The 5-year course of alcohol abuse among young adults.

PURPOSE: This study describes the course of alcohol abuse among a nationally representative sample of young adults over a 5-year time period for the purpose of examining the validity of the DSM-IV alcohol abuse category. METHODS: DSM-IV diagnoses of alcohol abuse at baseline and follow-up were examined using logistic regression analyses. RESULTS: Alcohol abuse and dependence were shown to have different courses. Very few abusers at Time 1 became dependent at Time 2, suggesting that abuse is not merely prodromal to dependence. Females, Blacks, and high school dropouts were less likely to receive an abuse diagnosis at baseline. Marital status, family history, earlier onset of drinking, and heavy drinking were also related to abuse at baseline. Alcohol abuse at baseline, in addition to gender, marital status, family history, early onset drinking, and heavy drinking, predicted abuse at follow-up. Exclusion of the hazardous criterion item "driving after drinking too much" from the abuse diagnosis yielded similar results. DISCUSSION: The DSM-IV alcohol abuse category was shown to have some diagnostic utility.

Alcohol use among college students: the effects of prior problem behaviors and change of residence.

OBJECTIVE: This article examines the relationship between prior problem behaviors and change in residence on alcohol use patterns among college students. METHOD: Measures of alcohol consumption (e.g., drinking frequency, average consumption and frequency of heavy episodic drinking were related to residence patterns and prior problem behaviors (e.g., conduct problems. illicit substance involvement and early age at onset of alcohol consumption). Subjects (N = 2,465; 51% women) were a subsample drawn from the National Longitudinal Study of Labor Market Experience in Youth. The analysis was conducted using a linear growth model for continuous outcomes with time-invariant and time-varying covariates for each of the drinking measures. RESULTS: The results of the structural equation analysis yielded significant and direct effects related to residence patterns and prior problem behaviors. Problem behaviors were related to drinking measures; however, there was no evidence for a mediational hypothesis. Neither was there systematic evidence that the relationship between prior problem behavior and alcohol use was mediated by residence patterns. The analysis of change in residence was related to both time-specific and longer-term influences on alcohol use. CONCLUSIONS: The presence of direct and independent effects for both dispositional and high-risk environmental factors in collegiate drinking practices support targeted and diverse strategies for prevention activities.

The dimensionality of alcohol abuse and dependence: a multivariate analysis of DSM-IV symptom items in the National Longitudinal Survey of Youth.

OBJECTIVE: This article examines the factor structure of 22 symptom items used to configure the criteria of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) alcohol abuse and dependence and relates the factor structure to background characteristics. METHOD: Data for this study were drawn from the National Longitudinal Study of Labor Market Experience in Youth (NLSY). The symptom items were related to the covariates using the statistical technique of structural equation modeling generalized to dichotomous outcomes. The present model is a special case of structural equation modeling, a multiple causes and multiple indicators (MIMIC) model, in which one or more latent variables (i.e., alcohol abuse and dependence) intervene between a set of observed background variables predicting a set of observed response variables (i.e., DSM-IV symptom items). RESULTS: The results of the structural equation analysis provide further support for two dimensions underlying the DSM-IV symptom items. Although the two-factor dimension bore a strong resemblance to the DSM-IV conceptions of abuse and dependence, there were notable differences in the item content of the symptom items for each dimension. The dependence dimension drew upon items related to the abuse criteria for continued drinking despite social problems and recurrent drinking resulting in failure to fulfill role obligations. The abuse dimension drew upon items related to the abuse criterion for hazardous drinking and the dependence criterion for larger amounts over time. The two factors were shown to have different relationships to the background variables. Alcohol dependence was related to family history of alcoholism and educational status. Age was not related to dependence and inversely related to alcohol abuse. CONCLUSIONS: Findings from this study replicate the two-dimensional model for DSM-IV criteria found in other studies and provide further support for the validity of alcohol dependence in general population samples. A major implication of the factor structure in the present study relates to the different classification of cases that would otherwise be obtained with DSM-IV criteria. These departures were shown to affect abuse, which retained only 40% of DSM-IV diagnoses, more strongly than dependence, which retained 91% of DSM-IV diagnoses.

Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up.

