Predicting the development of late-life late-onset drinking problems: a 7-year prospective study

There has been little empirical study of risk factors for the development of late-life late-onset drinking problems. In the current prospective study, we compare two groups of older adults who, at a baseline assessment, were nonproblem drinkers: individuals who developed drinking problems over the course of the next 7 years (n = 77) and those who did not (n = 197). Late-onset problem drinkers reported mild to moderate drinking problems and spontaneous remission rates were high. Compared with stable nonproblem drinkers, late-onset problem drinkers at baseline were more likely to report incipient problems, heavier alcohol consumption, greater friend approval of drinking, more reliance on avoidance coping strategies, were more likely to smoke, and were less likely to have acute medical conditions that could potentially be complicated by alcohol consumption. Contrary to expectation, life stressors did not predict drinking problem onset. However, compared with stable nonproblem drinkers, late-onset problem drinkers were more likely to have a history of responding to stressors and negative affect with increased alcohol consumption.     

Binge drinking in later life: Comparing young-old and old-old social drinkers.

Although widespread binge drinking has been documented in younger groups, few studies have examined this behavior among older individuals. We assessed differences in bingeing between young-old (n = 189) and old-old (n = 137) social drinkers. Of those who reported drinking, no significant age or gender differences were uncovered in alcohol consumption (M = 6.6. SD = 9.4) or degree of alcohol-related problems (M = 12.2, SD = 3. 1). Logistic regression analysis showed that old-old adults were 15.7 times less likely to binge drink than the young-old-, older women overall were 19.7 times less likely to binge relative to older men. Also, correlations were more diverse among old-old adults. The need for better understanding of bingeing among elders is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transitioning into and out of large-effect drinking in young adulthood.

As individuals age beyond the college years into young adulthood, many exhibit a tendency to moderate or "mature out of alcohol" involvement. The current study classified effect-drinking statuses in young adults and examined transitions among statuses using latent transition analysis, a latent variable state-sequential model for longitudinal data. At 3 occasions over 7 years (Years 1, 4, and 7), 443 men (47%) and women (mean age of both at baseline?=?18.5 years; 51% with family history of alcoholism) responded to 3 past-30-day items assessing drinking and subjective effects of drinking: whether the respondent drank alcohol, felt high, and felt drunk. Latent statuses included abstainers (14% at Year 1), limited-effect drinkers (8%), moderate-effect drinkers (23%), and large-effect drinkers (54%). Respondents with family history of alcoholism were less likely to transition out of large-effect drinking than those without family history. Men exhibited more severe initial effect-drinking statuses and lower transition probabilities into less severe effect-drinking statuses than women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abstinence or controlled drinking goals for problem drinkers: A randomized clinical trial.

24 adult problem drinkers were assigned to brief behavioral treatment with either an abstinence (AB) or a controlled drinking (CD) goal. Self-report and collateral report data reflect significant overall reduction in alcohol consumption and projected blood alcohol peaks at 3-mo and at 3.5-yr follow-up intervals. AB and CD Ss did not differ significantly from each other on outcome variables at any point before or after treatment. At 3.5 yrs, 4 Ss had been abstinent for at least 12 mo, 3 had been moderate and asymptomatic drinkers for at least 12 mo, 5 were improved but still somewhat impaired, 8 were unimproved, 3 refused to be interviewed, and 1 could not be located. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A typology of alcohol abusers: Correlates and implications.

Used data from 725 individuals (mean age 38.1 yrs) seeking help for alcohol-related problems who had been administered the Michigan Alcoholism Screening Test; the Social Readjustment Rating Scale; the Personality Research Form; Rotter's Internal–External Locus of Control Scale; the Standard Progressive Matrices; the Vocabulary and Digit Symbol subscales of the WAIS; and measures of alcohol use, lifetime drinking history, basic personality, SES variables, and response styles to cluster analyze for types of drinkers. Analysis yielded 3 types: Type 1 Ss (early-stage problem drinkers) represented a fairly heterogeneous group, Type 2 Ss (affiliative, moderately dependent drinkers) were more socially oriented and drank on a daily basis, and Type 3 Ss (schizoid, severely dependent drinkers) were socially isolative, tended to drink in binges, and reported the most severe symptoms of alcoholism. A speculative model is proposed that consists of the 3 types superimposed on an underlying continuum of alcohol dependence; it is suggested that the model has heuristic value for stimulating further research on the etiology and differential treatment of alcohol abuse. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholism: independent predictor of survival in patients with head and neck cancer

