Why Are People with Alcohol Use Disorder More Likely to Die Young?

We know that some alcoholics literally drink themselves to death. Alcohol use disorder leads to malnutrition, withdrawals, social isolation and the creation or aggravation of other mental health issues. And over time, the alcohol destroys many organs, including the liver, brain and pancreas.

Genetically Predisposed

But now researchers have found that many alcoholics are dying in early to mid-adulthood, even before the decades of drinking take a physical toll on the body. These alcoholics die from inherited predispositions that don’t mix well with the booze, scientists from Virginia Commonwealth University reported in an April paper in JAMA Psychology.1

In other words, if you’re genetically predisposed to being an alcoholic, your chances of dying at a young age from alcohol use disorder (AUD) may be even higher. A person can be genetically predisposed to certain attitudes, actions and other medical conditions, too, creating a synergy known as “familial confounding” that can lead to a dangerous situation.

The authors noted that alcohol use disorder was associated with a six-fold increase in mortality rate for all ages, but it was highest in the age group of 30 to 39 years.

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Virginia Commonwealth Study Details

Dr. Kenneth S. Kendler and colleagues at Virginia Commonwealth University arrived at their findings after examining Swedish registry information for people born from 1940 to 1965. These people were followed up on from 1973 until 2010. “Alcohol use disorder was assessed from medical, criminal and pharmacy registries,” the authors reported. “Half-siblings, full siblings and identical twin pairs (but “discordant” for AUD, meaning one has the diagnosis and the other doesn’t) were obtained from the Multi-Generation and Twin Register.”

The study’s massive starting sample — 1,447,877 males and 1,373,149 females — gives the authors’ findings added credibility. Of the original sample, 131,895 males and 42,163 females registered with AUD. “Controlling for sex, educational status and year of birth, the mortality hazard ratio (chances of dying) associated with alcohol use disorder…varied – with an inverted U-shape function – by age,” according to the paper.

When compared with the general population and in related people where one had AUD and the other did not, the study showed that those with inherited traits that aggravate AUD were more likely to die in early to mid-adulthood. People diagnosed with AUD but who did not appear to have inherited aggravating traits tended to die later in middle to late adulthood.

Confounding Inherited Traits Can Include Abuse of Other Substances, Too

What confounding familial factors could be causing the earlier deaths among those with AUD? When people with AUD die young, what’s killing them if not the alcohol directly?

The authors point to personality traits such as impulsivity or novelty seeking, as well as a tendency to use other substances, “which are both associated with alcohol use disorder and under genetic influence.”

In an accompanying JAMA editorial by German Psychiatrists Drs. Andreas Heinz, Michael Rapp and Anne Beck, they explain “Road traffic crashes and suicides represent a significant cause of mortality in alcohol use disorders. In addition, about half of all murders in the United States and Germany are committed under the influence of current alcohol intake, and elevated risks of alcohol-associated aggression are found in individuals with higher alcohol intake and hence also in those with alcohol use disorders, particularly if violent acts have been experienced during previous states of alcohol intoxication.”2

Tobacco also tends to tag along as a vice in those with AUD. Tobacco accounts for half of the deaths of people with AUD even 12 years after getting alcohol detoxification, Heinz et al. report.

“The study…disentangles the environmental and genetic risk factors that contribute to increased mortality among individuals with alcohol use disorders,” they wrote. “The authors carefully weighed the evidence for the genetic contribution in early to middle adulthood and emphasized that the comparison of mortality rates associated with AUDs in half-siblings reared together vs. apart supports the hypothesis that increased mortality during early to middle adulthood mainly reflects the influence of genetic factors.”

Study Shows Need to Study Others with AUDs and Develop Better Interventions

In 2014, 90,000 deaths in the United States were blamed on excessive alcohol use.3 This study shows the need for better interventions among younger alcoholics genetically predisposed to alcohol use disorder.

“This study by Kendler and co-authors highlights several key points for further study,” conclude Heinz et al. “Exploration of International Classification of Diseases codes for causes of death may stimulate research in the widely understudied area of alcohol-related aggression, the role of [co-occurring] drug consumption (e.g. tobacco), and other environmental and social risk factors. Sex differences in AUDs are an understudied research area, and the explanation of causes of death in different age groups according to sex and AUDs is a topic of high importance for public health.”

The study also shines a light on shortcomings related to alcohol interventions among elderly drinkers. “The decreasing effect of familial and hence genetic factors in elevated mortality associated with AUDs emphasizes the need to address harmful alcohol use in the aging populations. Campaigns to prevent or reduce alcohol use are too often focused on young adults while neglecting elderly individuals. We hope that the study by Kendler and co-authors sparks new efforts to better understand and treat AUDs.”

Written by David Heitz

1 Kendler, K.S. et. al. “Alcohol Use Disorder and Mortality Across the Lifespan.” (2016, April 20). JAMA Psychiatry. Retrieved May 15, 2016, from archpsyc.jamanetwork.com
2 Heinz, A. et. al. “Alcohol as an Environmental Mortality Hazard.” (2016, April 20). Retrieved May 15, 2016, from archpsyc.jamanetwork.com
3 Alcohol Facts and Statistics. (2015, March). National Institute on Alcohol Abuse and Alcoholism. Retrieved Jan. 31, 2016, from niaaa.nih.gov

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