U.S. trends in methamphetamine-involved psychiatric hospitalizations in the United States, 2015-2019

BACKGROUND

In the U.S., overdose deaths and substance treatment admissions related to methamphetamine are rising. This study aims to measure and compare U.S. temporal trends in methamphetamine-involved psychiatric hospitalizations.

METHODS

We conducted a population-based, trend analysis of U.S. psychiatric hospitalizations and calculated quarterly (Q) rates per 100,000 population of substance-involved psychiatric hospitalizations. We assessed U.S. regional quarterly percentage hospitalization rate changes using Joinpoint regression.

RESULTS

From Q4 2015-Q4 2019, there were 963,202 psychiatric hospitalizations, 50,223 (5.2 %) involved methamphetamine and 102,877 (10.7 %) involved opioids and/or cocaine without methamphetamine. Methamphetamine-involved psychiatric hospitalization rates increased by 68.0 %, psychiatric hospitalizations rates involving opioid and/or cocaine without methamphetamine decreased by 22 %, while nonsubstance-involved psychiatric hospitalizations rates remained unchanged. The largest significant increases in methamphetamine-involved psychiatric hospitalization rates were among people >61 years old, males, and Midwesterners. Methamphetamine-involved psychiatric hospitalization rates doubled among Black patients. The largest average percent increase among methamphetamine-involved psychiatric hospitalizations was 10.2 % from Q4 2015-Q2 2017 in the Midwest.

CONCLUSION AND RELEVANCE

Most psychiatric hospitalizations did not involve substances. Methamphetamine-involved psychiatric hospitalizations greatly increased while opioid-involved psychiatric hospitalizations decreased, but involved more total encounters. Greater access to harm reduction services, contingency management programs, and mental health services is urgently needed.

Transition to retirement impact on smoking habit: results from a longitudinal analysis within the Survey of Health, Ageing and Retirement in Europe (SHARE) project

BACKGROUND

In an ageing society, retirement impacts on behavioural risk factors and health outcomes should be carefully assessed. Scant evidence exists from longitudinal studies on the short- and long-term consequences of the transition to retirement on smoking habit.

METHODS

We conducted a longitudinal study based on the Survey of Health, Ageing and Retirement in Europe (SHARE) data from 27 European countries plus Israel collected in 2004-2020. To estimate relative risks (RR) and corresponding 95% confidence intervals (CI) for smoking status and intensity at seven time periods before and after retirement, we fitted adjusted generalised estimating equation (GEE) models for repeated measures.

RESULTS

We selected a cohort of 8998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). As compared to the year of retirement, the RR of smoking was 1.59 (95% CI 1.44-1.76) at 10 years or more before retirement, 1.35 (95% CI 1.25-1.46) from 5 to 9 years before retirement, and 1.18 (95% CI 1.10-1.27) from 1 to 4 years before retirement. Smoking steadily decreased after retirement, being 0.94 (95% CI 0.87-1.01) from 1 to 4 years after retirement, 0.76 (95% CI 0.69-0.84) from 5 to 9 years, and 0.58 (95% CI 0.46-0.74) 10 years or more after retirement. In smokers, the estimated number of cigarettes smoked/day decreased from about 27 cigarettes/day at 10 years or more before retirement to 9 cigarettes/day at 10 years or more after retirement (p trend < 0.001).

CONCLUSION

Longitudinal data suggest that lifestyles might favourably change with retirement. Further studies are needed to direct healthy ageing promotion policies better.

Are workplace factors associated with employee alcohol use? The WIRUS cross-sectional study

OBJECTIVES

Sociodemographic predictors of employee alcohol use are well established in the literature, but knowledge about associations between workplace factors and alcohol use is less explored. The aim of this study was to explore whether workplace factors were associated with employee alcohol use (consumption and alcohol-related problems).

DESIGN

Cross-sectional study. Linear and binary logistic regression analyses.

SETTING

Heterogeneous sample of employees (workers and supervisors) from 22 companies across geographical locations and work divisions in Norway.

PARTICIPANTS

Employees (N=5388) responded on survey items measuring workplace factors and alcohol use.