BACKGROUND: Despite recognition of the high prevalence of alcoholism among patients with head and neck cancer, the prognostic importance of alcoholism has not been evaluated adequately. Previous investigators have speculated that alcoholic patients may have a poorer prognosis than nonalcoholic patients because of more advanced stage of cancer, the immunosuppressive effects of alcohol, and an increased rate of death due to other alcohol-related diseases. PURPOSE: The goal of this population-based study was to identify the features of alcoholism that are associated with survival for patients with head and neck cancer and to develop an alcoholic severity staging system from a composite of the independent features of alcoholism. METHODS: This prospective study included 649 patients who were diagnosed with cancer of the oral cavity, oropharynx, hypopharynx, or larynx during the period from September 1, 1983, through February 28, 1987, in a three-county area of western Washington state that participates in the Surveillance, Epidemiology, and End Results Program of the U.S. National Cancer Institute. Details on lifetime alcohol consumption, treatment for alcoholism, abstinence from alcohol prior to the diagnosis of cancer, and alcohol-related health problems were ascertained through in-person interviews near the time of diagnosis. Patients were classified as either nonalcoholics or alcoholics according to their responses to questions from the Michigan Alcoholism Screening Test. The measures of alcohol consumption and abuse that were found to be independently associated with 5-year survival by logistic regression analysis were combined using conjunctive consolidation to create a final composite variable, called an alcoholic severity stage. Cox proportional hazards regression analysis was done to estimate the relative risk (R) of death within 5 years due to specific causes of death for each of the alcoholic severity stages. RESULTS: Alcoholism (RR = 2.06; 95% confidence interval [CI] = 1.43-2.98) and a history of alcohol-related systemic health problems (i.e., liver disease, pancreatitis, delirium tremens, or seizures) (RR = 2.76; 95% CI = 1.69-4.49) were associated with an increased risk of death, whereas abstinence (i.e., the consumption of fewer than one drink per week at 1 year prior to the diagnosis of cancer) (RR = 0.62; 95% CI = 0.39-0.97) was associated with a decreased risk of death. These associations were independent of age, site of cancer, anatomical stage, histopathologic grade, smoking, and type of antineoplastic treatment. Patients in the two worst alcoholic severity stages had an increased risk of dying not only of head and neck cancer but also of cardiovascular disease, pulmonary disease, and other alcohol-related causes. CONCLUSIONS: Alcohol abuse, measured by alcohol consumption, functional impairment, a history of alcohol-related health problems, or abstinence, can provide important prognostic information for patients with head and neck cancer. Our results suggest that sobriety among alcoholic patients can lead to prolonged survival.     

Help-seeking for alcohol-related problems in college students: Correlates and preferred resources.

Despite the development of a variety of efficacious alcohol intervention approaches for college students, few student drinkers seek help. The present study assessed students' history of help-seeking for alcohol problems, as well as their estimates of how likely they would be to use various help-seeking resources, should they wish to change their drinking. Participants were 197 college students who reported recent heavy drinking (46% male, 68.5% White, 27.4% African-American). Participants completed measures related to their drinking and their use (both past use and likelihood of future use) of 14 different alcohol help-seeking options. Repeated-measures analyses of variance revealed that students preferred informal help-seeking (e.g., talking to friends and family) over formal (e.g., talking with a counselor or medical provider) and anonymous resources (e.g., internet- or computer-based programs). Higher self-ideal discrepancy, greater depressive symptoms, and more alcohol-related consequences were positively associated with actual past help-seeking. Alcohol-related problems and normative discrepancy were negatively associated with hypothetical likelihood of utilizing all three help-seeking resources. These results suggest that heavy drinking college students prefer low-threshold intervention options including peer, family, computerized, and brief motivational interventions. Only 36 participants (18.3% of the sample) reported that they had utilized any of the help-seeking options queried, suggesting that campus prevention efforts should include both promoting low-threshold interventions and attempting to increase the salience of alcohol-related risk and the potential utility of changing drinking patterns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cue exposure in moderation drinking: A comparison with cognitive–behavior therapy.

