58 (1.48-1.69) in women. Among persons whose partner had somatic hospitalization, the IRR for own MDD was 1.14 (1.08-1.20) in men and 1.20 (1.15-1.25) in women. Among both men and women, the highest risk for incidence of own MDD was among persons whose partner had both MDD and SUD (IRR 2.65, 1.67-4.21 and IRR 2.13, 1.62-2.80, respectively). Further adjustment for sociodemographic and union characteristics had little effect on the associations.

CONCLUSIONS

In married and cohabiting couples, partner's somatic and particularly psychiatric morbidity associate with psychiatric disorders in non-psychiatric subjects, independent of sociodemographic and union characteristics. The healthy spouse's care burden is a potential point of intervention in order to prevent new psychiatric morbidity, but also to provide the mentally ill first partner a chance to recover in a supportive family environment.

Alcoholic marriage: later start, sooner end

BACKGROUND

Although associations between drinking behavior and marital status are well documented, timing of marital transitions as a function of alcohol use or disorder has received limited empirical attention.

METHODS

We examine the relationship between lifetime history of alcohol dependence (AD) and timing and survival of first marriages in a sample of 3,575 female and 1,845 male adult Australian twins born mostly between 1940 and 1964. Survival analyses were conducted using Cox proportional hazards regression models.

RESULTS

Results indicate moderate delays in marriage associated with AD for both women and men. Among ever-married respondents, AD was strongly predictive of early separation, with similar effects observed for women and men. Heritable sources of covariation were also documented. For women, genetic influences shared between early-onset AD and marital timing were found. Genetic influences shared between AD and marital survival were observed for women without regard to onset and for men with later-onset AD.

CONCLUSIONS

Results confirm the importance of AD as a predictor of both timing and survival of first marriages, with genetic influences contributing to observed associations.

Initial evidence of an association between OPRM1 and adolescent alcohol misuse

BACKGROUND

Considerable research efforts have attempted to identify genes associated with alcoholism among adults, yet few studies have examined adolescents. Identifying genes associated with alcohol misuse in youth is important given that the relative contribution of genetic and environmental influences on alcoholism varies across development. The purpose of this study was to examine the association between a polymorphism of the mu-opioid receptor gene (OPRM1) and alcohol misuse in a sample of youth and to test whether heightened sensitivity to the reinforcing effects of alcohol mediated this relationship.

METHODS

Adolescents (n = 187; mean age = 15.4 years; 47.6% female) were genotyped for A118G (rs1799971), a single-nucleotide polymorphism (SNP) of the OPRM1 gene, and assessed for alcohol use disorder (AUD) diagnoses and other psychopathology. Alcohol misuse was also measured continuously to maximize detection of drinking problems in youth. Drinking motives were used to capture the extent to which youth consumed alcohol to enhance positive affect.

RESULTS

AUD groups differed significantly in terms of allelic distributions of the A118G SNP, such that 51.9% of youth with an AUD carried at least one copy of the G allele compared to 16.3% of non-AUD controls. Those who carried the G allele endorsed drinking to enhance positive affect more strongly than those who were homozygous for the A allele and drinking to enhance positive affect mediated the association between OPRM1 and alcohol-related problems.

CONCLUSIONS

These data build on findings from adult studies and provide the first evidence that a polymorphism of the OPRM1 receptor gene is associated with the development of early-onset alcohol-related problems during adolescence, in part, by heightening sensitivity to the reinforcing effects of alcohol.

Alcohol consumption indices of genetic risk for alcohol dependence

BACKGROUND

Previous research has reported a significant genetic correlation between heaviness of alcohol consumption and alcohol dependence (AD), but this association might be driven by the influence of AD on consumption rather than the reverse. We test the genetic overlap between AD symptoms and a heaviness of consumption measure among individuals who do not have AD. A high genetic correlation between these measures would suggest that a continuous measure of consumption may have a useful role in the discovery of genes contributing to dependence risk.

