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National 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 problems 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 reduced 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 experienced in the later years, including hypertension, stroke, diabetes, cognitive loss, falls and fractures, depression, isolation, and suicide. Additionally, tolerance 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 population 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 ofalcohol’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 papers 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 scientists whose work is represented in these pages have been actively pursuing research 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