To date, the published controlled trials on exposure to alcohol cues have had an abstinence treatment goal. A modification of cue exposure (CE) for moderation drinking, which incorporated priming doses of alcohol, could train participants to stop drinking after 2 to 3 drinks. This study examined the effects of modified CE within sessions, combined with directed homework practice. Nondependent problem drinkers who requested a moderation drinking goal were randomly allocated to modified CE or standard cognitive-behavior therapy (CBT) for alcohol abuse. Both interventions were delivered in 6 90-min group sessions. Eighty-one percent of eligible participants completed treatment and follow-up assessment. Over 6 months, CE produced significantly greater reductions than CBT in participants' reports of drinking frequency and consumption on each occasion. No pretreatment variables significantly predicted outcome. The modified CE procedure appears viable for nondependent drinkers who want to adopt a moderate drinking goal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of controlled drinking by alcoholics and problem drinkers.

Recent research was reviewed on the following factors as predictors of controlled drinking (CD) by alcoholics and problem drinkers: severity of dependence, client attitudes and beliefs about controlled drinking and abstinence, previous treatment, pretreatment drinking style, psychological and social stability, demographic characteristics, family history of drinking, referral source, and posttreatment adjustment and drinking. No single personal characteristic has been consistently predictive, but there is convincing evidence that a lower severity of dependence and a persuasion that CD is possible are associated with CD after treatment. Prediction of CD might be improved by an approach that assesses the influence of 3 types of variables: enduring personal characteristics, changeable social and psychological characteristics, and transient precipitating events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body mass index and alcohol consumption: Family history of alcoholism as a moderator.

Recent research suggests that excess food consumption may be conceptualized as an addictive behavior. Much of the evidence comes from neurobiological similarities between drug and food consumption. In addition, an inverse relation between alcohol consumption and body mass index (BMI) has been observed. Previous research has hypothesized that this inverse relation is attributable to competition between food and alcohol for similar neurotransmitter receptors. The current study explored this neurobiological hypothesis further by examining the influence of an indicator of biological risk associated with alcohol problems (family history of alcoholism) on the relationship between alcohol and food intake. Data from 37,259 participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were included in the study. BMI, family history of alcoholism, gender, and race/ethnicity were assessed as predictors of typical drinking frequency and estimated blood alcohol concentration (BAC). An inverse relationship between alcohol consumption and BMI was demonstrated. An attenuation of family history effects on drinking behavior was evident for obese compared to nonobese participants. The results suggest a neurobiological link between alcohol use and food consumption, consistent with theories characterizing excess food consumption as an addictive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Random assignment to abstinence and controlled drinking: Evaluation of a cognitive-behavioral program for problem drinkers.

Assessed cognitive-behavioral program with a goal of either abstinence or controlled drinking using 70 early-stage problem drinkers who were randomly assigned to 1 of 2 goal conditions and within each condition to 1 of 2 therapists. Ss averaged 6 individual weekly sessions, each lasting approximately 90 min. Both groups were taught to identify risk situations and existing competencies, to develop cognitive and behavioral coping, and to assess their progress objectively. The controlled-drinking group was also taught procedures for moderate drinking. Over the 2-yr follow-up period, no significant differences were found between the groups in reported alcohol consumption. Six months after treatment, drinking had been reduced from an average of about 51 drinks/week to 13, and this reduction was maintained throughout the 2nd year. Reports of drinking were corroborated by independent measures. Although the outcomes of the groups were similar, controlled drinking was considered to be a more suitable goal; it was more acceptable to the majority of the clients, and most of those assigned to abstinence developed moderate drinking on their own. (51 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sertraline treatment of comorbid posttraumatic stress disorder and alcohol dependence

