Level of response to alcohol within the context of alcohol-related domains: an examination of longitudinal approaches assessing changes over time

Twenty-year alcohol-consumption and drinking-problem trajectories of older men and women

OBJECTIVE

The aim of this study was to describe older adults' 20-year alcohol-consumption and drinking-problem trajectories, identify baseline predictors of them, and determine whether older men and women differ on late-life drinking trajectory characteristics and predictors.

METHOD

Two-group simultaneous latent growth modeling was used to describe the characteristics and baseline predictors of older community-residing men's (n = 399) and women's (n = 320) 20-year drinking trajectories. Chi-square difference tests of increment in fit of latent growth models with and without gender invariance constraints were used to determine gender differences in drinking trajectory characteristics and predictors.

RESULTS

Unconditional quadratic growth models best described older individuals' within-individual, 20-year drinking trajectories, with alcohol consumption following an average pattern of delayed decline, and drinking problems an average pattern of decline followed by leveling off. On average, older men declined in alcohol consumption somewhat later than did older women. The best baseline predictors of more rapid decline in alcohol consumption and drinking problems were drinking variables indicative of heavier, more problematic alcohol use at late middle age.

CONCLUSIONS

The course of alcohol consumption and drinking problems from late middle age onward is one of net decline, but this decline is neither swift nor invariable. Gender differences in the timing of decline in drinking suggest that ongoing monitoring of alcohol consumption may be especially important for older men. Further research is needed to identify factors known at late middle age that prospectively explain long-term change in late-life use of alcohol.

Testing a level of response to alcohol-based model of heavy drinking and alcohol problems in 1,905 17-year-olds

BACKGROUND

The low level of response (LR) to alcohol is one of several genetically influenced characteristics that increase the risk for heavy drinking and alcohol problems. Efforts to understand how LR operates through additional life influences have been carried out primarily in modest-sized U.S.-based samples with limited statistical power, raising questions about generalizability and about the importance of components with smaller effects. This study evaluates a full LR-based model of risk in a large sample of adolescents from the United Kingdom.

METHODS

Cross-sectional structural equation models were used for the approximate first half of the age 17 subjects assessed by the Avon Longitudinal Study of Parents and Children, generating data on 1,905 adolescents (mean age 17.8 years, 44.2% boys). LR was measured with the Self-Rating of the Effects of Alcohol Questionnaire, outcomes were based on drinking quantities and problems, and standardized questionnaires were used to evaluate peer substance use, alcohol expectancies, and using alcohol to cope with stress.

RESULTS

In this young and large U.K. sample, a low LR related to more adverse alcohol outcomes both directly and through partial mediation by all 3 additional key variables (peer substance use, expectancies, and coping). The models were similar in boys and girls.

CONCLUSIONS

These results confirm key elements of the hypothesized LR-based model in a large U.K. sample, supporting some generalizability beyond U.S. groups. They also indicate that with enough statistical power, multiple elements contribute to how LR relates to alcohol outcomes and reinforce the applicability of the model to both genders.

A prospective evaluation of how a low level of response to alcohol predicts later heavy drinking and alcohol problems

BACKGROUND AND OBJECTIVES

Evaluations of how a genetically influenced characteristic, such as the low level of response (a low LR) to alcohol, relates to later heavy drinking and alcohol problems usually include environmental contributors. The best way to understand how LR works in the context of these additional characteristics is to study the process prospectively, but such analyses tend to be complex and the papers are sometimes cluttered with jargon. This report attempts to offer a more straightforward description of the results from such a prospective model of how a lower LR at age 20 relates to alcohol outcomes at age 40.

METHODS

A structural equation model of LR at age ∼20, outcomes of heavy drinking and problems at age ∼40, and additional characteristics at age ∼35 were tested in 378 men from the San Diego Prospective Study.

RESULTS

The results support both direct effects of age-20 LR on age-40 heavy drinking and alcohol problems, as well as indirect effects of LR through characteristics of these men at age 35. The latter include using alcohol to cope with stress and heavier drinking among peers.

CONCLUSIONS

A low LR to alcohol is an example of how both genes and environment can contribute to the risk for adverse alcohol outcomes. The identification of mechanisms through which LR impacts on later heavy drinking and problems can be approached in cross-sectional studies, but those may not be as sensitive as longitudinal models for identifying additional potential mediators of the LR-to-outcome relationship.