OUTCOMES

Data on alcohol use were collected with the Alcohol Use Disorders Identification Test (AUDIT). Consumption was measured with the AUDIT-C (the first three items), and alcohol-related problems were operationalised as a sum score of 8 or higher on the full 10-item AUDIT.

RESULTS

Higher levels of alcohol consumption were associated with more liberal workplace drinking social norms (b=1.37, p<0.001), working full-time (b=0.18, p<0.001), working from holiday home (b=0.40, p<0.01), being a supervisor (b=0.25, p<0.001), having supervisors with less desired leadership qualities (b=-0.10, p<0.01), shorter working hours (b=-0.03, p<0.05), higher workplace social support (b=0.13, p<0.05) and higher income (b=0.02, p<0.001). Alcohol-related problems were associated with more liberal workplace drinking social norms (OR=3.52, p<0.001) and shorter working hours (OR=0.94, p<0.05).

CONCLUSIONS

Workplace drinking social norms were the supremely most dominant predictor of both consumption and alcohol-related problems. Results suggest that some workplace factors may play a role in explaining employee alcohol consumption, although the predictive ability of these factors was limited. This study points to the importance of drinking social norms, workplace drinking culture and leadership for understanding employee alcohol use.

Neurocognitive and substance use disorders in older adults: challenges and evidence

Purpose

This study aims to review the presentation of substance use disorders in older adults, how addiction intertwines with neurocognitive disorders and how to approach this vulnerable population.

Design/methodology/approach

Electronic data searches of PubMed, Medline and the Cochrane Library (years 2000–2021) were performed using the keywords “neurocognitive,” “dementia,” “substance use,” “addiction,” “older adults” and “elderly.” The authors, in consensus, selected pivotal studies and conducted a narrative synthesis of the findings.

Findings

Research about substance use disorders in older adults is limited, especially in those with superimposed neurocognitive disorders. Having dual diagnoses can make the identification and treatment of either condition challenging. Management should use a holistic multidisciplinary approach that involves medical professionals and caregivers.

Originality/value

This review highlights some of the intertwining aspects between substance use disorders and neurocognitive disorders in older adults. It provides a comprehensive summary of the available evidence on treatment in this population.

Effects of genetic risk for alcohol dependence and onset of regular drinking on the progression to alcohol dependence: A polygenic risk score approach

BACKGROUND

Prior studies have established the importance of genetic contributions to the etiology of alcohol dependence (AD), and suggested an early onset of alcohol use represents an initial marker of this genetic risk, which is associated with a more rapid progression to AD and increased risk for AD itself. Building on prior work, the current study examined whether the additive effects of AD risk variants predicted the rate of progression to AD from the onset of regular drinking, a drinking milestone with high clinical relevance to AD prevention.

METHODS

Data from 1501 European-ancestry adults from the University of California - San Francisco Family Alcoholism Study were used to examine whether polygenic risk scores for AD (PRS_AD) and age-at-onset of regular drinking contributed uniquely to the likelihood of having a lifetime AD diagnosis and the rate of progression from regular drinking to AD. Mixed effects logistic regression and Cox proportional hazards regression analyses were employed.

RESULTS

Increases in PRS_AD were associated with a faster progression from regular drinking to AD independent of age-at-onset of regular drinking. An independent effect of age-at-onset of regular drinking was also observed indicating that a one-year delay in regular drinking was associated with a 7% decrease in the hazard of progression to AD among drinkers with an early onset (≤ 18), but a 3% increase among drinkers with a late onset (> 18) of regular drinking.

CONCLUSIONS

These results broaden our understanding of the contributions of measured genotypes underlying AD-risk on the etiology and clinical course of AD.

