Highlight
– General intelligence (IQ) inversely associates with long-term alcohol use disorder (AUD) risk.
– Mendelian randomization suggests a causal relationship between lower cognitive performance and increased AUD risk.
– Educational attainment mediates this relationship variably across different sociocultural contexts.
– Polygenic scores for cognitive performance predict reduced AUD risk in genetically characterized cohorts.
Study Background and Disease Burden
Alcohol use disorder remains a significant public health concern, contributing substantially to morbidity, mortality, and social burden worldwide. Understanding risk factors underlying AUD susceptibility is crucial for informed prevention and therapeutic strategies. General intelligence (IQ) and educational attainment (EA) have been hypothesized to relate inversely to substance use disorders, including AUD, yet the nature and causality of these associations remain inadequately characterized. Clarifying the interplay among cognitive traits, genetic predispositions, and sociocultural factors is essential to identify mechanisms and improve intervention targeting.
Study Design
This comprehensive investigation combined epidemiological, genetic, and polygenic risk approaches to elucidate the relationship between IQ, EA, and AUD risk. The research utilized a large Swedish national conscription cohort comprising 645,488 males born 1950-1962, of whom 573,855 had complete data. IQ assessment occurred at age 18, with follow-up spanning over 60 years, during which incident AUD cases were captured by national health registers. Key covariates included parental substance use disorders, psychiatric diagnoses, socioeconomic variables, and birth cohorts.
To evaluate causality, summary statistics from genome-wide association studies (GWAS) of cognitive performance (n=257,481) and AUD (total=753,248; cases=113,325) in individuals of European ancestry were incorporated into mendelian randomization (MR) analyses. The FinnGen consortium provided a replication sample (total=500,348; cases=20,597). Polygenic score (PGS) analyses of cognitive performance were conducted using the Yale-Penn cohort data (n=5,424) to examine genetic liability’s influence on AUD diagnosis.
Key Findings
The epidemiological analyses showed that lower IQ at age 18 markedly increased the risk of developing AUD later in life (adjusted hazard ratio [HR] 1.43; 95% confidence interval [CI], 1.40-1.47; P<.001), controlling for potential confounders including family history and socioeconomic factors. This robust association underscores IQ as an independent predictor for AUD susceptibility.
MR analyses reinforced these findings, indicating a statistically significant causal effect wherein genetically determined lower cognitive performance elevated AUD risk (beta [SE] 0.11 [0.02], P=2.6×10⁻¹²). The parallel results across GWAS derivations and validation cohorts strengthen confidence in causality rather than mere correlation.
Notably, the mediating role of educational attainment differed across national and cultural environments, suggesting sociocultural influences modulate how cognitive traits translate into AUD risk.
PGS analyses in the Yale-Penn cohort further revealed that higher cognitive performance polygenic scores were associated with reduced odds of AUD (odds ratio [OR] 0.83; 95% CI, 0.78-0.89), substantiating the genetic overlap between intelligence-related loci and AUD vulnerability.
Expert Commentary
This landmark study adds clarity to the longstanding debate regarding the relationship between intelligence and substance use disorders. The use of a large, well-characterized population cohort with extensive follow-up, combined with cutting-edge genetic epidemiological techniques, offers compelling evidence for a causal link between cognitive ability and AUD risk.
Importantly, the context-dependent role of educational attainment highlights the complexity of gene-environment interactions in AUD pathogenesis. It suggests that interventions enhancing educational opportunities might mitigate genetic risk in some settings but may be less impactful in others where cultural or systemic factors prevail.
Limitations include restriction to male participants in one national context for the prospective cohort and focusing predominantly on individuals of European ancestry in genetic analyses, which may limit generalizability. Future work should explore diverse populations and gender effects.
Mechanistically, cognitive performance may influence AUD risk through factors such as executive functioning, impulse control, and decision-making capacity—domains critical to substance use behaviors. Genetic variants linked to intelligence might affect neurodevelopmental pathways intersecting with reward and addiction circuits.
Conclusion
The integration of epidemiologic and genetic data provides strong evidence that lower general intelligence contributes causally to increased risk of alcohol use disorder, with educational attainment exerting a modifying effect influenced by sociocultural context. These findings underscore the importance of considering cognitive and genetic profiles in AUD risk assessment and prevention strategies. Future research should aim to delineate the biological mechanisms and sociobehavioral pathways involved, and expand investigations across diverse populations to enable targeted and equitable interventions.
References
1. Capusan AJ, Davis CN, Thern E, Rehm J, Gelernter J, Kranzler HR, Heilig M. Measures of General Intelligence and Risk for Alcohol Use Disorder. JAMA Psychiatry. 2025 Oct 1. doi:10.1001/jamapsychiatry.2025.2689. Epub ahead of print. PMID: 41032335.
2. Gelernter J, Kranzler HR, Sherva R, et al. Genome-wide association study of alcohol dependence: significant findings in African- and European-Americans including novel risk loci. Mol Psychiatry. 2014;19(1):41-49.
3. Davies G, Lam M, Harris SE, et al. Study of 300,486 individuals identifies 148 independent genetic loci influencing general cognitive function. Nat Commun. 2018;9(1):2098.
4. Richards M, Shires P, Sacker A. Lifetime cognitive function, educational attainment and health: findings from the British 1946 birth cohort. Soc Psychiatry Psychiatr Epidemiol. 2017;52(1):43-51.
5. Jansen PR, Watanabe K, Stringer S, et al. Genome-wide analysis of insomnia in 1,331,010 individuals identifies new risk loci and functional pathways. Nat Genet. 2019;51(3):394-403.