Objectives: The major goal of the proposed study is to evaluate alcohol outcomes among mid-late life veterans with a history of Alcohol Dependence (AD), and in so doing, to better understand differences in the course of alcoholism over the lifecourse, the predictors of successful remission, and the value of alternative treatment interventions for those veterans least likely to obtain conventional treatment. Our work over the past four years and the emergent findings described in this application provide the foundation for our project's next phase.
Aim 1 : To examine history of AD and other predictors of drinking and drinking-related outcomes in late life.
Aim 2 : To extend our work on the course of drinking to incorporate information on change and stability of problem drinking from mid to late life.
Aim 3 : To control for genetic influences in assessing events and conditions that may be most beneficial to target in existing or future evidence-based treatments.
Aim 4 : To identify barriers that keep mid-late life drinkers from seeking treatment and the types of nonconventional interventions that the veteran may be more likely to engage. Research Plan/ Methodology: The Principal Investigator's (PI's) current Merit Review project has assessed an unusual sample of veterans (1774 total, 841 with a lifetime history of AD) obtained from the Vietnam Era Twin Registry (VETR). An extensive assessment of this sample was conducted in 2001 when veterans averaged 50 years of age. Combining this data with materials from previous VETR-based studies (of these same veterans) allows for longitudinal assessments of drinking over the life course and identification of predictors of remission and relapse. This renewal application builds upon and extends this work as these veterans transition from midlife to later life (the 2011 assessment;average age=60 years) where we focus on (1) change and stability of problem drinking during mid to later life, (2) predicting late-life outcomes from various individual, interpersonal and contextual influences, and (3) identifying barriers to treatment and alternative approaches that will enhance treatment of veterans with Alcohol Use Disorder (AUD). Clinical Relevance: Given the large and increasing number of mid-late life veterans with AUD (over 350,000 veterans with AUD seen in the VA in 2008), it is essential that we achieve a better understating of alcoholism and comorbid disorders over the life course in order to develop more effective strategies for reducing the severity and persistence of alcoholism. The proposed study is aimed at providing this knowledge. Findings or Conclusions to Date: Notable findings: (1) the identification of 4 distinct drinking trajectories over the life course (severe chronic, severe nonchronic, young adult and late onset);(2) the identification of personality characteristics , coping strategies and earlier psychiatric disorders that are predictive of transitions from first drink to first AD episode and years from first AD episode to first remission;and (3) obtaining important validly data on the retrospective LDH procedure demonstrating correspondence between retrospective and prospective reports regarding key drinking measures.
Each year, over 350,000 veterans within the VA are diagnosed with Alcohol Abuse or Dependence (AUD) and approximately 2/3 of these veterans are between 40 and 60 years of age. Clearly, increased knowledge of mid-to-later life alcoholism is essential for the development of more efficient and effective interventions tailored to this population. The current project will contribute to this knowledge base by identifying predictors of successful remission, differentiating those with AUD in terms of differences in the developmental course of the disorder, and identifying barriers to treatment and alternative treatment interventions that are more likely to engage the large number of veterans with AUD who do not seek out conventional treatment.