Social Network Drinking Outweighs Family History in the Development of Alcohol

Dependence in Adults

Vivia V. McCutcheon, PhD, Christina Lessov-Schlaggar, PhD, Douglas Steinley, PhD., Kathleen K. Bucholz, PhD.

Association for Medical Education and Research in Substance Abuse

Bethesda, MDNovember 7-9, 2013

Background

• Genetic influences on risk for alcohol use disorder account for 40-60% of variance

• Alcohol use and peers– Homophily – Influence

Heath et al., 1997; Prescott et al., 1999; Knopik et al., 1999

Peer Influence on Alcohol Use

• Additional heavy drinkers/abstainers in close network increases likelihood heavy drinking/abstention in principal (Rosenquist et al., 2010)

• Affiliation with substance use promoting peers predicted increase in AUD symptoms at subsequent ages from age 17 to 40 (Chassin et al., 2012)

• Peer network substance use predicted changes in drinking from adolescence into young adulthood after controlling for genetic and shared environmental influences on peer selection (Cruz et al., 2012)

Objective

1. Characterize group of adults with high familial risk for AD– Parental alcohol problems– Drinking behavior in network

2. Examine associations of network drinking and familial risk with first-onset AD

Sample

• 11-year follow-up of subset of ECA sample selected for high risk of developing alcohol dependence (N=753)– Previous reports heavy drinking in self or 1st-

degree relatives– Risk score including conduct disorder, illicit drug

use, depression– Age 18-49 at baseline ECA interview• 29-62 at 11-year follow-up

Regier et al., 1984; Bucholz et al., 1996

Assessments

• DSM-III AD– Current (6.8%)– Remitted (7.7%)

• Family history alcohol problems in one or both parents– “I’d like to ask you some questions about the drinking

of some of your relatives. Have any of the following relatives drunk heavily or had ANY drinking problems, like problems with health, family, job, or police?”

Assessments

• Network drinking– “Now I’d like to know about the current drinking

habits of the people you may be close to. Which of the patterns on the card best describes the drinking pattern of (closest friend outside family, closest sibling, current spouse/partner)?”• Lifelong abstainer/Non-drinker/Light drinker• Moderate/Heavy/Problem drinker or Alcoholic• Recovering problem drinker or alcoholic who doesn’t

drink now

Demographic Characteristics

No AD (N=644)

Remitted AD(N=51)

Current AD(N=58)

Age, M(SD) 43.4 (8.3) 40.4 (6.3) 39.7 (7.3)

Female, % 63.5 51.0 51.7

Black, Hispanic, % 41.8 47.1 53.4

Years educ., M(SD) 12.9 (2.3) 13.2 (2.1) 12.5 (2.2)

Marital status, %

Married 55.9 52.9 41.4

SepDiv 26.9 13.7 24.1

Never Married 13.0 23.5 19.0

Living as married 4.2 9.8 15.5

Drinking Characteristics

No AD (N=644)

Remitted AD(N=51)

Current AD(N=58)

Age regular drinking, M(SD)

22.5 (6.6) 19.8 (4.0) 22.0 (4.9)

Abstinent last year, % 57.6 41.2 0.0

Typical drinks/week last year, M(SD)

5.4 (6.4) 9.4 (10.6) 11.9 (10.7)

Ever thought you drank too much, %

10.2 64.7 31.0

AD Incidence by Parental Alcohol Problems

None One Parent Both Parents0

5

10

15

20

25

Remitted ADCurrent AD

65% 30% 5%

*

AD Incidence by Spousal Drinking

None-light Mod-Hvy Recovering0

5

10

15

20

25

Remitted ADCurrent AD

*

5%57% 38%

*

AD Incidence by Friend, Sib Drinking

Closest Friend

None-Light Mod-Hvy Recovering0

5

10

15

20

25

Closest Sibling

None-Light Mod-Hvy Recovering0

5

10

15

20

25

41% 57% 2% 52% 44% 4%

*

*

*

*

Multinomial Regression Predicting Remitted and Current Incident AD

Remitted AD Current AD

RRR (95% CI) RRR (95% CI)

Network drinking

Moderate/Heavy 1.5 (0.8-2.8) 2.6 (1.4-5.1)

Recovering 5.8 (2.3-14.3) 2.7 (0.9-8.3)

Parental alcohol problems

One parent 0.9 (0.4-1.8) 0.8 (0.4-1.5)

Both parents 4.6 (1.8-11.7) 1.7 (0.5-5.5)

Adjusted for gender, age, marital status

Logistic Regression Predicting Incident AD

First-Onset AD

OR (95% CI)

Network drinking

Moderate/Heavy 2.0 (1.2-3.1)

Recovering 4.2 (1.9-8.9)

Parental alcohol problems

One parent 0.89 (0.5-1.4)

Both parents 3.0 (1.3-6.6)

Adjusted for gender, age, marital status

Conclusions

• Network heavy drinking and recovery had effects equal to that of alcohol problems in both parents in predicting first-onset AD, and outweighed the influence of AD in one parent.

• Future: Does association of recovery in network with remitted AD reflect network selection or network influence?

• Does recovery spread within network?

Acknowledgements

• K01 AA018146 (McCutcheon, PI)

• K01 DA027046 (Lessov-Schlaggar, PI)

• K25 AA017456, R21 AA022074 (Steinley, PI)

• R01 AA008752, P50 AA 011998, R01 AA012640, R01 DA 014363 (Bucholz, PI)

Thank You!Questions?

Contact info:Vivia V. McCutcheon, Ph.D.

Research Assistant Professor of PsychiatryWashington University School of Medicine, St. Louis, MO

vmccutcheon@wustl.edu314-286-2297