METHODS

Factor analysis of five alcohol use measures was used to create a measure of heaviness of alcohol consumption. Quantitative genetic analyses of interview data from the 1989 Australian Twin Panel (n = 6257 individuals; M = 29.9 years) assessed the genetic overlap between heaviness of consumption, DSM-IV AD symptoms, DSM-IV AD symptom clustering, and DSM-IV alcohol abuse.

RESULTS

Genetic influences accounted for 30%-51% of the variance in the alcohol measures and genetic correlations were .90 or higher for all measures, with the correlation between consumption and dependence symptoms among nondependent individuals estimated at .97 (95% confidence interval: .80-1.00).

CONCLUSIONS

Heaviness of consumption and AD symptoms have a high degree of genetic overlap even among nondependent individuals in the general population, implying that genetic influences on dependence risk in the general population are acting to a considerable degree through heaviness of use and that quantitative measures of consumption will likely have a useful role in the identification of genes contributing to AD.

Parental alcoholism and offspring behavior problems: findings in Australian children of twins

We examine the impact of rearing by an alcoholic parent on risk for child behavior problems using data on 2492 offspring drawn from two ongoing studies of children of female and male same- and opposite-sex twin pairs. Results of regression models predicting child behavior problems from parent and co-twin lifetime history of alcohol use disorder (AUD) provide support for genetic but not environmental transmission of externalizing and a measure of total problem behaviors. Results for internalizing behavior were inconclusive with respect to transmission of risk.

The crown of love: intimate relations and alcohol use in adolescence

BACKGROUND

Remarkably, little attention has been paid to the role of intimate partners and their drinking behavior in relation to adolescent alcohol use. In the current study, we examined associations between adolescent alcohol use and romantic partners' drinking behavior.

METHODS

A total of 428 families, consisting of both parents and two adolescents (aged 13.4 and 15.2 at Time 1) participated in a prospective study with four annual waves. Correlations and multivariate regressions were used to examine (1) similarity in drinking behaviors of adolescents and intimate partners, (2) whether alcohol use of partners prospectively predicts adolescent alcohol consumption, and (3) whether adolescents who consume alcohol select partners over time who show similar drinking behaviors.

RESULTS

(1) Frequency of alcohol consumption of adolescents and of their romantic partners correlated significantly. (2) Alcohol use of partners was not predictive of adolescent alcohol consumption over time, if previous levels of alcohol consumption were taken into account. (3) Adolescents acquired partners with similar drinking behaviors. Gender effects were found; adolescent girls, but not boys, were more likely to become involved with partners who also frequently consumed alcohol.

CONCLUSIONS

Regarding alcohol consumption, adolescents and their intimate partners were relatively similar in alcohol use. This resemblance is best explained by adolescents' selection of future partner on the basis of alcohol consumption. Less indication was found for influence effects, perhaps due to the transient nature of most adolescent romantic relationships.

Crossover of workplace aggression on to partner's alcohol intake

Purpose

This study aims to investigate the crossover of workplace aggression experienced by members of dual‐earner couples on alcohol intake of the partner

Design/methodology/approach

Cross‐sectional community data come from the 1998 Quebec Health and Social Survey containing a sub‐sample of 5,778 individuals nested in 2,889 dual‐earner couples. Data on alcohol intake, workplace aggression (physical, psychological, sexual), decision authority, working hours, irregular work schedule, marital strains, gender and age are gathered from self‐report questionnaires. Each member of the couple will answer the questionnaire.

Findings

The results show that being the target of workplace aggression is associated with low‐risk (OR=1.27, 95%CI=1.10‐1.46) and high‐risk drinking (OR=1.78, 95%CI=1.44‐2.20). Indicative of a crossover effect, partner workplace aggression victimization (OR=1.30, 95%CI=1.05‐1.62) is associated with high‐risk drinking

Research limitations/implications

Victims of workplace aggression and their immediate relatives might be supported to avoid adverse alcohol‐related problems. Organizations need to pay more attention to the problem of workplace aggression in their occupational health and safety programs

Originality/value

Using multilevel multinomial regression models, this study highlights the complexities of work‐family dynamics and of the crossover effect of workplace aggression into the lives and alcohol intake behavior of dual‐earner partners.

