Table Of ContentNational Institute on Alcohol Abuse arr^ Aifohol'sm
RESEARCH MONOGRAPH
33
-
Alcohol Problems
and Aging
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes ofHealth
Research Monograph No. 33
ALCOHOL PROBLEMS
AND AGING
NATIONALmINSTITUTES OF ''EALTirj
L
i
L J ' Edited by:
BLDG 10, 10 C Editl^ S. Lisansky Gomberg, Ph.D.
.^drea M. Hegedus, Ph.D.
BETHESDA, MD -
;_il.Rot>ert A. Zucker, Ph.D.
U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICES
Public Healtli Service
National InstitutesofHealth
National Institute onAlcoholAbuse andAlcoholism
6000 Executive Boulevard
MD
Bethesda, 20892
KC
A3‘/-
NIAAA has obtained permission from the copyright holders to reproduce fig-
j
AiM S ures and tables throughout this monograph. Further reproduction of these
materials is prohibited without specific permission from the copyright holders.
ft
/Q All other material contained in this monograph, except quoted passages from
copyrighted sources, is in the public domain and may be reproduced without
permission from NIAAAor the authors. Citation ofthe source is appreciated.
The U.S. Government does not endorse or favor any specific commercial
product (or commodity, service, or company). Trade or proprietary names (or
company names) appearing in this publication are used only because they are
considered essential in the context ofthe studies reported herein.
The opinions expressed herein are those ofthe authors and do not necessarily
reflect the official position of NIAAA or any other part of the National
Institutes ofHealth.
In Chapter 12, Table 2 is reprinted with permission fromJournalofStudieson
Alcohol59:180-190, 1998. Copyright © byAlcohol Research Documentation,
Inc., Rutgers Center ofAlcohol Studies, Piscataway, NJ 08855.
AODD
Keywords: elderly; aging; (alcohol or other drug use disorder);
AODE AODR
(effects ofalcohol or other drug use, abuse, and dependence);
disorder (alcohol or other drug related disorder); biochemical mechanism; dis-
AOD
ease course; treatment; intervention; prevention.
These descriptors are drawn from The Alcohol and Other Dru^ Thesaurus: A
Guide to Concepts and Terminology in Substance Abuse and Addiction^ Second
Edition, 1995 and may be used to retrieve this monograph in the Alcohol and
Alcohol Problems Science Database (commonly known as ETOH).
NIH PubHcationNo. 98-4163
Printed 1998
CONTENTS
Foreword v
Preface vii
Abbreviations andAcronyms xii
BASIC ISSUES
1 DevelopmentalAspects ofAging,Alcohol Involvement, and Their
Interrelationship
RobertA. Zucker 3
2 Methodological Issues in Survey ResearchWith OlderAmericans
A. Rc£fulaHerzo£f 25
3 Drinking in an Older Population: Cross-Sectional and Longitudinal Data
From the Australian Twin Registry
KathleenK. Bucholz, Andrew C. Heath, PamelaA.F. Madden,
WendyS. Slutske, DixieJ. Statham, MichaelP. Dunne,
and Nicholas G. Martin 41
4 Aging andAlcohol Use andAbuse AmongAfricanAmericans: ALife-
Course Perspective
JamesS.Jackson, DavidR. Williams,
andEdith S. Lisansky Gomherg 63
BIOLOGICAL MECHANISMS
5 Genetics,Aging, andAlcohol
GeraldE. McClearn 91
6 Pharmacological Interactions ofAging andAlcohol
HaroldKalant 99
7 Neuropathological Studies: The Relationship BetweenAlcohol andAging
CliveHarper, Donna Sheedy, GlendaHalliday, KayDouble, PeterDodd,
JoanneLewohl, andJillian Kril II7
1
8 Interaction ofAging and Ethanol on Brain Membrane Structure and
Neurotransmitters
W. Gibson Wood 135
9 Cerebral InjuryFrom Severe ChronicAlcoholism
Sid Gilmcm, KennethM. Adams, RobertA. Koeppe, LarryJunck,
DoupfJohnson-Greene, KarenJ. Kluin, andMaryL. Heumann 145
10 Neurotransmitter-Based Therapeutic Strategies in Late-Life Alcoholism
and OtherAddictions
David W. Oslin andAlanM. Mellow 169
COURSE AND CONSEQUENCES
11 Medical Consequences ofHeavy Drinking bythe Elderly
RichardE. Finlayson andRichardD. Hurt 193
12 Alcohol,Aging, and Cognition
SaraJo Nixon 213
13 Stress and Elderly Drinking
John W. Welte 229
14 Personality and Problem Drinking in Middle-Aged and OlderMen:
Longitudinal Findings From the NormativeAging Study
MichaelR. Levenson, CarolynM. Aldwin, Avron Spiro III,
andLeanne Friedman 247
J.
