Introduction: Cognitive Performance and Alcohol Use Disorder in the Context of Sustainable Development Goals

A comprehensive international study indicates a significant association between lower cognitive performance in late adolescence and an increased risk of developing alcohol use disorder (AUD) later in life. This research, integrating data from multiple countries, highlights a potential genetic link between cognitive ability and alcohol-related health issues. The findings have profound implications for achieving several Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), which aims to strengthen the prevention and treatment of substance abuse, including the harmful use of alcohol (Target 3.5).

Key Findings and Implications for SDG 3 (Good Health and Well-being)

The Link Between Cognitive Scores and Alcohol Use Disorder Risk

The study’s primary analysis focused on a large cohort of Swedish men, revealing a clear correlation between cognitive test scores at age 18 and subsequent AUD diagnoses. This evidence directly informs strategies for promoting health and well-being under SDG 3.

• Individuals in the low-IQ group demonstrated a 64% higher risk of developing AUD compared to those with average scores. This risk remained elevated at 43% even after adjusting for confounding variables like parental substance use and childhood environment.
• Conversely, those with high-IQ scores had a 40% lower risk of an AUD diagnosis.
• Sibling-pair analysis further substantiated these findings, showing that within the same family, the brother with the lower IQ score had a greater likelihood of developing AUD. This suggests that individual cognitive ability is a significant risk factor, independent of shared family background.

Genetic Pathways and Vulnerability

To investigate causality, researchers employed Mendelian randomization, a method that uses genetic variants to assess relationships. This genetic analysis reinforces the biological underpinnings of AUD risk, a critical aspect for developing effective prevention and treatment strategies as outlined in SDG 3.

• Genetic analyses indicated that a higher genetic predisposition for strong cognitive performance was associated with a lower likelihood of developing AUD.
• In a U.S. sample, individuals with the highest genetic scores for cognitive performance had an approximately 35% lower chance of an AUD diagnosis compared to those with average genetic scores.
• The consistency of these results across different analytical models and populations strengthens the case for a causal link between cognitive function and vulnerability to AUD.

Socioeconomic Dimensions and their Relation to SDG 4 and SDG 10

The Role of Education (SDG 4: Quality Education)

The research underscores the critical role of education as a mediating factor, aligning with the objectives of SDG 4 (Quality Education) to ensure inclusive and equitable learning opportunities for all.

1. Educational attainment was found to account for approximately 14% of the association between cognitive performance and AUD risk.
2. In some populations (U.S., U.K., Australia), the impact of cognitive performance on AUD risk was largely explained by educational attainment.
3. In a Finnish sample, education appeared to serve as a protective buffer against the risks associated with lower cognitive ability. This highlights quality education as a key preventative tool in public health.

Addressing Inequalities (SDG 10: Reduced Inequalities)

The study’s findings are deeply intertwined with SDG 10 (Reduced Inequalities), as the relationship between cognitive ability and health outcomes varies significantly depending on the social and environmental context. The research points to how socioeconomic status, often measured by educational attainment, can create or exacerbate health disparities.

• The initial premise of the research linked low socioeconomic status—a key driver of inequality—to addiction risk.
• The varying strength of the association across different countries suggests that social structures and support systems can either mitigate or amplify the underlying risks faced by individuals with lower cognitive performance.
• This emphasizes the need for policies that reduce inequalities in both education and health to ensure that vulnerable populations are not left behind.

Recommendations for Policy and Intervention Aligned with SDGs

Early Intervention and Inclusive Education (SDG 4 & SDG 8)

The study’s authors advocate for proactive measures that align with SDG 4 and SDG 8 (Decent Work and Economic Growth).

• Identify at-risk children who are struggling academically at an early stage.
• Develop specialized educational support and alternative learning tracks that focus on developing marketable skills, thereby promoting future employment and economic well-being.

Tailored Prevention and Treatment (SDG 3)

To effectively meet the targets of SDG 3.5, prevention and treatment programs must be adapted to individual needs.

• Implement specific preventative measures regarding alcohol and drug use for at-risk youth.
• Adapt treatment modalities, such as cognitive-behavioral therapy, to the cognitive capacity of the patient to ensure efficacy and prevent treatment failure.

Combating Stigma and Promoting Inclusivity (SDG 10)

A crucial takeaway is the need to address the stigma surrounding addiction and cognitive differences, a goal central to reducing inequalities under SDG 10.

