Functioning, life context, and help-seeking among late-onset problem drinkers: comparisons with nonproblem and early-onset problem drinkers

We compared the functioning and life contexts of late-middle-aged adults classified as late-onset problem drinkers (n=229), early-onset problem drinkers (n=475), and nonproblem drinkers (n=609). Compared with nonproblem drinkers, late-onset problem drinkers consumed more alcohol and functioned more poorly; they also reported more negative life events and chronic stressors, fewer social resources, and more use of avoidance coping. However, late-onset problem drinkers consumed less alcohol, had fewer drinking problems, functioned better, and had more benign life contexts than did early-onset problem drinkers. We found no evidence of an association between age-related loss events and the onset of late-life drinking problems. Very few problem drinkers sought help specifically for their alcohol abuse, but about 25% did seek treatment from mental health practitioners. Problem drinkers who were functioning more poorly and who reported more life stressors and fewer social resources were more likely to seek help.     

Influence of Socially Desirable Responding in a Study of Stress and Substance Abuse

Socially desirable responding is the reluctance to admit unpopular beliefs or behavior in order to avoid making a negative impression. It poses a problem for researchers who rely on self-report of heavy drinking and drug use. The Marlowe-Crowne Social Desirability Scale (SDS), which measures socially desirable responding, was administered to 1933 respondents in a general population survey. The relationships between SDS and various self-report measures were examined. SDS was not correlated with gender or race; it increased with greater age and decreased with higher socioeconomic status. With age and socioeconomic status controlled, SDS had a moderate negative relationship with alcohol and drug use, and a strong negative relationship with variables reflecting the expression of anger, Correlations between drinking/drug use and such variables as age, marital conflict, and stressful life events were not substantially changed by controlling for SDS. It was concluded that social desirability response bias probably results in underestimates of rates of heavy drinking and drug use, but does not compromise the study of predictors of heavy drinking or drug use.     

Drinking patterns, psychosocial characteristics and alcohol consequences

Aims. The purpose of this study was to investigate (a) the potential mediating role of alcohol consumption in the relationship between psychosocial variables and adverse consequences of drinking, and (b) the possible moderating role of psychosocial variables in the relationship between alcohol consumption and adverse consequences. Design. Multi-stage sampling procedures were used to select households for a general population survey. Interviews were conducted with one member in each of 35 479 households and self-administered questionnaires were left for all residents aged 12 years and older ( N = 49 164, response rate: 77.2%). Setting. Data were collected as part of the Ontario (Canada) Health Survey. Participants. The present study included 33 568 current drinkers aged 18 or older. Measurements. Analyses included the following variables: alcohol consumption, adverse consequences related to drinking, sex, age, marital status, self-rated health, perceived stress, income, education, employment status and family dysfunction. Findings. Alcohol consumption appeared to mediate the relationship of adverse consequences with age, sex, marital status, education, income and employment, but not with health, stress or family dysfunction which were independently associated with adverse consequences. The relationship between alcohol consumption and adverse consequences was moderated by age, marital status, education and employment. Conclusions. These results help to clarify the interrelationship of alcohol consumption and psychosocial characteristics in experiencing adverse consequences related to drinking.     

Remission of Late-Life Drinking Problems: A 4- Year Follow-up

This 4-year follow-up study compared stably remitted late-life problem drinkers to nonremitted problem drinkers and nonproblem drinkers. At time 1, to-be-remitted drinkers reported less alcohol consumption and fewer drinking problems, more depression and less self-confidence, less spousal support and approval of drinking from friends, and more help-seeking than did to-be-nonremitted drinkers. Remitted drinkers showed improvement in functioning and life context at the 4-year follow-up, but compared with nonproblem drinkers some deficits persisted. Stable remission and abstinence among late-onset drinkers were closely tied to receiving less spousal support and approval from friends for drinking at time 1, whereas helpseeking was a strong predictor of stable remission and abstinence among early-onset problem drinkers. For both late- and early-onset drinkers, abstinence was predicted by initially having more drinking problems, depression, and health stressors.     