PURPOSE: The purpose of this study was to examine the relationship between age at drinking onset and the development of DSM-IV alcohol abuse and dependence in a 12-year prospective study of youth in the United States. METHODS: Logistic regression analyses were used to quantify the relationship between age at drinking onset and the development of alcohol abuse and dependence controlling for sociodemographic factors and problem indicators. RESULTS: The odds of alcohol dependence decreased by 5% in 1989 and 9.0% in 1994 for each year drinking onset was delayed. In 1994, the odds of alcohol abuse increased by 7.0% with each decreasing year of age at drinking onset, while age at drinking onset was not related to alcohol abuse in 1989. Several other risk factors were found to be strong and consistent predictors of abuse and dependence in 1989 and 1994, including being male, divorced, separated or never married, younger, and having an early history antisocial behaviors and marijuana use. IMPLICATIONS: Implications of the results of this study are discussed in terms of other factors that may impact on the onset-abuse and onset-dependence relationship and the need to focus future prevention efforts.

Adolescent and young adult antisocial behavior and adult alcohol use disorders: a fourteen-year prospective follow-up in a national survey.

OBJECTIVE: Data from the National Longitudinal Survey of Youth (NLSY) are used to examine the association between antisocial behaviors (ASB) reported in youth (15-22 years old) and alcohol use disorders (AUD) 14 years later in a large (N = 7,326) representative national sample. METHOD: Structural equation modeling generalized to dichotomous outcomes was used to assess the associations between latent variables of ASB with latent variables of AUD and background variables. RESULTS: Exploratory factor analysis of 17 ASB items yielded three factors having clear interpretations with the literature-property offenses, person offenses and illicit substance involvement. When examined in the context of the multivariate structural equation model, several independent associations between ASB and AUD symptoms and covariates were found. Although there were significant and independent effects for each ASB factor on each of the alcohol use disorder factors, the strength of the association was strongest for the effects of early illicit substance involvement on alcohol abuse and dependence. CONCLUSIONS: Both illicit substance involvement and delinquency other than illicit substance involvement reported in 1980 were associated with alcohol use disorders 14 years later.

Marijuana use among adults. A longitudinal study of current and former users.

This study examines the pattern of marijuana use among respondents who have passed the age of risk of onset, as well as some of the correlates related to the initiation and current use of marijuana. The data for this study included 8885 respondents drawn from the National Longitudinal Survey of Labor Market Experience of Youth (NLSY). Based on cross-tabulations of lifetime marijuana use in 1984 and 1994, the following outcomes were examined: incidence of lifetime marijuana use, inconsistent reports of lifetime marijuana use, and current compared with former use. Controlling for the effects of all variables studied, significant and independent effects were noted for sociodemographic factors, former patterns of use, and the use of other substances.

Alcohol consumption and divorce rates in the United States.

OBJECTIVE: The objective of the present study is to analyze time series data on alcohol consumption and divorce rates and assess the directionality of this relationship using alternative aggregate measures of alcohol consumption rates. METHOD: Granger's causality test and Box-Jenkins time series analysis are used to examine aggregate data on divorce rates and two indicators of alcohol consumption: a per capita consumption measure based on sales and shipments, and an expenditure-based measure for U.S. data from 1934 to 1987. RESULTS: A consumption increase of 1 liter of alcohol per capita brings about an increase in the divorce rate of about 20%. This finding contrasts with results, using expenditures as the aggregate alcohol measure, that show that an increase of 1/1,000 in the divorce rate leads to a 10% increase in alcohol expenditures. (These latter findings confirm earlier published results.) CONCLUSIONS: The results from the present study provide support both for the effects of heavy drinking on divorce rates and the effects of divorce rates on expenditures for alcoholic beverages. While both aggregate measures of alcohol consumption are highly correlated, they may tap different aspects of consumption. The relationship between marital instability and alcohol consumption is far from a simple one, and more complete conceptual models need to be developed. Aggregate-level findings indicate that it is reasonable to assume that a bidirectional influence exists between divorce rates and alcohol consumption.

Prescription and non-prescription drug use: a longitudinal study.

This study examines changes in the lifetime prevalence of prescription and non-prescription drug use in a national longitudinal sample of young adults. Cohort data used in this study are from the National Longitudinal Survey, Youth Cohort (NLSY) who responded to questions on use of prescription drugs for the years 1984 and 1992 (N = 8,771). Results reveal increases in the lifetime prevalence of prescription use of sedatives, transquilizers, and stimulants. Prescription use was higher among women while non-prescription use was higher among men. Non-prescription drug use in 1984 was significantly related to prescription use in 1992.

