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Na PJ, Montalvo-Ortiz J, Petrakis I, Krystal JH, Polimanti R, Gelernter J, Pietrzak RH. Trajectories of alcohol consumption in U.S. military veterans: Results from a 10-year population-based longitudinal study. Drug Alcohol Depend 2023; 246:109833. [PMID: 36963160 PMCID: PMC10811960 DOI: 10.1016/j.drugalcdep.2023.109833] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Alcohol use disorder is a public health problem, especially among US veterans. This study examined the nature and predictors of 10-year trajectories of alcohol consumption in US veterans. METHODS Data were analyzed from the 2011-2021 National Health and Resilience in Veterans Study, a nationally representative, longitudinal study of 2309 US veterans. RESULTS Latent growth mixture modeling analyses revealed four trajectories of alcohol consumption (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) over a 10-year period: excessive (4.1%; mean [standard deviation] AUDIT-C baseline=8.6 [2.0], slope= -0.33 [0.07]); at-risk (22.1%; baseline=4.1 [1.6], slope=0.02 [0.07]); rare (71.7%; baseline=1.2 [1.3], slope= -0.01 [0.03]); and recovering alcohol consumption (2.1%; baseline=8.4 [1.9], slope= -0.70 [0.14]). The strongest predictors of excessive vs. rare alcohol consumption group were younger age (relative variance explained [RVE]=27.8%), and lower agreeableness (RVE=27.0%); at-risk vs. rare alcohol consumption group were fewer medical comorbidities (RVE=82.3%); recovering vs. rare alcohol consumption group were greater dysphoric arousal symptoms (RVE=46.1%) and current mental health treatment (RVE=26.5%); excessive vs. at-risk alcohol consumption group were younger age (RVE=25.9%), greater dysphoric arousal symptoms of posttraumatic stress disorder (RVE=22.0%), and lower conscientiousness (RVE=19.1%); and excessive vs. recovering alcohol consumption group were current mental health treatment (RVE=61.1%) and secure attachment style (RVE=12.4%). CONCLUSIONS Over the past decade, more than 1 in 4 US veterans consumed alcohol at the at-risk-to-excessive level. Veterans who are younger, score lower on agreeableness and conscientiousness, endorse greater dysphoric arousal symptoms, and currently not engaged in mental health treatment may require close monitoring and prevention efforts to mitigate the risk of a chronic course of at-risk-to-excessive alcohol consumption.
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Affiliation(s)
- Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Janitza Montalvo-Ortiz
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ismene Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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2
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Mahoney CT, Livingston NA, Wong MM, Rosen RC, Marx BP, Keane TM. Parallel process modeling of posttraumatic stress disorder symptoms and alcohol use severity in returning veterans. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:569-578. [PMID: 32118464 PMCID: PMC9077743 DOI: 10.1037/adb0000569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with higher levels of alcohol use among returning veterans. Persistent PTSD symptoms can predict alcohol use over the span of hours, days, weeks, and months; however, knowledge of the strength of these associations beyond 1 year remains limited. In this study, we examined the 6-year course of co-occurring PTSD and alcohol use to explicate the directional and possible enduring effects of PTSD on alcohol use severity over time. Our study included 1,649 returning veterans (M age = 37.49; SD = 9.88) who completed 4 waves of data collection between 2010 and 2016. We used parallel process modeling to evaluate temporal associations between PTSD symptoms and alcohol use severity across 4 (T1-T4) waves of data collection. PTSD and alcohol use both decreased significantly between T1 and T4 and in tandem with one another. That is, decreases in one were associated with decreases