In summary, first marriage to a spouse with no history of registration for alcohol use disorder is associated with a large reduction in risk for alcohol use disorder. This association does not arise as a result of confounding assessed either through the use of standard covariates or by co-relative analyses including marriage-discordant siblings and monozygotic twins. The protective effects of marriage on risk for alcohol use disorder are likely to arise largely from direct spousal interactions, and they are stronger in individuals who have an elevated familial risk for alcoholism. While causal effects are difficult to prove in observational data, and we cannot rule out the impact of hidden biases, these results are consistent with the hypothesis that the psychological and social aspects of marriage strongly protect against the development of alcohol use disorder.