Family members of people with alcohol or drug dependence: health problems and medical cost compared to family members of people with diabetes and asthma

AIMS

To compare the medical costs and prevalence of health conditions of family members of people with an alcohol or drug dependence (AODD) diagnosis to family members of people with diabetes and asthma.

SETTING

Kaiser Permanente of Northern California (KPNC).

PARTICIPANTS

Family members of people diagnosed with AODD between 2002 and 2005, and matched samples of family members of people diagnosed with diabetes and asthma.

MEASUREMENTS

Logistic regression was used to determine whether the family members of people with AODD were more likely to be diagnosed with medical conditions than family members of people with diabetes or asthma. Multivariate models were used to compare health services cost and utilization of AODD family members and diabetes and asthma family members. Analyses were for the year before, and 2 years following, initial diagnosis of the index person.

FINDINGS

In the year before initial diagnosis of the index person, AODD family members were more likely to be diagnosed with substance use disorders, depression and trauma than diabetes or asthma family members. AODD family members had higher total health-care costs than diabetes family members in the year following, and the second year following, the index date ($217 and $293, respectively). AODD family members had higher total health-care costs than asthma family members in the year before, and second year following, the index date ($104 and $269, respectively).

CONCLUSIONS

AODD family members have unique patterns of health conditions compared to the diabetes and asthma family members and have similar, or higher, health-care cost and utilization.

Spousal concordance for major coronary risk factors: a systematic review and meta-analysis

Spousal pairs permit assessment of determinants of diseases related to environment, because they share the same lifestyle and environment. The authors reviewed spouses' concordance for the major coronary risk factors. A search of the MEDLINE, PubMed, and EMBASE databases was performed. Seventy-one papers were selected for a total of 207 cohorts of pairs and 424,613 correlations in more than 100,000 couples. The most strongly correlated within-pairs factors were smoking and body mass index, with overall correlations of 0.23 (95% confidence interval: 0.12, 0.36) and 0.15 (95% confidence interval: 0.05, 0.25), respectively. Statistically significant positive correlations were also found for diastolic blood pressure, triglycerides, total and low density lipoprotein cholesterol, weight, and the waist/hip ratio. The overall odds ratios for concordance in hypertension, smoking, diabetes, and obesity were all statistically significant, ranging from 1.16 to 3.25. Assortative mating influenced concordance for blood pressure, smoking, glucose, low density lipoprotein cholesterol, weight, body mass index, and waist circumference. This systematic review shows a statistically significant positive spousal concordance for the majority of main coronary risk factors. However, the strength of the concordance was markedly different among factors and appeared to be quite modest for all of them. Interventions to reduce cardiovascular risk factors should be addressed jointly to both members of a marital couple.

Autosomal linkage analysis for cannabis use behaviors in Australian adults

Cannabis is the most commonly used illicit drug in developed and in developing nations. Twin studies have highlighted the role of genetic influences on early stages of cannabis use, such as a lifetime history of use, early-onset use and frequent use, however, we are not aware of any genomic studies that have examined these phenotypes. Using data on 2314 families consisting of 5600 adult Australian offspring and their parents, all of whom were scanned using 1399 unique autosomal markers, we conducted autosomal linkage analyses for lifetime history of cannabis initiation, early-onset cannabis use and frequency of use, using a variance components approach in the linkage package MERLIN. Suggestive evidence for linkage was found on chromosome 18 (LOD 2.14 for frequency of use, LOD 1.97 for initiation, at 90-97 cM) and also on chromosome 19 (LOD 1.92 for early-onset at 17 cM). These LOD scores did not meet genome-wide significance. Further replication of these linkage regions in other samples will be required, although these initial results suggest further targeted efforts on chromosome 18 may yield interesting candidate genes for early stages of cannabis-related behaviors.