The influence of changes in marital status on developmental trajectories of alcohol use in young adults.

OBJECTIVE: Multiple group latent curve analysis was used to assess the impact of changes in marital status on alcohol use trajectories in young adults and to test if these effects varied across ethnicity and gender. METHOD: Four years of data were obtained from a sample of young adults (N = 4,052; 54% male) drawn from the National Longitudinal Survey of Youth. Alcohol use and marital status were assessed once per year and covariates included age, gender, education and ethnicity. RESULTS: Latent curve models indicated that there was an overall nonlinear negative alcohol use trajectory across the four time points and that becoming married was reliably associated with an added down-turn to this trajectory. Multiple group models indicated that there was an interaction between ethnicity and marital status in the prediction of alcohol growth trajectories, but there was no interaction with gender. CONCLUSIONS: Becoming married for the first time exerted a unique effect on the overall developmental trajectory of alcohol use over time. This effect held for both ethnic groups but was reliably stronger for white compared to black respondents. This interaction may be attributable to lower levels of alcohol use reported by black respondents, or may be related to individual differences in reactivity to social influences by blacks relative to whites.

Time series analysis of alcohol consumption and suicide mortality in the United States, 1934-1987.

OBJECTIVE: The objective is to analyze time series data on per capita alcohol consumption and suicide mortality between 1934 and 1987. Specifically, the aim is to test the hypothesis that increases in per capita consumption are associated with increases in suicide mortality overall and in gender and age subgroups. This study also examines whether the effect of per capita consumption on subsequent rates of suicide is influenced by other aggregate factors, particularly unemployment rates, per capita income and divorce rates. METHOD: This analysis examines the temporal structure of suicide mortality, alcohol consumption and covariate time series data in the United States, 1934-1987, using the Box-Jenkins method. RESULTS: Bivariate associations between alcohol consumption and suicide rates were not significant. However, when unemployment was included in the model, increases in per capita alcohol consumption were significantly related to increases in suicide overall, for men and women, and for the young (under age 40) and middle-aged (40 to 59 years), but not for those over age 60. CONCLUSIONS: The use in modeling of other known covariates of suicide rates, particularly unemployment, affects the magnitude of the relationship between alcohol consumption and suicide. Consistent with other studies, unemployment was significantly related to suicide and was shown to confound the relationship between alcohol and suicide. The effects of changes in alcohol consumption on changes in suicide rates differ by gender and age group, which demonstrates that focusing on the total population alone can mask divergent effects that can cancel each other out when subgroups are combined.

Prevention and Treatment of Hypertension Study (PATHS): effects of an alcohol treatment program on blood pressure.

OBJECTIVE: To determine whether blood pressure is reduced for at least 6 months with an intervention to lower alcohol intake in moderate to heavy drinkers with above optimal to slightly elevated diastolic blood pressure, and whether reduction of alcohol intake can be maintained for 2 years. DESIGN: A randomized controlled trial. METHODS: Six hundred forty-one outpatient veterans with an average intake of 3 or more alcoholic drinks per day in the 6 months before entry into the study and with diastolic blood pressure 80 to 99 mm Hg were randomly assigned to a cognitive-behavioral alcohol reduction intervention program or a control observation group for 15 to 24 months. The goal of the intervention was the lower of 2 or fewer drinks daily or a 50% reduction in intake. A subgroup with hypertension was defined as having a diastolic blood pressure of 90 to 99 mm Hg, or 80 to 99 mm Hg if recently taking medication for hypertension. RESULTS: Reduction in average weekly self-reported alcohol intake was significantly greater (P<.001) at every assessment from 3 to 24 months in the intervention group vs the control group: levels declined from 432 g/wk at baseline by 202 g/wk in the intervention group and from 445 g/wk by 78 g/wk in the control group in the first 6 months, with similar reductions after 24 months. The intervention group had a 1.2/0.7-mm Hg greater reduction in blood pressure than the control group (for each, P = .17 and P = .18) for the 6-month primary end point; for the hypertensive stratum the difference was 0.9/0.7 mm Hg (for each, P = .58 and P = .44). CONCLUSIONS: The 1.3 drinks per day average difference between changes in self-reported alcohol intake observed in this trial produced only small nonsignificant effects on blood pressure. The results from the Prevention and Treatment of Hypertension Study (PATHS) do not provide strong support for reducing alcohol consumption in nondependent moderate drinkers as a sole method for the prevention or treatment of hypertension.