15 Life ContextFactors, Treatment, and Late-Life Drinking Behavior
RudolfMoos, FennyBrennan, andKathleen Schutte 261
16 Effects ofAlcohol on Sleep
MichaelS. Aldrich 281
17 Alcohol,Aging, and Driving
PatriciaF. Waller 301
11
TREATMENT AND PREVENTION
18 Alcohol Problems in Health Care Settings: Prevalence, Causal Factors,
and Interventions
WendyL. Adams 323
19 OlderAlcoholAbusers: Recurring Treatment Issues
Larry W. DupreeandLawrenceSchonfeld 339
20 AlcoholWithdrawal andAging
Kirk Brower 359
J.
21 The Spectrum ofAlcohol Interventions for OlderAdults
Frederic C. Blow 373
22 Natural Recovery Over the Lifespan
MarkB. Sobelly Linda C. Sobell,John C. Cunningham,
andSan^eetaA^rawal 397
23 Treatment ofComorbidityin OlderAdultsWithAlcohol Problems
MarkL. Willenbrinpf 407
24 Age-Specific Treatment for OlderAdultAlcoholics
RolandM. Atkinson 425
25 Commentary on Prevention ofAlcohol Problems in the Elderly
GayleM. Boyd 439
SUMMARY OF RESEARCH ISSUES AND PRIORITIES
26 Research Issues and Priorities
EdithS. Lisansky Gomberg, AndreaM. He^edus,
andRobertA. Zucker 451
iii
FOREWORD
One of our main tasks in the National Institute on Alcohol Abuse and
Alcoholism (NIAAA) is to identifypopulations at risk for alcohol-related prob-
lems and to develop the science-based knowledge necessary to guide the devel-
opment ofeffective treatment and prevention programs. For some time now,
we have been concerned with alcohol problems among the elderly, usually de-
fined as persons age 65 and older; compared with younger age groups, rela-
tively little is known about alcohol-related problems in this age group. Yet,
several changes in the population composition have occurred that make these
problems an increasingly important public health issue. One change is the
growing number ofpeople who are in this age group, now the fastest growing
segment ofthe U.S. population. Another is the aging ofthe large cohort ofin-
dividuals born during the post-World War II “baby boom.” This “baby
boomer” generation, the first ofwhom are nowin their fifties, appears to drink
more than generations preceding it. This alcohol consumption pattern may
herald anincrease in alcohol-relatedproblems as the “boomer” population ages.
Older persons are at special risk for some alcohol-related problems due to re-
duced alcohol tolerance, the presence ofage-related health conditions, and po-
tential alcohol/medication interactions. Both episodic and chronic drinking
appear to precipitate or aggravate a number ofconditions that may be experi-
enced in the later years, including hypertension, stroke, diabetes, cognitive
loss, falls and fractures, depression, isolation, and suicide. Additionally, toler-
ance for alcohol is reduced in older persons; and a level ofconsumption that is
moderate for a young person may be problematic for an older person. Because
alcohol problems among older persons often are mistaken for other conditions
associated with the aging process, alcohol abuse and alcoholism in this popula-
tion may go undiagnosed and untreated or be treated inappropriately. As with
their younger counterparts, alcoholism among older persons is treatable.
Regrettably, there remains a persistent belief among families, friends, and
health care providers that older individuals have earned the right to be left
—
alone if they wish to drink, even excessively, then so be it. However, every
stage of life has its own rewards for sobriety, and alcoholism treatment is
life-enhancing at any age. The expansion ofscience-based knowledge ofalco-
hol’s impact on the aging process, however, may help to counter these prevail-
ing beliefs, making the diagnosis and treatment of alcoholism among older
persons a standard ofmedical practice.
V
This monograph, AlcoholProblems andA£jin£j, which was developed from pa-
pers presented at the NIAAA-sponsored 1996 national conference on alcohol
and aging, clearly shows thatwe understand considerablymore about this sub-
ject area than we did at the time ofour first workshop on this topic in 1983.
However, it also is clear thatwe need to knowmuch more. Some ofthe scien-
tists whose work is represented in these pages have been actively pursuing re-
search on alcohol and aging for many years. Others are experienced scientists
who are relative newcomers to the alcohol research field. This is testimony to
the increasingly broad range ofbasic and biological studies that have been un-
dertaken to understand alcohol’s impact on the aging process; on the social,
economic, and health status ofolder Americans; and on society at large. Each
author has provided an excellent review ofthe state ofthe art on alcohol and
aging that 1 believe will be highlyuseful to scientists and clinicians alike.
I commend the monograph editors, Drs. Gomberg, Hegedus, and Zucker,
and the authors ofthe various papers for their efforts making this important
information on alcohol and aging accessible to awider audience.
Enoch Gordis, M.D.
Director
National Institute onAlcoholAbuse andAlcoholism
VI