BACKGROUND: Posttraumatic stress disorder (PTSD) often co-occurs with alcohol dependence, yet little is known about treatment of this comorbidity. The serotonin selective reuptake inhibitors have been shown preliminarily to be effective in decreasing symptoms of PTSD but have not been studied in individuals with comorbid alcohol dependence. This is of particular interest as the SSRIs also have a modest effect in decreasing alcohol consumption. METHOD: In this preliminary trial, nine subjects with comorbid PTSD and alcohol dependence were treated in an open-label trial with sertraline for a 12-week period. Symptoms of PTSD and depression were monitored monthly with the Impact of Event Scale and the Hamilton Rating Scale for Depression (HAM-D). Alcohol consumption was monitored by a self-report instrument (Time-Line Follow-Back). RESULTS: There were significant decreases in all three symptom clusters of PTSD measured by overall PTSD symptom scores (p < or = .001) and in HAM-D scores (p < or = .001) during the follow-up period. Days of abstinence increased and average number of drinks decreased during the follow-up period. Four subjects claimed total abstinence during the follow-up period. CONCLUSION: While limited by small sample size and the open-label, nonblinded study design, this study suggests that sertraline may be useful in the treatment of PTSD complicated by alcoholism. The medication was well tolerated and subjects showed improvement in PTSD symptoms as well as decreased alcohol consumption. A controlled trial of sertraline in this population would be of interest.     

One Too Many: Predicting Future Alcohol Consumption Following Heavy Drinking.

Adult social drinkers used handheld computers to monitor alcohol intake as well as the precursors and consequences of drinking over a 2-week period. The within-person relationship between mood and amount of alcohol consumed was examined, as well as the role of individual differences. When individuals made internal attributions for their greater than average consumption, they were in a more negative mood after drinking. Individuals who experienced a negative mood after drinking consumed more subsequently. This dysregulatory process may help explain the progression from social drinking to more problematic drinking; indeed, the relationship between mood and alcohol intake was stronger for heavier drinkers. Likewise, gender and trait temptation and restriction moderated this process. The results are consistent with the Limit Violation Effect model (R. L. Collins, 1993) of mood and regulation of alcohol intake. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of negative and positive mood phrases on priming of alcohol words in young drinkers with high and low anxiety sensitivity.

This study investigated whether potential emotional cues for drinking activate alcohol concepts in young drinkers. Participants were 84 university freshmen with high or low levels of anxiety sensitivity (AS). A verbal priming task measured activation (i.e., priming) of alcohol concepts (e.g., beer) by positive and negative mood phrases. Time to read alcohol target words was the dependent measure. Negative mood phrases consistently primed alcohol targets; positive mood phrases did not. Degree of negative mood priming did not differ as a function of gender or AS. Reported tendency to drink in bad moods predicted negative mood priming in women, whereas men showed negative mood priming irrespective of their reported drinking tendency. A general association between negative mood priming and severity of alcohol problems also emerged. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of a brief motivational intervention with college student drinkers.

This study consisted of a randomized controlled trial of a 1-session motivational intervention for college student binge drinkers. Sixty students who reported binge drinking 2 or more times in the past 30 days were randomly assigned to either a no-treatment control or a brief intervention group. The intervention provided students with feedback regarding personal consumption, perceived drinking norms, alcohol-related problems, situations associated with heavy drinking, and alcohol expectancies. At 6-week follow-up, the brief intervention group exhibited significant reductions on number of drinks consumed per week, number of times drinking alcohol in the past month, and frequency of binge drinking in the past month. Estimates of typical student drinking mediated these reductions. This study replicates earlier research on the efficacy of brief interventions with college students and extends previous work regarding potential mechanisms of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How many versus how much: 52 weeks of alcohol consumption in emerging adults.

In previous research using timeline follow-back methods to closely monitor drinking and related variables over the first year of college (9 months), we showed that drinking varied considerably over time in accord with academic requirements and holidays. In a new community sample (N = 576) of emerging adults (18- and 19-year-olds who reported having begun drinking prior to recruitment), we used similar methods to compare drinking patterns in college and noncollege individuals over a full calendar year (including summer). To reduce the extreme distortion in computations of average drinking over restricted time spans (i.e., 1 week) that arise because large numbers of even regular drinkers may not consume any alcohol, we analyzed data using recently developed two-part latent growth curve modeling. This modeling distinguished consumption levels from numbers of individuals drinking in a given period. Results showed that drinking levels and patterns generally did not differ between college and noncollege drinkers, and that both groups responded similarly to even those contexts that may have seemed unique to one (i.e., spring break). We also showed that computation of drinking amounts without accounting for “zero drinkers” could seriously distort estimates of mean drinking on some occasions; for example, mean consumption in the total sample appeared to increase on Thanksgiving, whereas actual average consumption for those who were drinking diminished. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clinician assessment of psychiatric comorbidity and alcoholism severity in adult alcoholic inpatients