Effects of early drinking and an antisocial orientation on the alcohol use of young Russians.

Drawing upon data from the Survey of Deviant Behavior Among Youth in the Moscow Region of Russia, this paper examines the effects of early drinking behavior and an antisocial orientation on the use of alcohol by young Russians. Using available data from the U.S. National Household Survey of Drug Abuse, the use of alcohol and the effects of early drinking among youth in the Moscow Region and the United States are compared. The analysis of the data from the two surveys indicates that a greater proportion of Russian youth began drinking by the age of 12 but that early drinking is associated with subsequent alcohol use among both Russian and American youth. Although there are no data on an antisocial orientation from the U.S. survey, there are such data from the Russian survey and an analysis of this data indicates that the greatest alcohol use is found among young Russians who began drinking by the age of 12 and who have an antisocial orientation.

The relation between heavy alcohol use and bar patronage: a latent growth model.

OBJECTIVE: Random effects latent growth (LG) models were used to study the relation between changes in heavy alcohol use and changes in the frequency of bar patronage over a 3-year period. Previous research has identified a close link between alcohol use and bar patronage, but these cross-sectional findings limit inferences about possible temporal ordering. LG models are highlighted and compared with the more traditional but restricted cross-lagged models. METHOD: Three annual measures of heavy alcohol use and frequency of bar patronage were administered to a sample of 3071 adults (62% male) who participated in the National Longitudinal Study of Youch from 1982 to 1984. Background variables included age, gender, ethnicity and marital status. RESULTS: Heavy alcohol use and bar patronage were characterized by negative longitudinal growth trajectories and there was significant individual variability in these changes over time. Changes in heavy alcohol use closely paralleled corresponding changes in bar patronage. Finally, the Time 1 measures of each construct were inversely predictive of subsequent changes over time in the second construct. CONCLUSIONS: These findings suggest that heavy alcohol users tended to continue to patronize bars, and bar patronage tended to encourage continued heavy alcohol use. This relation was particularly strong for singles and males. Compared to more traditional cross-lagged models, LG modeling appears to be a much stronger analytic technique for studying growth over time. It is recommended that LG models be used for future studies of change in alcohol use over time.

Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey.

The purpose of this study was to describe detailed patterns of comorbidity between Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition (DSM-IV) alcohol use disorders and major depression using a representative sample of the United States. Comorbidity rates and associations between DSM-IV alcohol use disorders and major depression were expressed as odds ratios with confidence intervals adjusted for the complex design characteristics of the NLAES. Comorbidity analyses were presented by sex, ethnicity and age for past year, prior to past year and lifetime diagnoses. Virtually all odds ratios were significantly greater than 1.0, demonstrating that comorbidity of alcohol use disorders and major depression is pervasive in the general population. The magnitude of the association remained stable across the three time frames but diagnostic and subgroup variations in comorbidity were noted. The association between alcohol dependence and major depression was greater than the association between abuse and major depression and the association between alcohol abuse and major depression was consistently greater for females and blacks, compared to their male and non-black counterparts. Implications of the results are discussed in terms of professional help seeking, the self-medication hypothesis, and differential social control theory.

The Alcohol Use Disorder and Associated Disabilities Interview schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample.

Using a representative sample of the general population, the test-retest reliability of the alcohol and drug modules of the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS) was examined. The AUDADIS showed good to excellent reliability for measures of alcohol consumption and use of sedatives, tranquilizers, amphetamines, opioids (other than heroin), cannabis and cocaine. Equally good reliability was demonstrated for diagnoses of alcohol, cannabis, cocaine and heroin abuse or harmful use and dependence defined in terms of the International Classification of Diseases-Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders-Third Edition-Revised (DSM-III-R) and Fourth Edition (DSM-IV). Results are discussed in terms of the need for future research on the psychometric properties of the AUDADIS in clinical and general population samples.

Variation in the association of alcohol consumption with five DSM-IV alcohol problem domains.