Risk factors for depression and anxiety in abstainers, moderate drinkers and heavy drinkers

Aims. To identify risk factors for depression and anxiety that are more prevalent in abstainers than in moderate drinkers and to estimate their contribution to U-shaped relationships of depression and anxiety with alcohol consumption. Design. Cross-sectional general population sample. Setting. Canberra, Australia. Participants. 2725 subjects completed questionnaires, including 1128 men and 1258 women aged 18-59 years. Measurements. Consumption categories from AUDIT quantity/frequency items: (1) non-drinkers (no alcohol in the past year), (2) occasional drinkers (monthly or less), (3) lower-level drinkers (up to 14 standard drinks per week for men and seven for women), (4) higher-level drinkers (up to 28 and 14 standard drinks per week, respectively), and (5) those drinking at hazardous or harmful levels (over 28 and 14 standard drinks per week, respectively). Goldberg and DSSI/sAD depression and anxiety scales. A range of demographic, socio-economic, socio-environmental and personality factors. Findings. Non-drinkers were more likely than lower-level drinkers to have low status occupations, poor education, current financial hardship, poor social support and recent stressful life events, and scored lower on extraversion, fun-seeking and drive. Many of these characteristics also applied to hazardous/harmful drinkers. In multivariate models, these risk factors accounted for a substantial part of the higher depression and anxiety scores of non-drinkers and occasional drinkers relative to lower-level drinkers. Conclusions. Abstainers have a range of characteristics known to be associated with anxiety, depression and other facets of ill health, and these factors may contribute significantly to their elevated levels of depression and anxiety.     

Differences between personal and general alcohol-related beliefs

The discrepancy between personal alcohol-related statements and general beliefs regarding alcohol was investigated in a community sample of 283 social drinkers. Discriminant analysis showed that subjects perceived themselves as significantly less dependent than others. "Self" statement responses accurately predicted drinking behavior, as measured by consumption; however, general statements did so less effectively. Medium-heavy drinkers considered others to be dependent on alcohol to change aversive events, suggesting that a self-fulfilling bias may have distorted their perception. For most drinkers the self-other discrepancy seemed best explained by media and societal influences rather than by a self-fulfilling bias model.     

Young heavy drinkers and their drinking experiences: predictors of later alcohol use.

This study illustrated the impact of late adolescent and young adult alcohol experiences on current level of alcohol use. Additional factors investigated include reported age of problem onset, initial age of alcohol use, marital status, and life-span risk-taking behavior. A stepwise discriminant analysis was used to determine the importance of various subtypes of drinking experiences and combinations of these subtypes. Correct classification of current light and heavy alcohol drinkers by use of these experiences was 83.7% for late adolescent experiences and 77.5% for young adulthood experiences. The results suggest that early drinking experiences are useful predictors of future drinking patterns.     

Prevalence and correlates of alcohol use: a population-based study in Hong Kong

Objective To estimate the prevalence and pattern of alcohol use and to analyse the socio‐demographic and biological correlates of alcohol drinking in Hong Kong Chinese. Design A population‐based cross‐sectional study conducted from December 1994 to October 1996. Setting and participants 2900 randomly selected subjects age 25–74 years who participated in the Cardiovascular Risk Factor Prevalence Study in Hong Kong. Results Alcohol consumers comprised 55.4% (95% CI: 52.8–58.0) of men and 19.4% (95% CI: 17.4–21.4) of women. The median weekly ethanol consumed by male and female drinkers were 9.6 g and 3.6 g, respectively. Beer was the main source of alcohol; 61.5% of drinkers consumed beer as their main drink. In stepwise multiple regression among drinkers, male sex, smoking, high density lipoprotein cholesterol, primary or below education, diastolic blood pressure and separated or widowed marital status were associated positively with weekly ethanol consumption. Conclusion In this representative sample of Hong Kong adults, the majority were either non‐drinkers or very light drinkers, which can be used as a benchmark to measure changes in drinking pattern in the future. The putative protective effect of alcohol on heart disease could be due to the higher level of HDL in moderate drinkers.     