in the other. Further, individuals with higher levels of PTSD symptom severity at T1 reported accelerated rates of change regarding PTSD symptoms and alcohol use over time. Conversely, baseline alcohol use severity did not predict the rate of change in PTSD symptom severity. Our findings provide evidence of a prospective association between PTSD symptoms and alcohol use and highlight the potential for reciprocal associations between them over the span of years. Importantly, our demonstration of the natural course of co-occurring PTSD symptoms and alcohol use suggests further trauma-focused and combined intervention strategies are needed to disrupt this enduring and reciprocal pattern among returning veterans. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Colin T. Mahoney
- VA Boston Healthcare System, Boston, MA,National Center for PTSD, Behavioral Science Division, Boston, MA,Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Nicholas A. Livingston
- VA Boston Healthcare System, Boston, MA,National Center for PTSD, Behavioral Science Division, Boston, MA,Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Maria M. Wong
- Department of Psychology, Idaho State University, Pocatello, ID
| | | | - Brian P. Marx
- VA Boston Healthcare System, Boston, MA,National Center for PTSD, Behavioral Science Division, Boston, MA,Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Terence M. Keane
- VA Boston Healthcare System, Boston, MA,National Center for PTSD, Behavioral Science Division, Boston, MA,Department of Psychiatry, Boston University School of Medicine, Boston, MA
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3
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Contractor AA, Weiss NH, Dixon-Gordon KL, Blumenthal H. Heterogeneity in the Co-occurrence of Substance Use and Posttraumatic Stress Disorder: A Latent Class Analysis Approach. J Dual Diagn 2019; 15:105-117. [PMID: 30838935 PMCID: PMC6541508 DOI: 10.1080/15504263.2019.1572258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/20/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
Objective: Posttraumatic stress disorder (PTSD) often co-occurs with substance use (SU). Although there has been independent research on subgroups of participants based on their PTSD or SU responses, rarely are PTSD-SU typologies examined consistent with a precision medicine approach (and corresponding person-centered statistical approaches). The current study examined the nature and construct validity (covariates of depression, physical aggression, verbal aggression, anger, hostility, reckless and self-destructive behaviors [RSDB]) of the best-fitting latent class solution in categorizing participants based on PTSD (PTSD Checklist for DSM-5) and alcohol/drug use responses (Alcohol Use and Disorders Identification Test Alcohol Consumption Questions, Drug Abuse Screening Test). Methods: The sample included 375 trauma-exposed participants recruited from Amazon's Mechanical Turk online labor market. Results: Latent class analyses indicated an optimal three-class solution (low PTSD/SU, moderate PTSD/drug and high alcohol, and high PTSD/SU). Multinomial logistic regressions indicated that depression (OR = 1.22) and frequency of RSDBs (OR = 1.20) were significant predictors of the moderate PTSD/drug and high alcohol class versus the low PTSD/SU class. Depression (OR = 1.55) and frequency of RSDBs (OR = 1.19) were significant predictors of the high PTSD/SU class versus the low PTSD/SU class. Only depression (OR = 1.27) was a significant predictor of the high PTSD/SU class versus the moderate PTSD/drug and high alcohol class. Conclusions: Results provide construct validity support for three meaningful latent classes with unique relations with depression and RSDBs. These findings improve our understanding of heterogeneous PTSD-SU comorbidity patterns and highlight acknowledgment of such subtyping (subgrouping) in considering differential treatment options, treatment effectiveness, and resource allocation.