Long-term stability and heritability of telephone interview measures of alcohol consumption and dependence

Alcohol dependence symptoms and consumption measures were examined for stability and heritability. Data were collected from 12,045 individuals (5376 twin pairs, 1293 single twins) aged 19 to 90 years in telephone interviews conducted in three collection phases. Phases 1 and 2 were independent samples, but Phase 3 targeted families of smokers and drinkers from the Phase 1 and 2 samples. The stability of dependence symptoms and consumption was examined for 1158 individuals interviewed in both Phases 1 and 3 (mean interval = 11.0 years). For 1818 individuals interviewed in Phases 2 and 3 (mean interval = 5.5 years) the stability of consumption was examined. Heritability was examined for each collection phase and retest samples from the selected Phase 3 collection. The measures examined were a dependence score, based on DSM-IIIR and DSM-IV criteria for substance dependence, and a quantity x frequency measure. Measures were moderately stable, with test-retest correlations ranging from .58 to .61 for dependence and from .55 to .64 for consumption. However, the pattern of changes over time for dependence suggested that the measure may more strongly reflect recent than lifetime experience. Similar to previous findings, heritabilities ranged from .42 to .51 for dependence and from .31 to .51 for consumption. Consumption was significantly less heritable in the younger Phase 2 cohort (23-39 years) compared to the older Phase 1 cohort (28-90 years).

Alcohol dependence and reproductive onset: findings in two Australian twin cohorts

BACKGROUND

Although early alcohol use is a strong predictor of future alcohol problems and adolescent drinking is associated with risky sexual behavior predictive of early childbearing, reproductive dysfunctions associated with delayed childbearing have been reported in adult drinkers. We examine the relationship between lifetime history of alcohol dependence (AD) and timing of first childbirth across reproductive development.

METHODS

Data were drawn from two cohorts of Australian twins born between 1893 and 1964 (3634 female and 1880 male twins) and between 1964 and 1971 (3381 female and 2748 male twins). Survival analyses were conducted using Cox proportional hazards regression models predicting age at first childbirth from AD, with sociodemographic characteristics, regular smoking, history of psychopathology, and family and childhood risks included as control variables in adjusted models.

RESULTS

Results suggest alcoholic women in both cohorts show overall delayed reproduction, with little effect of AD on timing of first reproduction in men. Effects of AD are particularly strong for women in the older cohort, where AD is associated with 73% decreased likelihood of first childbirth after age 29 [hazard ratio (HR) = 0.27, 95% CI: 0.10-0.75]. In adjusted models, effects reduce only slightly (HR = 0.29, 95% CI: 0.11-0.80). For women in the young cohort, AD is associated with delayed reproduction after age 24, with 40% decreased likelihood of first childbirth (HR = 0.60, 95% CI: 0.48-0.75). AD remains predictive in adjusted models, but without age interaction (HR = 0.72, 95% CI: 0.62-0.85).

CONCLUSIONS

Findings of delayed reproductive onset in alcoholic women are consistent with alcohol-related reproductive dysfunctions, although underlying mechanisms remain largely unknown. To better understand AD differences in reproductive onset, continued research on both biological and psychosocial risks is needed.

Are there genetic influences on addiction: evidence from family, adoption and twin studies

AIMS

In this exciting era of gene discovery, we review evidence from family, adoption and twin studies that examine the genetic basis for addiction. With a focus on the classical twin design that utilizes data on monozygotic and dizygotic twins, we discuss support in favor of heritable influences on alcohol, nicotine, cannabis and other illicit drug dependence.

METHODS

We review whether these genetic factors also influence earlier stages (e.g. experimentation) of the addictive process and whether there are genetic influences specific to each psychoactive substance.

RESULTS

Converging evidence from these studies supports the role of moderate to high genetic influences on addiction with estimates ranging from 0.30 to 0.70. The changing role of these heritable factors as a function of gender, age and cultural characteristics is also discussed. We highlight the importance of the interplay between genes and the environment as it relates to risk for addiction and the utility of the children-of-twins design for emerging studies of gene-environment interaction is presented.

CONCLUSIONS

Despite the advances being made by low-cost high-throughput whole genome association assays, we posit that information garnered from twin studies, especially extended twin designs with power to examine gene-environment interactions, will continue to form the foundation for genomic research.