The lingering effects of work context: Ambient work-unit characteristics and the impact of retirement on alcohol consumption

While it is well established that workplace demands and culture can affect employee well-being, to what degree might these same factors have lingering implications on individual wellbeing after employees retire? To begin to answer this question, in this paper we propose and test a model explaining how retiree alcohol consumption may depend on pre-retirement contextual conditions. Specifically, we propose and test a moderated-mediation model in which two ambient work unit characteristics-work-unit stress climate and work-unit drinking norms-moderate the indirect effects of retirement, via distress, on modal alcohol consumption (i.e., the typical quantity and frequency of alcohol consumed). Using a prospective study design and a multi-level, zero-inflated negative binomial model for predicting modal alcohol consumption, our findings lend partial support for the proposed model. We found retirement (vs. continued employment) to be associated with a heightened probability of being an abstainer after retirement eligibility (i.e., at Time 2), regardless of the hypothesized unit-level moderators. Still, retirement had mixed effects on the level of modal consumption among those not abstaining at Time 2, with these effects being partially mediated by distress and contingent upon unit-level stress climate and unit-level drinking norms.

Social networks and alcohol use among older adults: a comparison with middle-aged adults

OBJECTIVES

This study compared the association between social networks and alcohol consumption among middle-aged (MA) and older adults (OA) to better understand the nature of the relationship between those two factors among OA and MA.

METHOD

We examined Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Current drinkers aged over 50 were subdivided into two age groups: MA (50-64, n = 5214) and OA (65 and older, n = 3070). Each age group was stratified into drinking levels (low-risk vs. at-risk) based on alcohol consumption. The size and diversity of social networks were measured. Logistic regression models were used to examine age differences in the association between the social networks (size and diversity) and the probability of at-risk drinking among two age groups.

RESULTS

A significant association between the social networks diversity and lower odds of at-risk drinking was found among MA and OA. However, the relationship between the diversity of social networks and the likelihood of at-risk drinking was weaker for OA than for MA. The association between social networks size and at-risk drinking was not significant among MA and OA.

CONCLUSION

The current study suggests that the association between social networks diversity and alcohol use among OA differs from the association among MA, and few social networks were associated with alcohol use among OA. In the future, research should consider an in-depth exploration of the nature of social networks and alcohol consumption by using longitudinal designs and advanced methods of exploring drinking networks.

Optimizing follow-up and study retention in the 21st century: Advances from the front line in alcohol and tobacco research

AIMS

Longitudinal studies are integral in addiction research but retention of participants over time can be challenging. While statistical algorithms for missing data have advanced, they remain less desirable than collecting actual data with high retention rates. An update to methodological primers with consideration of evolving technology and privacy concerns is needed for 21st century researchers.

METHODS

Comprehensive follow-up methodological strategies were conducted in four concurrent laboratory- and intervention-based studies across N=697 drinker and smokers enrolled in studies at the Clinical Addictions Research Laboratory at the University of Chicago. The methods of three key longitudinal research themes and their outcomes are outlined, including: a) mindset of the research team starting at study enrollment, b) modalities with a particular focus on advances in technological strategies in follow-up, and c) mitigating difficult to reach and challenging participants.

RESULTS

The techniques described herein produced follow-up rates of 95% and 99% in two laboratory-based studies with follow-ups of 1- and 6-years, respectively and 94% and 97% in two intervention studies with follow-ups of 6- and 12- months. Adapting incentive strategies more than tripled on-time follow-up, from 18% to 68% of the sample, switching to more advanced technologies decreased participant burden and time by 30% from traditional telephone interviews, and difficult-to-reach participants averaged 47 contact attempts.

CONCLUSIONS

The methods presented produced exceptional follow-up retention across four studies. The principles and methodologies discussed may be modified across a range of studies to target various sub-populations in the addiction field.

Changes in Health and Health Behavior Associated With Retirement

Objectives: While poor health contributes to early work exits, it is less clear how early work exits affect health. This study therefore examines changes in health associated with retirement. Method: Survey data from gainfully employed individuals aged 57 to 66 in 2002 were used to assess changes in health status and behaviors associated with retirement (49%) 5 years later ( N = 546). Results: Compared with workers, retirees were more likely to report improvements in mental health (odds ratio [OR] = 1.67), and less likely to report mental health deteriorations (OR = 0.56). Retirees were more likely to both increase (OR = 2.03) and reduce (OR = 1.87) their alcohol intake, and to increase physical activity (OR = 2.01) and lose weight (OR = 1.75). Discussion: As welfare states aim to extend working life to counteract repercussions of population aging, findings on possible health benefits for retirees may warrant more focus on the pros and cons of a prolonged working life.