Spouses of older adults with late-life drinking problems: health, family, and social functioning

OBJECTIVE

This study focuses on the health, family, and social functioning of spouses of late-life remitted and continuing problem drinkers, and on predictors of spouses' alcohol-related functioning and depressive symptoms.

METHOD

Three groups of spouses were compared at baseline and a 10-year follow-up: (a) spouses (n = 73) of older adults who had no drinking problems at baseline or follow-up, (b) spouses (n = 25) of older adults who had drinking problems at baseline but not follow-up, and (c) spouses (n = 69) of older adults who had drinking problems at both baseline and follow-up. At each contact point, spouses completed an inventory that assessed their alcohol-related, health, family, and social functioning.

RESULTS

At baseline, compared with spouses of problem-free individuals, spouses of older adults whose drinking problems later remitted reported more alcohol consumption, poorer health, more depressive symptoms, and less involvement in domestic tasks and social and religious activities. At the 10-year follow-up, spouses of remitted problem drinkers were comparable to spouses of problem-free individuals, but spouses of continuing problem drinkers consumed more alcohol, incurred more alcohol-related consequences, and had friends who approved more of drinking. Overall, spouses whose friends approved more of drinking and whose partners consumed more alcohol and had drinking problems were likely to consume more alcohol and to have drinking problems themselves.

CONCLUSIONS

Spouses of older adults whose late-life drinking problems remit can attain normal functioning; however, spouses of older adults with continuing late-life drinking problems experience some ongoing deficits.

Patterns and predictors of late-life drinking trajectories: a 10-year longitudinal study

This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age. Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories. Community residents (n = 1,291; age 55 to 65 years at baseline) were assessed at 4 points over a 10-year interval on demographic and health characteristics, coping responses, social context, and alcohol consumption. Descriptive cross-wave statistics, and multilevel regression analyses, indicated that in the sample overall, participants' 10-year patterns of alcohol consumption were relatively stable. However, men's patterns, and those of individuals drinking beyond recommended alcohol consumption guidelines at baseline, were more variable and showed steeper rates of decline, than did those of women and individuals drinking within recommended levels. Contrary to expectation baseline use of substances to reduce tension and heavier reliance on avoidance coping predicted faster rate of decline in alcohol consumption. Post hoc prospective mediation analyses suggested that this may have occurred because these and other baseline predictors heighten risk of developing new health problems which, in turn, motivate reduced alcohol consumption.

Patterns and predictors of late-life drinking trajectories: a 10-year longitudinal study

This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age. Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories. Community residents (n = 1,291; age 55 to 65 years at baseline) were assessed at 4 points over a 10-year interval on demographic and health characteristics, coping responses, social context, and alcohol consumption. Descriptive cross-wave statistics, and multilevel regression analyses, indicated that in the sample overall, participants' 10-year patterns of alcohol consumption were relatively stable. However, men's patterns, and those of individuals drinking beyond recommended alcohol consumption guidelines at baseline, were more variable and showed steeper rates of decline, than did those of women and individuals drinking within recommended levels. Contrary to expectation baseline use of substances to reduce tension and heavier reliance on avoidance coping predicted faster rate of decline in alcohol consumption. Post hoc prospective mediation analyses suggested that this may have occurred because these and other baseline predictors heighten risk of developing new health problems which, in turn, motivate reduced alcohol consumption.

Late-life and life history predictors of older adults' high-risk alcohol consumption and drinking problems

AIMS

This prospective, longitudinal study focused on late-life and life history predictors of high-risk alcohol consumption and drinking problems during a 20-year interval as adults matured from age 55-65 to 75-85.

DESIGN, SETTING, PARTICIPANTS

A sample of older community residents (N=719) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 10 and 20 years later.

MEASUREMENTS

At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems, and personal and life context factors. Participants also provided information about their life history of drinking and help-seeking.

RESULTS

Older adults who, at baseline, had more friends who approved of drinking, relied on substances for tension reduction, and had more financial resources were more likely to engage in high-risk alcohol consumption and to incur drinking problems at 10- and 20-year follow-ups. With respect to life history factors, drinking problems by age 50 were associated with a higher likelihood of late-life high-risk alcohol consumption and drinking problems; having tried to cut down on drinking and participation in Alcoholics Anonymous were associated with a lower likelihood of high-risk consumption and problems.