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Affiliation(s)
- Ateka A Contractor
- a Department of Psychology , University of North Texas , Denton , TX , USA
| | - Nicole H Weiss
- b Department of Psychology , University of Rhode Island , Kingston , RI , USA
| | - Katherine L Dixon-Gordon
- c Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA
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4
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Vickers Smith R, Kranzler HR, Justice AC, Tate JP. Longitudinal Drinking Patterns and Their Clinical Correlates in Million Veteran Program Participants. Alcohol Clin Exp Res 2019; 43:465-472. [PMID: 30592535 DOI: 10.1111/acer.13951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND A variety of measures have been developed to screen for hazardous or harmful drinking. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is one of the screening measures recommended by the U.S. Preventive Services Task Force. Annual administration of the AUDIT-C to all primary care patients is required by the U.S. Veterans Affairs Health System. The availability of data from the repeated administration of this instrument over time in a large patient population provides an opportunity to evaluate the utility of the AUDIT-C for identifying distinct drinking groups. METHODS Using data from the Million Veteran Program cohort, we modeled group-based drinking trajectories using 2,833,189 AUDIT-C scores from 495,178 Veterans across an average 6-year time period. We also calculated patients' age-adjusted mean AUDIT-C scores to compare to the drinking trajectories. Finally, we extracted data on selected clinical diagnoses from the electronic health record and assessed their associations with the drinking trajectories. RESULTS Of the trajectory models, the 4-group model demonstrated the best fit to the data. AUDIT-C trajectories were highly correlated with the age-adjusted mean AUDIT-C scores (rs = 0.94). Those with an alcohol use disorder diagnosis had 10 times the odds of being in the highest trajectory group (consistently hazardous/harmful) compared to the lowest drinking trajectory group (infrequent). Those with hepatitis C, posttraumatic stress disorder, liver cirrhosis, and delirium had 10, 7, 21, and 34%, respectively, higher odds of being classified in the highest drinking trajectory group versus the lowest drinking trajectory group. CONCLUSIONS Trajectories and age-adjusted mean scores are potentially useful approaches to optimize the information provided by the AUDIT-C. In contrast to trajectories, age-adjusted mean AUDIT-C scores also have clinical relevance for real-time identification of individuals for whom an intervention may be warranted.
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Affiliation(s)
- Rachel Vickers Smith
- University of Louisville School of Nursing , Louisville, Kentucky.,Mental Illness Research, Education and Clinical Center , Crescenz VAMC, Philadelphia, Pennsylvania
| | - Henry R Kranzler
- Mental Illness Research, Education and Clinical Center , Crescenz VAMC, Philadelphia, Pennsylvania.,Department of Psychiatry, Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Amy C Justice
- VA Connecticut Healthcare System , West Haven, Connecticut.,School of Medicine , Yale University, New Haven, Connecticut
| | - Janet P Tate
- VA Connecticut Healthcare System , West Haven, Connecticut.,School of Medicine , Yale University, New Haven, Connecticut
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5
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Wallen GR, Park J, Krumlauf M, Brooks AT. Identification of Distinct Latent Classes Related to Sleep, PTSD, Depression, and Anxiety in Individuals Diagnosed With Severe Alcohol Use Disorder. Behav Sleep Med 2019; 17:514-523. [PMID: 29377714 PMCID: PMC6289902 DOI: 10.1080/15402002.2018.1425867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective/Background: Alcohol use disorders (AUDs) are often accompanied by comorbid physiologic and psychosocial conditions, including sleep disturbances. Sleep disturbances in these individuals may be associated with increased risk of relapse to drinking following detoxification and rehabilitation. Participants: The sample of inpatient treatment-seeking individuals with AUDs (N = 164) was 70.1% male and 47.6% African American with a mean age of 45.6 years (±9.5 years). Methods: Latent class analysis (LCA) was used to identify unmeasured class membership based on seven indicators: maximum Clinical Institute Withdrawal Assessment (CIWA) scores; sleep efficiency (actigraphy); sleep disturbances (Pittsburgh Sleep Quality Index-PSQI); anxiety or depression (Comprehensive Psychopathological Rating Scale [CPRS]); and current and lifetime posttraumatic stress disorder (PTSD). Results: The average number of drinking days in the 90 days preceding admission was 72.0 (±22.0 days), with an average of 13.16 drinks per day (±5.70 drinks). Nearly one quarter (24.4%) of respondents reported lifetime PTSD. Three latent classes were identified: Sleep Disturbance (SD); Sleep Disturbance, Anxiety and Depression (SD/AD); and Sleep Disturbance, Anxiety and Depression, and PTSD (SD/AD/PTSD). Members of the SD/AD/PTSD group were more likely to be female and had the highest withdrawal and sleep disturbance scores of all three groups. Conclusion: Findings support the use of LCA to identify subgroups of individuals with AUDs and accompanying sleep disturbances. Class identification may provide clinicians with insight into the integrative tailoring of interventions that meet the varied needs of individuals with AUDs, accompanying comorbidities, and sleep disturbances.