Alcohol screening results in elderly male veterans: association with health status and mortality

OBJECTIVES: To evaluate the association between alcohol screening results and health status or mortality in elderly patients. DESIGN: Cross-sectional and longitudinal cohort studies. SETTING: Primary care clinics at seven Veterans Affairs medical centers. PARTICIPANTS: A total of 16,958 male patients aged 65 and older. MEASUREMENTS: Alcohol screening questionnaires were used to divide patients into four mutually exclusive groups: drinkers who screened negative or positive for problem drinking and nondrinkers (in the previous year) who screened negative or positive for problem drinking. A subset of patients (n=12,491) completed a measure of health status, the Medical Outcomes Study Short Form (SF-36). All-cause mortality was ascertained using Veterans Affairs data over a mean follow-up of 2.8 years. RESULTS: Forty-eight percent of participants reported drinking in the previous year. Half of the drinkers and nondrinkers screened positive for problem drinking. The SF-36 item scores were consistently higher for drinkers than for nondrinkers and for patients who screened negative for problems than for those who screened positive. Similarly, survival was consistently better in drinkers than nondrinkers (mortality hazard ratio (HR)=0.74, 95% confidence interval (CI)=0.68-0.82) and in patients who screened negative for problem drinking than in those who screened positive (mortality HR=0.87, 95% CI=0.80-0.95). Nondrinkers who screened positive for problem drinking had the poorest health status and survival, whereas drinkers who screened negative for problem drinking had the best health status and survival. CONCLUSION: Elderly patients who reported drinking alcohol and those who screened negative for problem drinking had consistently better health status and survival than those who did not drink and those who screened positive.     

Indicators of active and passive coping in myocardial infarction victims.

This retrospective study attempted to explore life events, personality factors, subjective perceptions, and coping reactions in myocardial infarction (MI) patients. Seventy-seven MI survivors participated in the study. The PERI Life Events Scale, the 16 PF personality inventory, and a questionnaire covering self-ratings of subjective perception and coping reactions were used to assess event-related influences. The following results were obtained: Multiple regression analyses yielded strong relationships between insecurity predicting perceived changeability, challenge, and threat. The number of prior events was a good predictor for problem solving and self-reflection, while self-attribution for the occurrence of the MI predicted self-blame and denial. A structural equation model indicated that anxiety and experience with stressful events were salient predictors for appraisal, whereas experience with prior events best predicted active coping, and socioeconomic status negatively predicted passive coping.     

Nonauditory determinants of self-perceived hearing problems among older adults: the role of stressful life conditions,neuroticism, and social resources

BACKGROUND: The present study explored factors that influenced older individuals' subjective perception of hearing problems. In addition to objectively screened hearing ability, nonauditory factors such as stressful life conditions (visual impairment, chronic disease, disability, and recent stressful life events), neuroticism, and social resources were hypothesized to be predictors of self-perceived hearing problems. METHODS: These hypotheses were tested with a hierarchical regression model using a stratified sample of 425 community-dwelling older individuals (mean age = 72.2). RESULTS: Individuals with more recent stressful life events, higher levels of neuroticism, and less emotional support reported greater hearing problems after controlling for objectively screened hearing. In addition to the main effects, a significant interaction was observed between neuroticism and screened hearing, indicating that the combination of poor hearing and high neuroticism increased the level of self-perceived hearing problems. CONCLUSIONS: The findings suggest that the effects of nonauditory factors should be taken into account in the application of self-assessed measures of hearing problems.     

Screening for high- and moderate-risk drinking during pregnancy: a comparison of several TWEAK-based screeners

