Both Alcohol Dependence and Conduct Disorder Contribute to Having a High Number of Sex Partners

• High-risk sexual behaviours can lead to unwanted pregnancies, infection and reproductive problems. • A new study has linked the clinical diagnoses of alcohol dependence and conduct disorder in young adults to having 10 or more sexual partners. • Although both disorders contribute to high-risk sexual behavior, alcohol dependence is the greater risk factor.

Previous studies have linked heavy drinking and conduct disorder to high-risk sexual behaviors that can, in turn, lead to unintended pregnancies, infection, and damage to reproductive health. A new study has linked the clinical diagnoses of alcohol dependence and conduct disorder among 18-to-25-year-olds to the risk of having a high number of sexual partners. Results are published in the December issue of Alcoholism: Clinical & Experimental Research. “Our study is the first of its kind to link problematic drinking and alcohol dependence with a high number of sex partners,” said Patricia A. Cavazos-Rehg, research instructor in the Department of Psychiatry at Washington University School of Medicine and corresponding author for the study. “We have moved beyond self-reports of heavy and/or frequent drinking to utilizing a clinical diagnosis of alcohol dependence in order to improve understanding of how alcohol use influences risky sexual behaviors.” “The relationship between risky sexual behavior and conduct disorder has been well documented, especially among young women,” added Denise Hallfors, senior research scientist at the Pacific Institute for Research and Evaluation. “What was not known was whether alcohol dependence and conduct disorder independently contribute to the number of sexual partners. Previous studies tended to look at either alcohol dependence and conduct disorder, or conduct disorder and sexual risk, or heavy drinking and sexual risk, but not at all three behaviors together.” Researchers gathered data through personal interviews from 601 unmarried relatives, 18 to 25 years of age, of alcohol-dependent individuals who participated in the Collaborative Study on The Genetics of Alcoholism. Variables examined included: problem drinking, alcohol dependence, conduct problems, conduct disorder, family status, educational attainment, gender, race, age at first intercourse, age at time of interview, and number of sexual partners. “A significant number of participants with alcohol dependence, 45 percent, had 10 or more sexual partners,” said Cavazos-Rehg. “Moreover, we categorized individuals into three levels of alcohol involvement – non-dependent, problem drinking, alcohol dependent – and demonstrated how a stepwise increase from non-dependence to problematic alcohol use to alcohol dependence was associated with a higher rate of sexual partners. We also found a risk for high number of sexual partners among persons with conduct disorder independent of level of alcohol involvement. In addition, individuals with co-occurring alcohol dependence and conduct disorder are at even greater risk of multiple sex partnerships.” “These young adults with alcohol dependence and conduct problems are likely to have many sexual partners,” said Hallfors. “This suggests that they are not only at greater risk for STDs and HIV, but if infected, they are likely to infect many others.” Hallfors suggested that college campuses help address this problem. “Students are frequently referred to the campus health clinic for alcohol-related problems,” she said. “Young adults who are running into problems because of their heavy drinking and who present for treatment should be screened for sexually transmitted diseases and treated if infected. Furthermore, college health care staff could greatly improve care by asking about sexual risk behaviors and screening for STDs.” Hallfors also suggested two other possibilities for public-health intervention. “Young adults who present in emergency rooms for drinking-related injuries or illnesses could be screened for HIV and STDs,” she said. “Similarly, a majority of prison inmates have been incarcerated for substance-abuse related crimes, including alcohol problems. Prison populations are known to have higher rates of STDs and HIV, but few prisons screen inmates at admission for these diseases. These data provide additional support for screening young adults in jail or prison for HIV and STDs.” “At the alcohol-treatment level, clients could be targeted by health professionals to receive education, screening, and treatment for STDs,” added Cavazos-Rehg. “Furthermore, STD prevention programs and clinics can better understand the role of alcohol dependence and conduct disorder as part of a comprehensive strategy for reducing STD transmission.”

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

Articles were written based on the following published research:

Edward L. Spitznagel, Kathleen K. Bucholz, Karen Norberg, Wendy Reich, Laura Jean Bierut, John Nurnberger, Jr., Victor Hesselbrock, John Kramer, Sam Kuperman (December 2007). The relationship between alcohol problems and dependence, conduct problems and diagnosis, and number of sex partners in a sample of young adults. Alcoholism: Clinical and Experimental Research (ACER). 31(12):