Does Retirement Offer a “Window of Opportunity” for Lifestyle Change? Views From English Workers on the Cusp of Retirement

Objective: Improving health behaviors can delay or prevent lifestyle diseases. Previous quantitative studies suggest that interventions at retirement may be particularly effective. This study introduces the voices of older people to explore the potential of retirement as a change point. Method: This qualitative study of current and anticipated health behaviors among 55 people approaching retirement in England reports thematic analysis of semi-structured interviews. Results: Many respondents expected improved health behaviors whether from conscious changes or simply as a beneficial side effect of retiring, while a smaller group felt retirement carried inherent health risks, with a need to guard against these. Discussion: The retirement transition can potentially establish positive health behaviors, but interventions need careful targeting to maximize their benefit. Further research is required to explore how far intentions translate into practice and the barriers and facilitators to doing so.

Understanding older adults' attitudes and beliefs about drinking: perspectives of residents in congregate living

Drinking motives may change as adults age, yet few studies in the United States of America have examined older adults' perspectives about their own drinking habits. The current study explored beliefs and attitudes of alcohol use of retired adults residing in a congregate care setting in the Baltimore/Washington DC metro area. Individual interviews were conducted with a sub-sample of 11 individuals who participated in a daily diary study on alcohol use among older adults. All participants in the study were identified as regular drinkers, meaning they had an alcoholic beverage on at least six of the eight days prior to screening. The participants' mean age was 81.5 years with a majority being women (54.5%). Older adults reported alcohol use as a long-term habit or routine. Participants also recognised that their alcohol use was influenced by peer drinking and by the availability of alcohol at the congregate care setting. Participants normalised their drinking as a form of routine socialisation carried from earlier life stages. Participants did not report reactive drinking, suggesting that older drinkers do not see their alcohol use as driven by specific reactions to life stresses or losses associated with ageing. The study also indicates that drinking may provide older adults in congregate care with a sense of continuity from before retirement and preserve their identity and autonomy.

Substance abuse among older adults

Although the myth that older adults do not use mood-altering substances persists, evidence suggests that substance use among older adults has been underidentified for decades. The baby boom generation is unique in its exposure to, attitudes toward, and prevalence of substance use-causing projected rates of substance use to increase over the next twenty years. Given their unique biological vulnerabilities and life stage, older adults who misuse substances require special attention. Prevalence rates of substance use and misuse among older adults, methods of screening and assessment unique to older adults, and treatment options for older adults are reviewed.

The effect of retirement on alcohol consumption: results from the US Health and Retirement Study

BACKGROUND

Prior research examining the association between retirement and alcohol consumption is inconsistent with respect to salience, direction and magnitude. Reasonable conceptual arguments for both positive (e.g. coping, introduction of leisure time) and negative (e.g. severance of work-related social relationships) changes further complicate investigations of this critical association, as do differences in study design, national setting and measurement of alcohol use.

METHODS

This prospective longitudinal study analyses 2-year wave-pairs drawn from seven waves (14 years) of data from the US Health and Retirement Study to assess the effect of complete retirement on weekly alcohol consumption (n = 9979 observations; 4674 unique participants). We use multiple regression analysis in a two-period follow-up design and account for potential selection bias and reverse causality not addressed in prior research on this topic.

RESULTS

We find that retirement is positively associated with subsequent weekly alcohol consumption for men who reported drinking at both follow-up and the prior study wave (β = 1.9, 95% confidence interval = 0.43-3.36). No association was observed among women.

CONCLUSION

Our results suggest that health care professionals should monitor the drinking habits of retired men, as older individuals are particularly susceptible to the adverse effects of heavy alcohol use.