PURPOSE: This study investigated the use of the TWEAK and nine alternative screeners for predicting high-risk and moderate-risk drinking during pregnancy. METHOD: The analysis was based on self-reports from 404 lifetime drinkers who presented for an initial visit at nine prenatal clinics in Washington, DC. Data were collected anonymously by having women directly enter their responses onto an audio, computer-assisted interview that was programmed onto a laptop computer. Pregnancy risk drinking status was based on both average daily volume of intake and frequency of drinking 3+ drinks in a day. Each of the alternative screeners was constructed by adding one additional risk indicator to the TWEAK, and three different scoring options were explored. RESULTS: Using thresholds of 2 points for high-risk drinking and 1 point for moderate-risk drinking, the TWEAK demonstrated a sensitivity and specificity of 70.6% and 73.2% for high-risk drinking and a sensitivity and specificity of 65.6% and 63.7% for any (high- or moderate-) risk drinking during pregnancy. None of the alternative screeners resulted in significant improvement, but the addition of current smoking status showed enough promise to warrant further testing in larger samples. CONCLUSIONS: Despite some loss in sensitivity and specificity, the TWEAK, in its original or a modified form, can be extended to measures of high-risk drinking that incorporate infrequent heavy intake and can be used to test for moderate- as well as high-risk drinking. Because identification of moderate-risk drinkers substantially increases the pool of women targeted for intervention, cost implications must be considered in designing appropriate interventions.     

Recruitment to Alcohol Treatment: a comparison between male and female problem drinkers recruited to treatment in two different ways

This study looks at similarities and differences between four groups of problem drinkers. The subjects were 143 men and 39 women, inpatients of an alcoholism treatment clinic; and 84 male and 51 female participants in an outpatient treatment research project at The National Institute of Alcohol Research in Oslo, Norway. The latter were recruited by newspaper advertisements. The results showed that the outpatients when entering the study, were in a better socio-economic situation, were better educated and had higher job status than the inpatients. The outpatients had a lower alcohol consumption, a less severe drinking pattern, and had fewer alcohol-related treatment experiences. The differences between subjects seemed to be more pronounced for the women. However, the length of problem drinking and the age of the subjects were the same for inpatients and outpatients. The outpatients did not appear to be early problem drinkers, but may have been recruited from a different segment of the population of problem drinkers, namely with more moderate drinking problems. This finding may have therapeutic and prognostic significance.     

Problem drinking and high-risk driving: an analysis of official and self-reported drinking-driving in New York State

The authors collected data from 878 respondents at high risk of problem drinking and drunk driving and tested a hypothesis that stipulates problem drinking and high-risk driving as two necessary conditions of drunk driving. Controlling for a number of alcohol and non-alcohol-related variables, the analysis shows problem drinking to have consistent and significant effects on repeat DWI offenses and on the frequency of self-reported drinking-driving events. High-risk driving increases the frequency of self-reported drinking-driving. Males are more likely than females to be arrested for DWI, but there is no gender differences in self-reported drinking-driving. The authors further note a possible ‘suppress effect’ in that a negative relationship between DWI arrests and high-risk driving is concealed by problem drinking. That is, problem drinkers with multiple DWI arrest records may drive more carefully than before so as to avoid further contact with the police and licensing authorities. Public policy implications of the findings are discussed.     

Short-term processes of remission and nonremission among late-life problem drinkers.

This prospective study compares alcohol use, functioning, life stressors, social resources, and help-seeking among three groups of older adults: remitted problem drinkers, nonremitted problem drinkers, and nonproblem drinkers. At initial assessment, to-be-remitted problem drinkers had several advantages compared with individuals who would continue to have drinking problems. Specifically, they consumed less alcohol, reported fewer drinking problems, had friends who approved less of drinking, and were more likely to seek help from mental health practitioners. Problem drinkers who remitted improved somewhat over time, but they did not attain the level of functioning or type of life contexts shown by nonproblem drinkers. Time of onset of drinking problems influenced the short-term process of remission: Compared with early-onset individuals, late-onset problem drinkers were more likely to remit over the 1-year interval. The predictors of short-term remission suggested that late-onset problem drinkers may be more reactive to physical health stressors and to social influences than are individuals with more long-standing problems with alcohol.     