• The findings should not be used to stigmatize individuals but rather to understand a complex web of risk factors.
• Promoting an ethical foundation that embraces human diversity is essential for creating inclusive societies where all individuals can achieve good health and well-being.

Study Limitations and Future Directions

Methodological Considerations

The authors acknowledge several limitations that temper the generalizability of the findings.

1. The primary Swedish cohort included only men.
2. The diagnostic data likely captured only the most severe cases of AUD.
3. Genetic analyses relied on cognitive measures from a mixture of tests, which could introduce inconsistencies.

The Need for Diverse Research

A significant limitation is that the genetic studies included mostly individuals of European descent. To fully support the global agenda of the SDGs and the principle of “leaving no one behind,” future research must be more inclusive.

• There is a critical need for more diverse genetic research to ensure findings are applicable across different global populations.
• Future investigations will explore how cognitive traits influence other life challenges, particularly in environments that may disadvantage individuals with lower cognitive performance.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article’s primary focus is on alcohol use disorder, a significant public health issue, and discusses its risk factors, prevention, and treatment.
• SDG 4: Quality Education: The research extensively explores the link between cognitive performance, IQ scores, and educational attainment as critical factors influencing the risk of developing alcohol use disorder. It also calls for educational interventions for at-risk youth.
• SDG 10: Reduced Inequalities: The article touches upon socioeconomic status, stigma associated with addiction, and the need for tailored support for vulnerable individuals (those with lower cognitive performance) to ensure equal opportunities and better life outcomes.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. The entire article is dedicated to understanding the risk factors for alcohol use disorder to improve prevention and treatment. The author’s concluding remarks emphasize the need for “specific preventive measures when it comes to the risks of using alcohol and drugs” and for treatment measures to be “adapted to the patient’s capacity.”

2. SDG 4: Quality Education

   • Target 4.1: By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and effective learning outcomes. The study’s conclusion directly supports this target by stating, “We need to identify kids at risk, who are failing in school early, and help them avert the risk.” This points to the need for quality education that produces effective outcomes for all students.
   • Target 4.5: By 2030, eliminate gender disparities in education and ensure equal access to all levels of education and vocational training for the vulnerable…and children in vulnerable situations. The article identifies children with lower cognitive performance as a vulnerable group. The recommendation for “special ed” and “alternative tracks that do not heavily emphasize [theoretical skills], but rather allow them to develop marketable skills” aligns perfectly with ensuring equal access to education and vocational training for this vulnerable population.

3. SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of…economic or other status. The article highlights how individuals with lower cognitive performance may face “hidden disadvantages.” The call for tailored educational and treatment approaches that don’t “set you up for failure” is a call for inclusion and empowerment of a vulnerable group based on their cognitive status.
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome… The article discusses the “destructive phenomena” of stigma surrounding addiction and the risk of misinterpreting the findings to worsen it. By advocating for an “ethical foundation that embraces… diversity” and tailored support, the article addresses the need to reduce inequalities of outcome (like developing an addiction) and ensure equal opportunity for well-being.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. SDG 3: Good Health and Well-being

   • Implied Indicator for Target 3.5: The article focuses on the “diagnosis of alcohol use disorder” and “alcohol-related diagnoses and deaths.” These serve as direct measures of the prevalence and severity of the harmful use of alcohol, which is what official indicators like 3.5.2 (Harmful use of alcohol) aim to track.

2. SDG 4: Quality Education

   • Implied Indicator for Targets 4.1 and 4.5: The study explicitly uses “educational attainment” as a key variable to measure the link between cognitive performance and addiction risk. This is a clear, measurable indicator of educational outcomes. Furthermore, the mention of “failing in school early” implies that school performance and completion rates are crucial metrics for identifying at-risk individuals.

3. SDG 10: Reduced Inequalities

   • Implied Indicator for Targets 10.2 and 10.3: The article implies the need to measure the prevalence of alcohol use disorder across different socioeconomic and cognitive performance groups. A reduction in the disparity of these rates would indicate progress. Additionally, the availability and accessibility of “adapted” and non-stigmatizing treatment services for different groups could serve as an indicator of reduced inequality in health outcomes.

4. Table of SDGs, Targets, and Indicators

Source: psypost.org