CONCLUSION

Specific late-life and life history factors can identify older adults likely to engage in excessive alcohol consumption 10 and 20 years later. Targeted screening that considers current alcohol consumption and life context, and history of drinking problems and help-seeking, could help identify older adults at higher risk for excessive or problematic drinking.

Social and financial resources and high-risk alcohol consumption among older adults

BACKGROUND

This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life.

METHOD

A sample of 55- to 65-year-old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption.

RESULTS

Over the 20-year interval, there was evidence of both social causation and social selection processes in relation to high-risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends' approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high-risk alcohol consumption. Conversely, indicating the presence of social selection, high-risk alcohol consumption was associated with subsequent higher levels of friends' approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members.

CONCLUSIONS

These findings reflect mutual influence processes in which older adults' social resources and high-risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late-life social factors may amplify their excessive alcohol consumption.

An evaluation of the full level of response to alcohol model of heavy drinking and problems in COGA offspring

OBJECTIVE

The low level of response (LR) to alcohol is an endophenotype related to heavier drinking and alcohol problems. Structural equation models (SEMs) indicate LR affects alcohol outcomes (ALCOUT) both directly and through mediation by drinking in peers (PEER), alcohol expectancies (EXPECT), and drinking to cope with stress (COPE), with some variation depending on the sample tested. This article presents the first full test of this LR-based model in young subjects from the Collaborative Study on the Genetics of Alcoholism (COGA).

METHOD

Data were generated from 325 12- to 22-year-old (47.4% male) drinking offspring from COGA families, using the Self-Report of the Effects of Alcohol questionnaire to determine LR early in the drinking career and a validated, structured interview for demography and alcohol use/problem patterns. Standardized questionnaires were used to measure PEER, EXPECT, and COPE, with the model tested through the maximum likelihood estimation for analyses of the variance/covariance matrix using both Amos and Mplus.

RESULTS

The SEM yielded good fit characteristics and explained 59% of the variance, with LR relating both directly to ALCOUT and as partially mediated by PEER and COPE. Although GENDER related to both LR and ALCOUT in the model, and AGE related to ALCOUT, the SEM results were invariant across both AGE and GENDER, with generally similar invariant results regarding the presence or absence of an alcohol-use disorder diagnosis.

CONCLUSIONS

The results support the applicability of the LR-based model of heavy drinking and alcohol problems in the COGA offspring, a group with different demography compared with the two other samples of adolescents tested to date. The modest differences observed across samples will be evaluated in future research to enhance understanding of how the model operates across socioeconomic groups.

The relationships of the level of response to alcohol and additional characteristics to alcohol use disorders across adulthood: a discrete-time survival analysis

BACKGROUND

A low level of response (LR) to alcohol has been shown to relate to a higher risk for alcohol use disorders (AUDs). However, no previous research has examined the association between LR and the development of AUDs in the context of additional robust risk factors for AUDs. This study evaluated whether LR and other related characteristics predicted the occurrence of AUDs across adulthood using discrete-time survival analysis (DTSA).

METHODS

A total of 297 probands from the San Diego Prospective Study reported on the LR to alcohol, a family history (FH) of AUDs, the typical drinking quantity, the age of drinking onset, the body mass index and the age at the baseline (T1) assessment. Alcohol use disorders (AUDs) were evaluated at the 10-year (T10), T15, T20, and T25 follow-ups.

RESULTS

A low LR to alcohol predicted AUD occurrence over the course of adulthood even after controlling for the effects of other robust risk factors. Interaction effects revealed that the impact of FH on AUDs was only observed for subjects with high T1 drinking levels, and probands with high T1 drinking were at high risk for AUDs regardless of their age of onset.

CONCLUSIONS

The findings illustrate that LR is a unique risk factor for AUDs across adulthood, and not simply a reflection of a broader range of risk factors. The continued investigation of how LR is related to AUD onset later in life will help inform treatment providers about this high-risk population, and future longitudinal evaluations will utilize DTSA to assess rates of AUD remission as well as the onset of drinking outcomes in adolescent samples.

