Abstract
Background: Alcohol use is a major public health concern and a leading cause of preventable disease and death worldwide. Loneliness has been identified as a psychosocial risk factor associated with negative mental health outcomes such as increased alcohol use and alcohol-related problems through stress-relieving or self-medication processes. In turn, alcohol use may exacerbate loneliness through social and interpersonal consequences. Our goal was to examine the longitudinal dynamics of these factors in a population with alcohol use disorder (AUD).Methods: Data were drawn from the Collaborative Research Center Transregio (TRR) 265 longitudinal cohort study, which included adults with AUD who were assessed across four waves with 4 months in-between waves. Alcohol use was measured by frequency, quantity, binge drinking of alcohol, and the Alcohol Use Disorders Identification Test (AUDIT). Subjective loneliness was assessed using the UCLA Loneliness Scale. Dynamic panel models were used to examine within-person associations over time. Gender and age were tested as moderators.Results: Analyses revealed no evidence that loneliness predicts subsequent alcohol consumption frequency, quantity, or binge drinking episodes. However, elevated loneliness was associated with lower subsequent AUDIT scores. This relationship was significantly moderated by baseline age, specifically, the negative association was more pronounced among older birth cohorts. In contrast, alcohol use did not significantly predict subsequent loneliness across any indicator. No evidence of gender interactions was observed.Conclusions: The relationship between loneliness and alcohol use appears asymmetric rather than bidirectional, characterized primarily by fluctuations in problematic drinking rather than consumption levels in an AUD sample over four waves with four-month intervals. Diverging from self-medication hypotheses, loneliness was associated with fewer alcohol-related problems, particularly among older adults. These findings highlight the importance of distinguishing between alcohol consumption and alcohol-related problems and of using within-person approaches to understand their dynamic interplay.