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Course of Alcohol Use Disorders: Data from a 35 Year Follow Up

Course of Alcohol Use Disorders: Data from a 35 Year Follow Up. Priscila Dib Gonçalves, Ph.D. Marc A. Schuckit, M.D. Tom L. Smith, Ph.D. University of São Paulo; University of California San Diego. This Lecture Covers. Background on this study - Definitions - AUD clinical course

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Course of Alcohol Use Disorders: Data from a 35 Year Follow Up

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  1. Course of Alcohol Use Disorders: Data from a 35 Year Follow Up Priscila Dib Gonçalves, Ph.D. Marc A. Schuckit, M.D. Tom L. Smith, Ph.D. University of São Paulo; University of California San Diego

  2. This Lecture Covers • Background on this study - Definitions - AUD clinical course • San Diego Prospective Study results

  3. This Lecture Covers • Background on this study - Definitions - AUD clinical course • San Diego Prospective Study results

  4. Middle Age Heavy Drinking • Prevalent 25%: men drink daily or have 5+ drinks/day • ↑ BAC/drink with age • ↑ age → ↓ alcohol oxidation • Higher body fat vs. muscle as ↑ age: ↑ BAC/drink • Most alcohol-related deaths occur ages 45-60

  5. Alcohol Use Disorders (AUDs) • Chronic • Persistent pattern of problems • Onset early to mid 20s • Middle age AUD prevalence • 10% past year • 28% lifetime • AUDs ↓ lifespan ~10 years

  6. This Lecture Covers • Background on this study - Definitions - AUD clinical course • San Diego Prospective Study results

  7. High Risk Drinking Standard drink = 10-12 grams of ethanol 8oz malt 12oz beer 5oz wine 1.5oz liquor National Institute on Alcohol Abuse and Alcoholism (NIAAA) (2010)

  8. DSM-IV AUD Criteria Dependence (3+ criteria) Abuse (1+ criterion) - Tolerance - Unable to stop/cut down - Taken ↑ amounts/periods - Given up activities - A lot of time spent - Use despite health probl. - Withdrawal - Failure major roles - Hazardous use - Legal problems - Use despite social probl. Remission: abstinence of all symptoms

  9. Level of Response (LR) • LR rationale • - Youth drinks for effects • - If need more for effect→ will drink more • Instrument • Self-Report of the Effects of Alcohol • - Number of drinks required up to 4 effects • - ↑ Scores → more drinks for effects = ↓ LR • Low LR: predicts heavy drinking and AUDs

  10. This Lecture Covers • Background on this study - Definitions - AUD clinical course • San Diego Prospective Study results

  11. AUD Course • Onset early to mid 20’s • Fluctuates • - Heavy drinking • - Remission • Remission types • - Non-abstinence (2 types) • - Abstinence

  12. Remission Types and Predictors • Drinking Abstain Lo risk Hi risk • Predictors • Drinking intensity Low ? High • Drinking frequency Low ? High • Alcohol problems Low ? High • AUD onset Late ? Early • Dependence No ? Yes • Treatment/ AA No ? Yes

  13. This Lecture Covers • Background on this study - Definitions - AUD clinical course • San Diego Prospective Study results

  14. Longitudinal Studies • Important to: • - Evaluate AUD course • - Observe remission predictors • But few studies are • - > 10 years • - Begin early and continue to age 50+ • - Distinguish between drinking outcome types

  15. San Diego Prospective Study • University of California, San Diego (UCSD) • 453 participants at study entry 1978-1988 • - 18-25 year-old white males • - Students/non-academic staff UCSD • - No baseline alcohol dependence • - 50% had a parent with AUD

  16. Assessments • Baseline: Age 20 • Interview and alcohol challenge • Followed at 10 years; then every 5 years • Alcohol, drug, psychiatric problems • Additional measures at some follow ups • Self-Report of the Effects of Alcohol (SRE) • Personality • “Significant other” report

  17. Probands at Age 50 Original sample: 453 men 11 died 442 followed 397 in all follow ups through age 50 (90%) 165 developed AUD by age 50 156 of AUDs followed at age 55 (94.5%)

  18. Hypotheses • 1. Most will have low risk/abstinence at 55 • 2. Remission outcome characteristics • Lo risk Hi risk Abstain • AUD onset Late Early Early • LR High Low Low • Prior drinking Low High High • Alcohol problems Low High High • Other drug use Low High High LR= level of response

  19. Age 50-55 Outcomes • Group (%)AbstinentRisky Drinking1+ DSM • Low (14) No No No • High (20) No Yes No • AUD (56) No N/A Yes • Abstain (10) Yes N/A N/A

  20. Groups = at Baseline (Age 20) • Demography 23 years old • 14% were married • 80% had a religion • Drinking patterns 3 drinks/usual • 10 days/month • + Family History AUD 65%

  21. Groups From 50 to 55 • = Demography 17 years of education • 92% ever married • 34% ever divorced • 60% high job status • ≠ Drinking patterns • Low risk High risk AUD • - Frequency 12 17 21 • - Usual quantity 1.7 2.4 3.4 • - Max quantity 3.2 6.8 9.0

  22. Overall Substance Use 30-50 • Drinking patterns 3 drinks/usual • 15 drinks/max • AUD onset 29 years old • Drug use 63% tobacco • 85% cannabis • 50% stimulants

  23. Groups Differed Ages 30-50 • Lo risk Hi risk AUD Abstain • Level of response 3.8 4.3 4.7 5.8 • Usual frequency 12 16 19 18 • Dependence, % 48 53 63 93 • Treatment/AA, % 5 15 18 67 • CUD, % 10 16 28 53 CUD = cannabis use disorders

  24. Group Membership Predictors • Analyses: logistic regression • Results showed in odds ratios • Lo risk Hi risk Abstain • Drinks for effect 0.48 2.03 • Usual frequency 0.34 • Treatment 8.66 • CUD 4.68 CUD = cannabis use disorders

  25. Take Home Message • AUDs: persistent in white collar men (56%) • Remission types and predictors • - Low risk drinking: ↑ LR, ↓ alcohol frequency • - High risk drinking: similar to active AUD • - Abstinence: ↓ LR, ↑ treatment, ↑ CUD • Physicians: screen for alcohol use & problems • - 50’s & 60’s • - All socioeconomic status

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