The Diabetes, Depression, and Alcohol Triad

Type 2 diabetes, depression and alcohol abuse exist in many populations as co-morbidities. These conditions contribute to worsened health status and lost productivity. Such diseases also contribute to high medical expenses and other societal costs. Diabetes, depression and alcohol abuse are individually associated with compromised financial status. Treating these combined conditions as a syndrome rather than as isolated disease states may result in improved quality of care, better health outcomes, and reduced costs to society. A conceptual model that could be used to address this triad is the Social Ecological Model in which intrapersonal, interpersonal, institutional and community factors as well as public policy are considered for their impact on outcomes. The triad of diabetes, depression and alcohol abuse may have common etiological factors such as social isolation and poverty, and such a holistic approach to the common determinants underlying all three conditions holds out the most hope to reduce both the prevalence of this unique disease triad and the associated costs to society.

Retirement and a healthy lifestyle: opportunity or pitfall? A narrative review of the literature

BACKGROUND

Retirement is a life-course transition in late adult life that is marked by major changes that may affect healthy lifestyles. Our aim is to give an overview of the current knowledge on changes in smoking, alcohol consumption, physical activity and dietary habits during the transition to retirement. This may provide clues to a better targeting and timing of preventive activities at older age.

METHODS

Literature search in Medline, Scopus, Embase, PsycInfo, Social SciSearch and SciSearch limited to English-language papers published between 2001 and May 2013. Results of 20 original papers are summarized in a narrative review.

RESULTS

Some studies report an increase in alcohol consumption after retirement, whereas others found a decrease or no change at all. Those who retired involuntarily tended to increase their alcohol consumption, whereas retirees who quit voluntarily did not change their alcohol consumption. Leisure-time physical activity seems to increase slightly after retirement, especially moderately intensive physical activity. This increase does not compensate the loss of work-related physical activity such as the work itself or work-related transportation. The studies on changes in smoking and dietary habits were too limited to draw conclusions.

CONCLUSIONS

The transition to retirement is accompanied with both favourable and unfavourable lifestyle changes, depending on the type of lifestyle, lifestyle indicator and the personal situation of the retiree. The (pre-)retirement period may well offer a suitable opportunity for preventive action, for example in pre-retirement programmes, planning or other retirement-related support.

Functioning of alcohol use disorders criteria among middle-aged and older adults: implications for DSM-5

This study explored dimensionality and rank-order severity of the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) alcohol use disorder (AUD) criteria among adults 50+ years old. Secondary analysis was performed on data from individuals 50+ (N = 3,412) from the 2009 National Survey of Drug Use and Health. Confirmatory factor analyses (CFA) and item response theory (IRT) analyses were performed on the 11 AUD criteria. DSM-IV and DSM fifth edition (DSM-5) classifications were compared. CFA revealed a one-factor model. IRT analyses revealed that AUD criteria identify only severe cases of AUD. Overall, 5.8% met criteria for a DSM-IV AUD; 7.5% met criteria for DSM-5 AUD.

Workforce Disengagement Stressors and Retiree Alcohol Misuse: The Mediating Effects of Sleep Problems and the Moderating Effects of Gender

We generate and test a moderated mediation model of the effects of two retirement-related stressors (namely, financial and marital) on the severity of alcohol misuse among retirees. We posit that in addition to using alcohol to cope with stressors in retirement, alcohol may also be used to self-medicate the secondary, sleep-related effects of such stressors, and that gender serves as a key boundary condition, moderating the impact of such stressors on sleep-related problems, and of sleep-related problems on alcohol misuse. Using longitudinal data collected from a sample of 292 retirees, our findings generally support this model, suggesting that both stressors are associated with the severity of alcohol misuse among male retirees. Moreover, our findings demonstrate that -- for male retirees -- the effect of both stressors on the severity of alcohol misuse is to a large extent secondary to the stressors themselves, mediated by the sleep-related problems they may generate.

The impact of retirement on the drinking patterns of older adults: a review

OBJECTIVE

Due to the aging of the population, there is renewed focus on the public health issues of middle-aged and older adults. One area of such focus is unhealthy drinking, and researchers seek to understand the unique developmental risk and protective factors among those entering older adulthood. Retirement has been hypothesized as a contributing factor in the onset and maintenance of unhealthy drinking in late life. This review describes the relevant theories and critically reviews empirical evidence that explores the relationship between alcohol and retirement drawn from both the industrial and organizational psychology and substance misuse literatures.