Although psychiatric comorbidity and alcoholism severity are risk factors for poor outcomes in treating alcoholism, little is known about whether clinicians assess these conditions accurately. In this study we evaluated four clinicians' assessments of two indicators of alcoholism severity and three psychiatric co-morbidities in 78 inpatients in their third to seventh day of hospitalization in alcohol treatment programs. Clinicians overestimated the number of days drinking in 28% of subjects, and the number of drinks per drinking day in 37% of subjects. Clinicians underestimated alcohol consumption for patients with higher incomes. Clinicians correctly diagnosed 67% of 18 subjects with antisocial personality disorder, 65% of 26 with major depression, and 89% of 28 with drug abuse. These preliminary results need to be replicated in larger samples of clinicians to determine whether interventions are needed to improve the recognition of important prognostic factors in the treatment of alcoholic patients.     

Local interaction fields and adaptive regularizers for surface reconstruction and image relaxation

This study investigates familial alcoholism effects and the comparative probability of risk for alcohol dependence in adult children of alcoholics (ACAs) with a control group of non-ACAs. A cohort of 12,686 young adults from the National Longitudinal Survey of Youth (NLSY) is examined over a five-year period and conventional and lineal intergenerational models of alcoholism transmission are assessed. The results of multivariate logistic regression analyses indicate that the risk is relatively greater for male ACAs; sons of alcoholics drink significantly more heavily, experience problems earlier, and develop alcohol dependence more extensively than female ACAs or non-ACAs of either gender. The extent of dependence found in subjects with a lineal history of alcoholism on the father's side of the family, as well as heavy drinking, cigarette smoking and drinking onset in adolescence should be considered as critical predisposing factors of high risk for dependence at later ages. These observations corroborate clinical studies and support a growing body of biopsychosocial research literature.     

Efficacy of moderation-oriented cue exposure for problem drinkers: A randomized controlled trial.

The effectiveness of cue exposure following a priming dose was compared with cognitive-behavioral intervention in a community sample of problem drinkers. Participants were randomly associated to 1 of the 2 conditions and received a mean of 5.84 (SD=2.69) sessions. A psychologist blind to treatment condition conducted an 8-month follow-up. Compared with pretreatment levels, significant decreased in alcohol consumption were evidence posttreatment and maintained at follow-up for both groups. Reductions in severity of dependence, impaired control, and alcohol-related problems were also evidence for both groups at follow-up. No differences in outcome associated with initial severity of alcohol dependence were apparent. The results raise the issue of the appropriateness of reserving a goal of controlled drinking for those with relatively mild alcohol problems and low alcohol dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Take control of your drinking? and you may not need to quit.

Reviews the book, Take control of your drinking? and you may not need to quit by Michael S. Levy (see record 2007-12140-000). This book is a self-help book explicitly designed for drinkers in the general population. It is written in a conversational, second-person style, and throughout the conversation, Levy encourages readers to be honest with themselves about how alcohol fits into their lives. In return, he adopts a nonjudgmental mentoring role throughout the text. As suggested by the title, Levy's approach includes options for reducing alcohol consumption (moderation) or quitting alcohol use altogether. Although allowing that moderation is a legitimate goal for treatment and/or self-help is still quite controversial in some quarters, the effectiveness of adopting this option for some drinkers is supported by research, some of which is cited in the notes that accompany each chapter. I suspect that the even-handed way that moderation or abstinence goals are treated in the book, along with its plain-spoken writing style and awareness that alcohol problems often exist in a context of other mental health issues, will appeal to any drinker who is curious about their own alcohol use and whether to reduce or quit drinking. Those who choose to engage with the material in the book will be using techniques that are, in general, well-supported by intervention research with problem drinkers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)