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Affiliation(s)
- Gwenyth R. Wallen
- Corresponding author. National Institutes of Health Clinical Center, 10 Center Drive Room 2B09, MSC-1151, Bethesda, MD 20892, USA. address:
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6
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Wojciechowski TW. Heterogeneity in the Development of Drug Use Versatility: Risk Factors for Polydrug Use throughout the Life-Course. Subst Use Misuse 2019; 54:758-768. [PMID: 30636563 DOI: 10.1080/10826084.2018.1536721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Polydrug use is a major public health issue associated with numerous undesirable physical and mental health outcomes. While past research has identified risk factors for polydrug use and elevated drug use variety, there has yet to be any research which seeks to examine this phenomenon from a developmental perspective. There also has yet to be any research which examines the impact of risk factors for predicting differential development. OBJECTIVES Identify developmental subgroups of polydrug use. Identify risk factors predicting heterogeneity in development. METHODS The Pathways to Desistance data were used in this research. The present study used group-based trajectory modeling to elucidate general developmental patterns of drug use variety and sought to identify risk factors predicting the heterogeneity in the development of this outcome using multinomial logistic regression among a sample of juvenile offenders. RESULTS A six group model best fit the drug use variety count data. Several risk factors were identified which predicted assignment to the most problematic developmental subgroup, including: low self-control, low religiosity, and history of victimization at baseline. White participants were more likely to engage in any level of drug use. Conclusions/Importance: These results indicate that juvenile offenders are at-risk for chronic issues with polydrug use and more general engagement in polydrug use. Public health and criminal justice professionals should work together to develop and implement psychosocial interventions for targeting risk factors associated with accelerating and chronic polydrug use.
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Affiliation(s)
- Thomas W Wojciechowski
- a Department of Sociology and Criminology & Law and Society , University of Florida , Gainesville , Florida , USA
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7
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Wojciechowski TW. Illicit Stimulant Use Development in Adolescence and Early Adulthood Among Juvenile Offenders: Risk Factors Predicting Heterogeneity. JOURNAL OF DRUG ISSUES 2018. [DOI: 10.1177/0022042618803066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The objectives of this article are to identify groups of trajectories of stimulant use across adolescence and early adulthood among juvenile offenders and to identify risk factors predicting development. Group-based trajectory modeling was used to identify developmental subgroups of stimulant users during the study period. Multinomial logistic regression was used to examine baseline covariates’ relevance for predicting assignment to identified trajectory groups. A six-group model of stimulant use was found to best fit the data. Race, history of direct victimization at baseline, gender, low school commitment at baseline, low religiosity at baseline, and other substance use at baseline were all identified as predictors of trajectory group assignment. Juvenile offenders, particularly White and female offenders, are at elevated risk of illicit stimulant use during adolescence and early adulthood. Despite this, the vast majority of juvenile offenders in the sample had desisted by age 23, differing from research on other substances using this same sample.
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8
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Fuehrlein BS, Kachadourian LK, DeVylder EK, Trevisan LA, Potenza MN, Krystal JH, Southwick SM, Pietrzak RH. Trajectories of alcohol consumption in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. Am J Addict 2018; 27:383-390. [PMID: 29667712 DOI: 10.1111/ajad.12731] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 03/13/2018] [Accepted: 03/20/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES While alcohol use disorder is prevalent in U.S. veterans, little is known about the nature and determinants of predominant trajectories of alcohol consumption in this population. The objective of the current study was to identify predominant trajectories of alcohol consumption over a 4-year period, and baseline determinants of these trajectories in veterans. METHODS Data were analyzed from the National Health and Resilience in Veteran Study, which surveyed a nationally representative sample of 3,157 veterans (Wave 1). Assessments (Waves 2 and 3) were conducted every 2 years thereafter. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test-Consumption, a brief alcohol screen for identifying problematic drinking based on alcohol consumption. Wave 1 sociodemographic, military, health, and psychosocial variables were examined as possible determinants of trajectories of alcohol consumption. RESULTS Latent growth mixture modeling revealed that a four-class model best fit the data: rare drinkers (65.3%), moderate drinkers (30.2%), excessive drinkers (2.6%), and recovering drinkers (1.9%). Lifetime major depressive disorder (MDD) was linked to an excessive drinking trajectory, while fewer medical conditions and lower social support were linked to a moderate drinking trajectory. Having a secure attachment style and greater social support, and absence of lifetime MDD was linked to recovery from excessive drinking. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Four predominant trajectories of alcohol consumption were identified. Targeting MDD and related interpersonal factors such as attachment style and social support in population-based prevention and treatment initiatives may help prevent, mitigate, and promote recovery from excessive alcohol consumption in veterans. (Am J Addict 2018;XX:1-8).