Alcohol consumption, alcohol dependence, and all-cause mortality

BACKGROUND: This study examined the effects of alcohol consumption and DSM-IV alcohol dependence on the risk of mortality. METHODS: Data from the 1988 National Health Interview Survey Alcohol Supplement were matched to the National Death Index for the years 1988 to 1995 (baseline n = 37,682 U.S. adults age > or =25 linked to 3,586 deaths). All mortality analyses were based on proportional hazards models that adjusted for age, sex, race/ethnicity, marital status, education, income, labor force status, body mass index, smoking status, and poor health indicators at baseline. RESULTS: When dependence was not considered and all past-year abstainers were used as the reference group, both light and moderate drinkers exhibited a reduced risk of mortality, with hazards ratios of 0.76 (0.68-0.84) and 0.84 (0.74-0.96). Heavy drinkers had about the same risk of dying as did past-year abstainers, and very heavy drinkers had an increased risk that was not significant (OR = 1.17, CI = 0.93-1.47). When lifetime abstainers were used as the reference category, the protective effect of moderate drinking fell short of significance, and there were nearly significant increased risks among former drinkers and very heavy drinkers. When dependence was considered, light and moderate drinkers without dependence had a reduced mortality risk regardless of reference group, and there was no significant effect among heavy or very heavy drinkers without dependence. Among dependent drinkers, there was no protective effect of light or moderate drinking, and very heavy drinkers had a significantly increased risk (OR = 1.56 relative to past-year abstainers and 1.65 relative to lifetime abstainers). CONCLUSIONS: Because alcohol dependence nullifies the protective effect of light and moderate drinking, it is important to understand its role as an independent risk factor for mortality. Differences between dependent and nondependent drinkers who drank comparable amounts suggest that this risk may result from longer and heavier drinking histories before baseline, more severe health problems at baseline, more heavy episodic drinking, and, possibly, differences in beverage preference.     

What Triggers the Resolution of Alcohol Problems Without Treatment?*

This study investigated natural recoveries (self-change) from alcohol problems, and overcame several methodological problems that affected the few previous studies of this phenomenon. Three groups of individuals who had resolved an alcohol problem without treatment were interviewed about their drinking history, life events that occurred during the year prior to their resolution, and factors that helped maintain their resolution. As a control for prevalence of life events, a control group of nonresolved, nontreated alcohol abusers were interviewed about events in a randomly selected year. Collaterals were interviewed for all subjects. No life event or constellation of events was differentially associated with the resolutions across the three resolved groups or differentiated the resolved and nonresolved groups. Interviews with resolved subjects were qualitatively analyzed—the majority (57%) of recoveries were characterized as Involving a “cognitive evaluation” or appraisal of the pros and cons of drinking. Spousal support was reported by the greatest number of resolved subjects as having helped them maintain their resolution. Findings from this study may provide direction for developing new treatment strategies and for accelerating self-change among problem drinkers in the community. The study also demonstrates the importance of using a control group, without which very different conclusions might have been drawn.     

Alcohol's harm to others: reduced wellbeing and health status for those with heavy drinkers in their lives

Aims The impact of alcohol on those other than the drinker is an under‐researched area with important policy implications. This study is a first step in investigating relationships between exposure to heavy drinkers in respondent's lives with measures of health status and wellbeing. Design setting and participants A cross‐sectional general population survey was carried out among 3068 New Zealand residents aged 12–80 years (response rate 64%) using an in‐house computer‐assisted telephone interviewing system. Measurements Respondents' estimates of health status (European Quality of Life–5 Dimensions) and subjective wellbeing (Personal Wellbeing Index) were measured along with self‐reports of heavy drinkers in their lives, demographic variables and own drinking. Findings More than one in four of the sample had experienced someone they considered to be a heavy drinker in their environment in the past 12 months. An index of exposure to heavy drinkers, reflecting numbers of heavy drinkers and cohabitation, predicted lower health status and personal wellbeing while controlling for demographic variables and respondent's own drinking Conclusions Cross‐sectional data from a general population sample suggest that there is a relationship between exposure to heavy drinkers and reduced personal wellbeing and poorer health status. Exposure to heavy drinkers may have negative impacts for others.     

Parental and peer influences as correlates of problem drinking among high school students

This study was concerned with the relative importance of parental, peer, and demographic variables in predicting problem drinking among young people. A survey of drinking and drinking problems was conducted among 1,439 students in two schools in Ontario. A Multiple Classification Analysis was employed to identify variables with a significant and unique predictive power. It was found that problem drinking is best predicted with situational factors and those directly connected with drinking. Parental and peer variables had little unique predictive power. Problem drinkers were more often male, had their first drinks away from home, and usually drank in cars.