The Role of Alcohol Use, Social Factors and Heritability as Risk Factors for Drug and Alcohol Depend

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The Role of Alcohol Use, Social Factors and
Heritability as Risk Factors for Drug and Alcohol
Dependence Among Swedish Twins

• Barbro Engdahl) , Marlene Stenbacka)
• Stockholms Universitet, SORAD, Sveaplan, SE-106
  91 Stockholm ,Sweden. )Karolinska Institutet,
  Addiction Center Stockholm. Magnus Huss M44. 171
  76 Stockholm
• NORDIC ALCOHOL AND DRUG RESERCHERS ASSEMBLY APRIL
  21-23, 2008 HOTEL VUORANTA, HELSINKI, FINLAND

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The Swedish Twin Register
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Twin births in Sweden and Swedish Twin Registry

• Historically, between 1 and 2 of all births are
  twin births with some geographical variation.
• Twins become more common. 3.2 of all born
  children in 2004 were twins.
• The increase depends on IVF- treatments and that
  the women are older when they have children.
• Of twin pairs born alive 1/3 are monozygotic, 1/3
  are like-sexed dizygotic, and 1/3 are
  unlike-sexed dizygotic twins.
• There are more than 172,000 twins in the Swedish
  Twin Registry. Of these roughly 86,000 twin
  pairs, there are about 61,000 pairs in which both
  twins are alive.

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Background

• Studies have found that early alcohol use is
  associated with the development of problem
  drinking and alcohol dependence. (GrantDawaon,
  1997 Dewit et al.,2000, Kraus et al.2000Guo et
  al. 2001).
• Longitudinal studies shows that use of illicit
  drugs is preceded by use of alcohol use and
  tobacco smoking (Kandel, 2002).
• Twin studies have shown that genetic factors
  contribute to use of licit and illicit drugs,
  abuse and dependence.
• The genetic factors contribute to early tolerance
  and early rush of the drugs (sensitivity for the
  drugs).

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Studies on heredity and alcohol and drug use

• Twin studies (Grant et al., 2006)
• Adoption studies (Bohman et al., 1984,1986)

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Aims

• To analyse eventual links between early alcohol
  use and development of abuse/dependence (DSM IV)
  among MZ- and DZ twins.
• To analyse heritability for alcohol and drug
  abuse, controlled for social, behavioural and
  home background factors among both MZ- and DZ
  twin pairs.
• As outcome measures self-reported alcohol and
  drug abuse and inpatient care stays or death with
  alcohol and /or drug abuse related diagnoses.

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What does the registry contains?

• The Swedish Twin Registry consists of several
  birth cohorts
• It is a national health-related database, and is
  updated
• monthly with regards to the Address Register and
  annually with regards to Cause of Death Registry.
  Additional information is collected depending on
  different actual research questions and specific
  needs.

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Questionnaire 1973 (Q73)- cohort

• Twins born in 1926-1958
• During 1972, every like-sexed twin pair born
  between 1926 and 1958 received a questionnaire.

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STAGE-cohort

• This cohort is based on a twins born 1959-1985.
• A web-based questionnaire was sent to 42 592
  twin individuals.
• A total of 25 369 (60) answered the
  questionnaire in May 20, 2005 and June 1, 2005.
  Of these 16 women and 17 of the men completed a
  telephone interview.

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STAGE-cohort

• The questionnaire contained questions
  concerning
• Civil status
• Health
• Family back ground
• Work situation etc.
• The cohort were followed in inpatient and cause
  of death register up to 2006.

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Alcohol dependence (DSM-IV).

• Three or more of the following seven criteria,
  occurring at any time in the same 12-month
  period
• Tolerance.
• Withdrawal symptoms
• Alcohol is often taken in larger amounts or over
  a longer period than was intended.
• Desire to cut down or control alcohol use.
• A great deal of time associated to alcohol use
• Important social, occupational, or recreational
  activities are given up
• Alcohol use is continued despite knowledge of
  having a persistent or recurrent physical or
  psychological problem

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High alcohol consumption and Binge drinking

• High alcohol consumption
• Men170 gr./week (14 glasses of wine)
• Women110 gr./week (9 glasses of wine)

• Binge drinking
• 5 drinks at one and same occasion

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Results from STAGE
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Results

• 11 255 men and 14 114 women in this cohort
• Age category
• 20-24 5
• 25-34 36
• 35-44 39
• 45-49 20
• Mean age
• Men 37 years
• Women 36 years
• Total 37 years

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Twin-individuals in STAGE
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Drug use among 25 369 twins born 1959-1985. STAGE
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Results from Q73- questionnaire
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Age at 1972, among twin individuals who had been
treated at hospital for alcohol related diagnoses
and death of alcohol related diagnoses 1973-2003
among persons born 1926-1958 . (Q73)
questionnaire 1972-73).
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Treated at hospital for alcohol and drug related
diagnoses 1973-2005 and mortality 1973-2003
among persons born 1926-1958. (Q73-questionnaire
1972-73).
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Treated at hospital for alcohol related diagnoses
1973-2005 and death of alcohol related diagnoses
1973-2003 among men and women born 1926-1958.
(Q73- questionnaire 1972-73).
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Binge-drinkers at interview (Q73-questionnaire
1972-73)
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Binge-drinking (n3485) at 1972-73 and future
alcohol- and drug abuse. Follow-up 1973-2003
among persons born 1926-1958. (Q73-questionnaire
1972-73)
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Inpatient care or death of alcohol- or drug
related diagnoses during follow-up (1973-2003)
in relation to Binge-drinking at 1972-73 among
persons born 1926-1958 (Q73-questionnaire)
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Conclusions

• We found that high alcohol consumption and
  alcohol dependence was rather equal among both
  women and men in the younger cohort (STAGE) while
  in the older cohort binge drinking was more
  frequent among men (Q73).
• Having tried any illicit drug was evident for
  about 16 of the STAGE-cohort. Cannabis was the
  most frequent used drugs, followed by Central
  stimulants and opiates.
• A total of 7 of the men and 2 of the women
  had been treated for an alcohol related diagnose
  and about 1 of both men and women for a drug
  related diagnose in the old cohort.
• In logistic regression analyses we found a
  tendency that monozygotic twins compared to
  DZ-twins had higher heritability for high
  alcohol consumption in relation to alcohol
  dependence.

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Conclusions

• Early detection of vulnerable families with risk
  for heritability for alcohol and drug abuse seem
  to be an important task for the society in order
  to prevent different social adjustment problems.
• Also, social adjustment problems should be
  noticed and prevented with different early
  prevention programs.

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Acknowledgement

• Addiction Center Stockholm
• Mse Barbro Engdahl
• Mse Anders Leifman
• Docent Peter Wennberg
• Professor Anders Romelsjö

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• Thank you for your attention!!!!