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Affiliation(s)
- Brian S Fuehrlein
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Lorig K Kachadourian
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Elizabeth K DeVylder
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut
| | - Louis A Trevisan
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Marc N Potenza
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - John H Krystal
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut
| | - Steven M Southwick
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut
| | - Robert H Pietrzak
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut
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9
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Possemato K, Maisto SA, Wade M, Barrie K, Johnson EM, Ouimette PC. Natural Course of Co-Occurring PTSD and Alcohol Use Disorder Among Recent Combat Veterans. J Trauma Stress 2017; 30:279-287. [PMID: 28585777 DOI: 10.1002/jts.22192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 03/04/2017] [Accepted: 03/21/2017] [Indexed: 11/12/2022]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur in veterans, yet little is known about the longitudinal course of PTSD and drinking in comorbid populations. This study assessed the natural course of daily alcohol consumption and weekly changes in PTSD symptoms in 112 recent combat veterans over the course of 11 months. Latent class growth mixture modeling was used to classify individuals into distinct classes with similar PTSD symptom and alcohol use growth trajectories. We then investigated theorized predictors of class membership including sociodemographics; pre-, peri-, and postdeployment factors; coping; symptom severity; and number of mental health/substance use appointments attended. Results revealed that most participants had severe and nonremitting PTSD. Trajectories for alcohol use included gradual and drastic declines, and chronic low-level drinking. The use of behavioral health services (odds ratio = 2.47) and fewer current stressors (odds ratio = 0.42) predicted AUD remission. Because little variation was observed in the PTSD course, our study did not observe coordinated fluctuations of PTSD symptoms and heavy drinking. Our findings suggest that treatment impacts the course of AUD and that recent combat veterans who do not seek PTSD treatment may have chronic and severe PTSD symptoms.
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Affiliation(s)
- Kyle Possemato
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, New York, USA.,Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Stephen A Maisto
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, New York, USA.,Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Michael Wade
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, New York, USA
| | - Kimberly Barrie
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, New York, USA
| | - Emily M Johnson
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, New York, USA
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10
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Jester JM, Buu A, Zucker RA. Longitudinal phenotypes for alcoholism: Heterogeneity of course, early identifiers, and life course correlates. Dev Psychopathol 2016; 28:1531-1546. [PMID: 26652050 PMCID: PMC5091665 DOI: 10.1017/s0954579415001157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alcoholism is a heterogeneous disorder; however, characterization of life-course variations in symptomatology is almost nonexistent, and developmentally early predictors of variations are very poorly characterized. In this study, the course of alcoholic symptomatology over 32 years is differentiated, and predictors and covariates of trajectory class membership are identified. A community sample of alcoholic and neighborhood matched control families, 332 men and 336 women, was recruited based on alcoholism in the men. Symptoms were assessed retrospectively at baseline (mean age = 32) back to age 15 and prospectively from baseline every 3 years for 15 years. Trajectory classes were established using growth mixture modeling. Men and women had very similarly shaped trajectory classes: developmentally limited (men: 29%, women: 42%), developmentally cumulative (men: 26%, women: 38%), young adult onset (men: 31%, women: 21%), and early onset severe (men: 13%). Three factors at age 15 predicted class membership: family history of alcoholism, age 15 symptoms, and level of childhood antisocial behavior. Numerous measures of drinking and other psychopathology were also associated with class membership. The findings suggest that clinical assessments can be crafted where the profile of current and historical information can predict not only severity of prognosis but also future moderation of symptoms and/or remission over intervals as long as decades.