The overlap in predicting alcohol outcome for two measures of the level of response to alcohol

BACKGROUND

Two different measures have been used to establish a person's level of response (LR) to alcohol as a risk factor for alcohol use disorders. LR values established by the alcohol challenge protocol and the Self-Report of the Effects of Ethanol (SRE) questionnaire usually correlate at 0.3 to 0.4, up to 0.6. However, it is not clear how this correlation relates to the ability of each measure to predict alcohol outcomes. This paper evaluates that overlap.

METHODS

Sixty-six Caucasian males (mean age = 22 years) from 2 protocols participated in alcohol challenges with 0.75 ml/kg of ethanol, filled out the SRE, and were followed with a structured interview approximately 5 years later. The relationship between the subjective feelings of intoxication at the time of peak breath alcohol levels from the alcohol challenge and the SRE score for a time early in the drinking career were evaluated regarding predicting the drinks per occasion in the 6 months prior to follow-up.

RESULTS

Cross-sectional correlations between alcohol challenge and SRE LR's ranged from -0.25 (p < 0.05) to -0.32 (p = 0.02) for the full sample, and the 2 LR measures correlated with drinking at follow-up (-0.26 and 0.41, respectively). The SRE measure was more robust than the challenge in a regression analysis predicting the outcome in the context of other baseline predictors (e.g., drinking at baseline). As much as 60% of the ability of the more well established (gold standard) alcohol challenge LR to predict outcome was shared with the SRE. The alcohol challenge accounted for as much as 44% of the ability of the SRE to predict outcome.

CONCLUSIONS

The SRE-generated LR overlapped considerably with the alcohol challenge LR in the ability to predict future heavier drinking.

The performance of elements of a 'level of response to alcohol'-based model of drinking behaviors in 13-year-olds

AIM

The goals of this paper are to evaluate whether drinking practices among peers mediates the relationship between a low level of response (LR) to alcohol and a person's heavier drinking and alcohol-related problems in 12-14-year-olds.

DESIGN

Correlations and structural equation models (SEM) were used to test a hypothesized model of the relationships among key variables in adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC), a longitudinal birth cohort study in Bristol, England.

PARTICIPANTS

These included 688 boys (40.4%) and girls who were offspring of the pregnant women who had been selected as ALSPAC participants in 1991 and 1992. The offspring were interviewed at about age 13 years, and those who had ever consumed a full drink completed the Self-Report of the Effects of Alcohol (SRE) questionnaire indicating the number of drinks required for up to four effects early in their drinking histories. A higher number of drinks required for effects indicated a low LR per drink consumed.

FINDINGS

The SEM explained 58% of the variance of the alcohol pattern, and had good fit characteristics. A low LR was related to heavier drinking and more alcohol problems both directly and as mediated partially by drinking in peers. The model performed well across the narrow age range, and applied equally well in boys and girls.

CONCLUSIONS

The perceived drinking practices of peers is a potentially important mediator of how a low LR to alcohol relates to drinking practices during early adolescence. The findings may be useful in developing approaches to prevent heavier drinking in this young group.

The self-rating of the effects of alcohol questionnaire as a predictor of alcohol-related outcomes in 12-year-old subjects

AIMS

A low level of response (LR), or low sensitivity, to alcohol as established by alcohol challenges has been shown to predict future heavier drinking, alcohol-related problems and alcohol use disorders. To date, only one study has evaluated the predictive validity of a second measure of LR as determined by the Self-Report of the Effects of Alcohol (SRE) Questionnaire. The current analyses evaluate the ability of SRE scores as determined at age 12 to predict heavier drinking and alcohol-related problems 2 years later in a sample from the United Kingdom.

METHODS

The subjects were 156 boys (54.5%) and girls from the Avon Longitudinal Study of Parents and Children (ALSPAC) who had reported consuming one or more standard drinks by age 12 and who were followed up 2 years later.

RESULTS

The age 12 SRE scores correlated with the number of drinks per week, maximum drinks and the number of alcohol problems both at baseline and at age 14 follow-ups. In these evaluations, a larger number of drinks required for effects on the SRE (i.e. a lower LR per drink consumed) related to heavier intake and alcohol-related difficulties. Simultaneous entry multiple regression analyses revealed that the age 12 SRE score maintained a significant relationship with age 14 higher number of drinks per week and the number of alcohol problems even when the age 12 values for alcohol intake and problems were used as covariates.

CONCLUSION

The SRE scores appear to have value in predicting future heavier drinking and alcohol problems in 12-year olds that go beyond the information offered by the earlier drinking pattern alone.