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A 4-Year Longitudinal Study on Risk Factors for Alcoholism
Andrew T. A. Cheng, MD, PhD, FRCPsych;
Shur-Fen Gau, MD, PhD;
Tony H. H. Chen, MD, PhD;
Jung-Chen Chang, PhD;
Yuh-Terng Chang, PhD
Arch Gen Psychiatry. 2004;61:184-191.
Background Longitudinal studies are needed to resolve inconsistencies in previous findings regarding antecedents of alcoholism.
Objective To investigate genetic and environmental risk factors for alcoholism.
Design A 4-year longitudinal cohort study.
Setting General community.
Participants A population-based cohort was randomly selected from 4 aboriginal groups in Taiwan. Cohort subjects free from any alcohol use disorder at phase 1 (n = 499) were reassessed approximately 4 years later (phase 2). The percentage of participants who completed the study was 98.4%.
Main Outcome Measures A standardized semistructured clinical interview for alcoholism and other psychiatric comorbidity was used in both phases of the study. The main outcome measure was the incidence of alcohol use disorder. Specific risk factors examined included sociodemographic factors, family history of alcoholism, extent of acculturation, psychiatric comorbidity, and alcohol-metabolizing genes.
Results Using Cox proportional hazards regression analysis, the risk for alcoholism was significantly higher among subjects who were male (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.79-4.32), aged 15 to 24 years (OR, 5.05; 95% CI, 2.06-6.18), unmarried (OR, 1.60; 95% CI, 1.03-2.49), and employed (OR, 2.25; 95% CI, 1.34-3.77) and had a higher educational level (OR, 1.76; 95% CI, 1.12-2.75), a family history of alcoholism (OR, 1.73; 95% CI, 1.06-2.83), and a higher extent of cultural assimilation (OR, 2.07; 95% CI, 1.28-3.35). Two specific risk pathways emerged on multivariate analysis: the highest risk was among subjects aged 25 to 34 years with anxiety disorders (OR, 16.86; 95% CI, 3.98-71.41), and the other was among men with the less active ADH2*1 gene (OR, 5.87; 95% CI, 2.73-12.60).
Conclusion Based on incidence cases of alcoholism among aboriginal Taiwanese, this study confirms the significant roles of anxiety disorders and of the ADH2*1 allele as antecedents of alcoholism among specific age and sex groups.
From the Institute of Biomedical Sciences, Academia Sinica (Drs Cheng and Y.-T. Chang), Department of Psychiatry, College of Medicine, and National Taiwan University Hospital (Dr Gau), and Institute of Preventive Medicine, College of Public Health (Dr Chen), National Taiwan University, Taipei, and Deh-Yu Institute of Technology, Gee-Lung (Dr J.-C. Chang), Taiwan.
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