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11
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Wachsmuth W, Blonigen DM, Jacob T, Price RK. Course of drug use from early adulthood to mid-life among Vietnam-era veterans. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.950701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Wendi Wachsmuth
- Washington State Department of Corrections, Washington Corrections Center, Shelton, WA, USA,
| | - Daniel M. Blonigen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health System, Menlo Park, CA, USA,
| | - Theodore Jacob
- Family Research Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA, and
| | - Rumi K. Price
- Department of Psychiatry, Washington University School of Medicine, Washington, DC, USA
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12
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Cranford JA, Krentzman AR, Mowbray O, Robinson EA. Trajectories of alcohol use over time among adults with alcohol dependence. Addict Behav 2014; 39:1006-11. [PMID: 24613058 DOI: 10.1016/j.addbeh.2014.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 02/10/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
Abstract
This study sought to identify trajectories of drinking behavior change over time in a sample of adults with current alcohol use disorder (AUD). We conducted secondary analyses of seven waves of data from a prospective longitudinal study of 364 adults (mean age=44.0 years, SD=12.8 years) who met criteria for DSM-IV alcohol dependence (AD), 74.4% of whom were entering alcohol treatment. Participants were followed for 2 1/2 to 3 years with in-person interviews every 6 months. Results from latent class growth analyses of drinks per drinking day over 3 years indicated five trajectory classes: 1) Moderate Baseline→Slow Decline; 2) Heavy Baseline→Stable Abstinent; 3) Heavy Baseline→Slow Decline; 4) Heaviest Baseline→Steep Decline, and 5) Heaviest Baseline→Stable Heavy. Findings are consistent with previous research and suggest that these trajectory classes might represent longitudinal phenotypes of alcohol involvement across diverse samples. Treatment modality, Alcoholics Anonymous involvement, and purpose in life were associated with diverse trajectories of drinking behavior among adults with AD. AA involvement was associated with higher odds of membership in trajectory classes that showed declines in drinking from baseline, and having higher purpose in life predicted lower odds of membership in the Heaviest Baseline→Stable Heavy class. AA involvement predicts different pathways of recovery characterized by stable abstinence, steep declines, and/or slower declines in drinking over time. Higher purpose in life may protect against chronic heavy drinking by strengthening motivations to pursue goals that are unrelated to substance use.
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13
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Balan S, Widner G, Shroff M, van den Berk-Clark C, Scherrer J, Price RK. Drug use disorders and post-traumatic stress disorder over 25 adult years: role of psychopathology in relational networks. Drug Alcohol Depend 2013; 133:228-34. [PMID: 23726975 PMCID: PMC3786051 DOI: 10.1016/j.drugalcdep.2013.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 04/16/2013] [Accepted: 04/24/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND In traumatized populations, drug use disorders and post-traumatic stress disorder (PTSD) persist for many years. Relational factors that mediate this persistence have rarely been systematically examined. Our aim is to examine the relative effects of psychopathology in familial and non-familial networks on the persistence of both disorders over adulthood. METHODS We utilized longitudinal data from an epidemiologically ascertained sample of male Vietnam veterans (n=642). Measures included DSM-IV drug use disorders, other psychiatric disorders, network problem history and time-varying marital and employment characteristics. Longitudinal measures of veterans' psychopathology and social functioning were retrospectively obtained for each year over a 25 year period. We used generalized estimating equations (GEE) to estimate the relative effects of network problems on veteran's drug use disorders and PTSD after adjusting for covariates. RESULTS Veterans' mean age was 47 years in 1996. Prevalence of illicit drug disorders declined from 29.8% in 1972 to 8.3% in 1996, but PTSD remained at 11.7% from 13.2% in 1972. While 17.0% of veterans reported a familial drug use problem, 24.9% reported a non-familial drug use problem. In full GEE models, a non-familial drug problem was a significant predictor of illicit drug use disorders over 25 years (OR=2.21, CI=1.59-3.09), while both familial depression (OR=1.69, CI=1.07-2.68) and non-familial drinking problem (OR=1.66, CI=1.08-2.54) were significant predictors of PTSD over 25 years. CONCLUSIONS Familial and non-familial problems in networks differentially affect the persistence of drug use disorders and PTSD in traumatized male adults.
