Longitudinal Outcomes in Relational Dynamics and Alcohol Use
Year: 2025
Type: study-registration
Abstract: The consumption of alcohol is frequently a behavior that occurs in the context of social environments and relationships (Heath, 2000). Studies investigating real-world drinking patterns have found that factors such as normative peer group drinking (Clapp & Shillington, 2001), social group composition (Lewis et al., 2011; Reed et al., 2013), and perceived social familiarity (Caumiant et al., 2023) exhibit relationships with levels of alcohol consumption, patterns of behavior that hold true across both clinical and subclinical levels of drinking behaviors (Cooper et al., 2014; Fairbairn et al., 2018a; Terlecki & Buckner, 2015). At the theoretical level, social models of alcohol’s effects implicate alcohol in the enhancement of social interaction quality and interpersonal enjoyment, indicating that alcohol may operate by way of positive reinforcement in facilitating easier, more pleasant social interactions (see Fairbairn et al., 2018a), as well as by way of negative reinforcement in alleviating social stressors (Fairbairn & Sayette, 2014). Implicit within this model, then, is the proposal that social relationships perform an essential function in shaping drinking behaviors, with positive social experiences playing both enhancement and reinforcement roles in motivating alcohol use (Kuntsche et al., 2006; van Damme et al., 2013). Therefore, understanding the mechanisms by which social relationships influence drinking represents a key objective in the development of models for detecting and preventing emerging addictive behaviors. As a result of these proposed social models of drinking motivation, social connections and the relational rewards associated with alcohol consumption have emerged as key constructs of interest in the investigation of drinking patterns that may precede the onset of alcohol use disorder (AUD; see Blane & Leonard, 1999). The emotion-enhancing properties of alcohol consumption in social contexts have been well documented in real-world drinking settings (Venerable & Fairbairn, 2020), and these properties have been associated with increases in alcohol consumption following both experiences of heightened positive emotion (Mohr et al. 2001) and reduced negative emotion (Dvorak et al., 2014). Such patterns also carry important motivational implications with regards to drinking behaviors, with individuals endorsing desires for social cohesion and the alleviation of social tension as common benefits of drinking (Kuntsche et al., 2005); critically, these patterns hold true across increasing levels of alcohol consumption and span both clinical and subclinical populations (Cooper et al., 2014; Terlecki & Buckner, 2015). However, there remains some uncertainty regarding the moderating and mediating variables that influence the inarguably complex relationship between relational rewards and drinking, and meta-analyses seeking to understand the impact of alcohol on emotion have long produced findings ranging from equivocal to null that often seem to stand in opposition to traditional theory and experimental results (Bresin, 2019; Dora et al., 2023). Extant research, therefore, suggests that focusing solely on the drinker is insufficient to explain drinking behaviors and motivations, thereby establishing a need for drinking-related assessments that are sensitive to the social and relational contexts in which alcohol consumption takes place. The deleterious impact of drinking on social relationships serves as not just one symptom, but an entire symptom category, within the DSM-5 conceptualization of AUD (APA, 2013). It is here that it is essential distinguish between attachment as a construct and relational outcomes as a functional product of this construct. In the context of alcohol use specifically, elevated levels of consumption have been linked to such relational consequences as decreased relational satisfaction (Rodriguez et al., 2013), increased depression and anxiety within relationships (Lambe et al., 2015), increased dyadic conflict (McArthur et al., 2025) and, in severe cases, heightened relational aggression (Grimaldi et al., 2014). When viewed through the lens of attachment, then, such observed patterns of changes in behavior and relational functioning invite questions regarding the mechanisms by which alcohol changes underlying relationship structures and, in doing so, introduces adverse relational outcomes that produce declines in overall relationship quality. Despite the definitional role of interpersonal deficits in shaping conceptualization of and assessment for AUD, the precise timing and even the extent to which these symptoms truly co-occur in clinical settings remains, at best, equivocal (Newcomb, 1994). Multiple potential pathways for this relationship emerge throughout the addiction literature and carry reasonable interpretations in the context of extant theories. For instance, some studies have found support for a causal pathway in which initial alcohol use predicts relational challenges in both experimental (Samp & Monahan, 2009) and real-world settings (Leonard & Roberts, 1998), driven by behavioral dysregulation induced by the pharmacological effects of alcohol. Such results, however, do not consistently replicate (Fairbairn, 2017), and in fact some studies have found the opposite, wherein drug and alcohol use within close relationships and social networks facilitates social bonding by way of promoting social cohesion (Fairbairn & Testa, 2016). This latter finding is of particular note, as while it may initially appear to stand in contrast to the predicted harmful interpersonal consequences of drinking, it is broadly consistent with the empirically supported proposal that many individuals are motivated to drink due to alcohol’s social rewards (Fairbairn & Sayette, 2014). As a result, a clear point of tension emerges, with the extant literature suggesting that alcohol operates both as a social facilitator and as a social hindrance; importantly, meta-analytic investigations documenting these effects have found them to be robust when consolidating findings from high-quality, well-powered studies featuring large sample sizes (Fairbairn, 2017; Fairbairn et al., 2018b), suggesting this pattern is not merely an artifact of variable research quality, but rather representative of variable consequences of alcohol use itself. Conventionally, the idea that alcohol can have varying effects in the context of varying social relationships may be consistent with anecdotal drinking experience; mechanistically, however, this process warrants investigation as a means of clarifying the process by and conditions under which alcohol’s relational effects may transform from enhancing to destructive. Given the well-validated interpersonal consequences of elevated alcohol consumption, interactions between attachment styles and patterns of alcohol use have received much attention within the addiction literature. Of particular interest has been insecure attachment, given that this relational structure most directly captures broad relational distress that has commonly been associated with patterns of heavy drinking behaviors and identified as characteristic of AUD (Insel, 2003; Kassel et al., 2007). Furthermore, parallels between this attachment style and such commonly endorsed drinking motivations as efforts to alleviate social discomfort (Cooper et al., 2014) and attain social rewards (Cooper et al., 1995) are immediately apparent, providing solid experiential and theoretical ground on which to investigate connections between relational attachment and drinking behaviors. In performing such investigation, insecure attachment has been found to be linked to elevated rates of alcohol consumption in developmental contexts (Tucker et al., 2022), as well as heightened risk for AUD in clinical environments (Liu et al., 2016). Such connections extend even to the realm of AUD intervention, with therapeutic interventions designed to promote secure patterns of attachment having been found to be effective in decreasing alcohol use within treatment contexts (Gidhagen et al., 2018). Clearly, then, extant results provide support for the proposal that insecure attachment may exhibit relevant clinical correlations with AUD symptoms.
Source: Open Science Framework
Authors: Fairbairn, Catharine, Caumiant, Eddie
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7116661096