Data from a nationally representative sample of the U.S. adult population were used to investigate the association between alcohol consumption and five discrete problem domains included in the DSM-IV formulations for alcohol abuse and dependence. Two dimensions of consumption were considered in the analysis: average daily ethanol intake and the relative frequency of drinking five or more drinks. The sample consisted of 22,102 adults defined as current drinkers. After controlling for various sociodemographic characteristics, family history of alcoholism, and age at onset of drinking, both consumption measures retained significant levels of association within all five problem domains. The magnitudes of the odds ratios at selected levels of consumption were approximately 50% greater for the domains of impaired control, continued drinking despite problems and hazardous drinking than for the domains of tolerance and withdrawal. Moreover, the factors that modified the effect of the consumption measures varied markedly across domains, with age, college education, and race the most consistent modifiers of the effect of alcohol consumption.

Prevention and Treatment of Hypertension Study (PATHS). Rationale and design.

Alcohol consumption has been recognized as an important correlate of blood pressure in many epidemiologic studies, but few interventional studies have been conducted to examine the effect of a reduction in alcohol intake on blood pressure. Because these studies have usually included few subjects and been of short duration, the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Veterans Affairs (VA) Cooperative Studies Program have initiated a randomized, controlled, multicenter trial to determine whether blood pressure and left ventricular mass are lowered over 6 months of alcohol moderation in non-dependent moderate to heavy drinkers (three or more drinks per day average but not alcohol dependent) with above-average normal (80 to 89 mm Hg) and mildly hypertensive (90 to 99 mm Hg) levels of diastolic blood pressure, and whether a reduction in alcohol intake can be maintained for 2 years. Eligible veterans are randomized to either an alcohol reduction intervention or a control observation group at seven clinical sites. The projected sample size is 580 participants. Alcohol intake is assessed by self-report using a retrospective diary (Chronological Drinking Record) and by various biochemical markers, including apolipoproteins, HDL cholesterol (and subfractions), and carbohydrate deficient transferrin, analyzed at a central laboratory. The alcohol intervention technique is a cognitive-behavioral program, the intensive phase of which consists of six counseling sessions over 3 months. Echocardiograms are obtained at baseline and 6 months after randomization. This trial has important implications for both the prevention and treatment of hypertension.

The effects of order of questions on reported alcohol consumption.

This research note draws upon the US National Longitudinal Survey (NLS) of Labor Market Experience among youths aged 17-24 to report the effects of variation in the ordering of alcohol questions upon the prevalence of heavier drinking. A secondary analysis of the NLS indicated a substantial decrease in the prevalence of heavier drinking between 1984 and 1985 which is attributed to the order of presentation of two differently styled questions regarding heavier drinking.

Antisocial behavior, family history, and alcohol dependence symptoms.

Drawing on data from the National Longitudinal Survey of young adults, this study examines the effects of antisocial behavior on alcohol dependence among young men and women in the United States. An analysis of the data from the study indicates that there are effects of antisocial behavior and that these effects cannot be attributed to a lower social class family of origin or to a positive family history of alcoholism. The analysis also indicates that the strongest effects are found among young adults with both antisocial behavior and a positive family history.

Relationship between age and drinking patterns and drinking problems among Japanese, Japanese-Americans, and Caucasians.

Comparing alcohol consumption patterns by age and gender among Japanese in Japan and Japanese-Americans and Caucasians in the United States, this study examined the associations between age and both heavy drinking and social problems using logistic regression for each ethnic group of male current drinkers. As reported in previous studies of Caucasians, men drink more alcohol than women, older respondents are more likely than younger ones to be abstainers, and the percentages of heavier drinkers and problem drinkers are higher among the young than among older people. Although Japanese-Americans reported consuming less alcohol than Caucasians, their drinking patterns by age were similar: among both United States populations, younger respondents are at higher risk for drinking problems than older respondents, even when alcohol consumption and sociodemographic variables are controlled by logistic regression. However, this association of age and drinking patterns and drinking problems is not universal. Japanese men consumed more alcohol and had a higher proportion of heavier drinkers in the middle age groups; the association between age and drinking problems also varied in this group. In addition to aging, sociocultural factors such as drinking norms probably account for the differences in drinking behavior among different age groups. This study may stimulate further cross-cultural comparison of drinking patterns and problems.