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Affiliation(s)
- Sundari Balan
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
| | - Greg Widner
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
| | - Manan Shroff
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
| | - Carissa van den Berk-Clark
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
| | - Jeffrey Scherrer
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
,Research Service, VA St. Louis Health Care System, 915 North Grand Blvd. St. Louis MO 63106, United States
,Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St. Louis MO 63104, United States
| | - Rumi Kato Price
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
,Research Service, VA St. Louis Health Care System, 915 North Grand Blvd. St. Louis MO 63106, United States
,Corresponding author. Tel.: +1 314-286-2282; fax +1 314 286 2285. (R.K. Price)
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14
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Jacob T, Blonigen DM, Upah R, Justice A. Lifetime drinking trajectories among veterans in treatment for HIV. Alcohol Clin Exp Res 2013; 37:1179-87. [PMID: 23448171 PMCID: PMC5596456 DOI: 10.1111/acer.12071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 11/21/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous work on the course of drinking across the life course identified 4 distinct patterns of problem drinking: severe chronic (SC), severe nonchronic (SNC), late onset (LO), and young adult (YA). The purpose of the current study was to determine the generalizability of these findings to a sample of midlife veterans with quite different characteristics from those previously assessed; specifically, veterans in treatment for HIV and veterans in treatment for non-HIV medical issues. METHODS Participants were drawn from the Veterans Aging Cohort Study that included HIV-positive and matched non-HIV participants. As in our earlier studies, the lifetime drinking history was used to assess drinking phases, and latent growth mixture models were used for analyses. RESULTS Similar to previous findings, both the HIV+ and non-HIV groups exhibited 4 patterns of drinking (SC, SNC, LO, and YA). SC drinkers had younger ages of onset for drinking and longer duration of smoking. SC drinkers also had the highest rates of cocaine use. Within the HIV+ subsample, SC and LO drinkers increased their drinking after their HIV diagnosis. CONCLUSIONS This study is the first to examine lifetime drinking patterns among those treated for HIV and provides an excellent starting point for examining finer-grained relationships involving drinking, onset of HIV, and treatment outcomes. Absent from the current study and of particular importance to future work in this area is the need for precise information regarding the temporal relationship between date of HIV diagnosis, onset of treatment, and changes in drinking behavior over the life course.
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Affiliation(s)
- Theodore Jacob
- Family Research Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025-2539, USA.
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15
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Capone C, McGrath AC, Reddy MK, Shea MT. Trauma-related correlates of alcohol use in recently deployed OEF/OIF veterans. J Trauma Stress 2013; 26:354-60. [PMID: 23696495 DOI: 10.1002/jts.21817] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorders (AUDs) is well documented. Little is known about the factors that contribute to alcohol use and the development of AUDs among military personnel following deployment. The primary aim of this study was to examine trauma-related correlates of alcohol use in recently deployed Operation Enduring Freedom/Operation Iraqi Freedom veterans. Members of the Rhode Island National Guard and Army Reserves (N = 238) completed an in-person, initial assessment an average of 6 months postdeployment. Multiple regression analyses examined predictors of drinking outcomes (combat exposure, total PTSD symptoms, and PTSD symptom clusters) after accounting for gender, age, and history of AUD. Results indicated that total PTSD symptoms, but not combat exposure, significantly predicted alcohol use at the initial assessment. When PTSD symptom clusters were considered separately, reexperiencing symptoms (Cluster B) were the strongest predictor of total alcohol use (B = 3.58, p = .002) and heavy drinking episodes (B = 0.31, p = .005). Implications for these findings include early identification of risk factors that could lead to the development of AUDs, and the importance of integrated treatment approaches for co-occurring PTSD and AUD among veterans postdeployment.