METHOD

Using four research databases, thirteen studies published in the last 25years that investigated the relationship of retirement and alcohol use and met specific selection criteria were reviewed.

RESULTS

The literature suggests that retirement may not have a strong direct impact on drinking behaviors or problems, but attributes of the process (e.g. retirement voluntariness) of transition to retirement and individual attributes, such as having a history of problem drinking, may facilitate or inhibit drinking.

CONCLUSIONS

Future research should delve into the social context of drinking in retirement with a goal of understanding the aspects and conditions of retirement that increase risk of alcohol problems. Investigation should also examine heterogeneity in retirement drinking patterns with a goal of identifying subpopulations that are at greater risk.

Perceived Agency in Retirement and Retiree Drinking Behavior: Job Satisfaction as a Moderator

Based on recent findings that post-retirement adjustment may be influenced by the conditions leading up to the decision to retire, we examine the impact of individual agency in the retirement decision on problematic drinking behavior, as well as the extent to which such an effect may itself depend upon the valence of the pre-retirement work experience. Using a sample of 304 blue-collar retirees, our findings indicate that, when controlling for pre-retirement drinking behavior, perceptions of retirement as the result of a more forced or involuntary decision are associated with greater alcohol consumption, while perceptions of retirement as the result of a more volitional or voluntary process are associated with lower levels of alcohol consumption and a lower risk of problematic drinking behavior. Our results also indicate that pre-retirement job satisfaction amplifies the former relationship, while attenuating the latter one.

Retirement and drug abuse: the conditioning role of age and retirement trajectory

Although recent research on the link between retirement and drinking behavior among older adults suggests that retirement may also serve as a risk factor for drug abuse, the latter association has yet to be subject to rigorous research. We examined this association, as well as the possible conditioning effects of age and retirement trajectory, using a sample of 978 retirement-eligible workers (some having retired, others deferring their retirement) from 3 blue-collar employment sectors: (e.g., construction, manufacturing, and transportation). The findings indicate a weak but significant positive association between retirement and the severity of drug abuse. Age moderated the retirement-drug abuse relationship with - among older workers - higher rates of drug abuse found among those deferring retirement and lower rates among those actually retiring, and the exact opposite pattern found among younger retirement-eligible workers. Also, as hypothesized, the moderating effects of age on the association between retirement and drug abuse were weaker among those opting to return to work post-retirement as opposed to those fully retiring.

Effects of retirement voluntariness on changes in smoking, drinking and physical activity among Dutch older workers

BACKGROUND

Although several studies have investigated the association of health behaviors with retirement, none has examined this relationship in the context of retirement voluntariness.

METHODS

Using data from the 2001 and 2007 waves of a panel study of retirement in the Netherlands, we used multinomial logistic regression models to investigate the impact of retirement voluntariness on changes in smoking, alcohol use, and physical activity. Participants included 1604 individuals, aged 50-64 years, who were employed in 2001.

RESULTS

During the 6-year follow-up, 884 (55%) sample members retired: 676 (42%) perceived their retirement as voluntary and 208 (13%) perceived their retirement as involuntary. Results of multinomial logistic analyses indicated that, relative to non-retired participants (n = 720), the voluntarily retired had higher risk of increased physical activity [relative risk ratio (RR) = 2.90, 95% confidence interval (CI): 2.19-3.84] and lower risk of decreased physical activity (RR = 0.35, 95% CI: 0.22-0.56). The involuntarily retired had both higher risk of increased smoking (RR = 3.68, 95% CI: 1.45-9.30) and lower risk of decreased smoking (RR = 0.50, 95% CI: 0.25-0.99), lower risk of decreased alcohol use (RR = 0.47, 95% CI: 0.29-0.73), and both higher risk of increased physical activity (RR = 2.14, 95% CI: 1.47-3.13) and lower risk of decreased physical activity (RR = 0.46, 95% CI: 0.23-0.92).

CONCLUSION

Accounting for the perceived voluntariness of retirement is essential to obtaining a clear assessment of the behavioral effects of this type of labor force departure.