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Affiliation(s)
- Christy Capone
- Providence Veterans Affairs Medical Center, Providence, RI 02908, USA.
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16
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Blonigen DM, Burroughs T, Haber JR, Jacob T. Psychiatric morbidity is linked to problem drinking in midlife among alcohol-dependent men: a co-twin control study. J Stud Alcohol Drugs 2013. [PMID: 23200159 DOI: 10.15288/jsad.2013.74.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Prior research on predictors of problem drinking has been limited because of an inability to attribute an unambiguous environmental explanation to observed findings. Using a prospective co-twin control design, we examined the extent to which a history of psychiatric symptoms exerts an environmental influence on problem drinking in midlife that is unconfounded by genetic underpinnings. METHOD Participants were 367 complete male twin pairs (208 monozygotic, 159 dizygotic) from the Vietnam Era Twin Registry who were assessed in midlife as part of the Family Twin Study (Mage = 51.4 years, SD = 2.8). Twin pairs who were concordant for a lifetime diagnosis of an alcohol use disorder (AUD) in 1992 were selected for participation and were reinterviewed in 2001 to measure symptoms of AUD (i.e., problem drinking) since the prior assessment (past 10 years). RESULTS Within-pair differences in lifetime symptom counts of several psychiatric disorders measured in 1992 (i.e., major depression, dysthymia, generalized anxiety disorder, panic disorder, antisocial personality, mania, and posttraumatic stress disorder) were significantly associated with within-pair differences in AUD symptoms in the subsequent 10 years. CONCLUSIONS A history of psychiatric problems, particularly one marked by internalizing symptoms, appears to be linked to problem drinking in midlife above and beyond the confounding influence of genetic effects and underscores the potential value of integrated interventions for comorbidity to address problem drinking among individuals during this period of the life course.
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Affiliation(s)
- Daniel M Blonigen
- Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA.
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17
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Jacob T, Blonigen DM, Hubel K, Wood PK, Haber JR. Drinking course through midlife based on diagnostic versus quantity-frequency indices. Alcohol Clin Exp Res 2012; 36:477-89. [PMID: 21913942 PMCID: PMC3244505 DOI: 10.1111/j.1530-0277.2011.01619.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior efforts to examine the course of drinking from onset to midlife have been limited to analyses of year-to-year changes in alcohol dependence (AD). The current investigation sought to examine the course of drinking over this time frame using consumption-based measures of drinking and evaluate the degree of comparability in trajectories estimated from diagnostic and quantity-frequency data. METHODS Participants included 420 men with a lifetime history of AD who were drawn from the Vietnam Era Twin Registry and administered the Lifetime Drinking History, which provided person-year (retrospective) data on patterns of consumption and diagnostic symptoms from drinking onset to participants' current age. Consumption-based data were aggregated into age categories that ranged from "up to age 20" to "ages 54 to 56" and analyzed separately as a dichotomous measure of "heavy drinking (HD)" and continuous quantity-frequency index (QFI) scores. RESULTS Using latent growth mixture modeling, trajectories based on the HD measure were moderately concordant with those based on changes in AD that were previously identified in this sample, whereas trajectories based on QFI scores were only weakly related to those based on AD diagnoses. Moreover, examination of the degree of concordance between AD- and QFI-derived trajectories revealed that measures of consumption (and potentially other continuous indices of drinking) may qualify past interpretations of various developmental trajectories that have been discussed in the alcoholism typology literature (particularly "Late Onset" alcoholism). CONCLUSIONS Collectively, the findings highlight the importance of integrating repeated measures of alcohol consumption in future efforts to describe the course of drinking across the life span.
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Affiliation(s)
- Theodore Jacob
- Family Research Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California 94025-2539, USA.
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