Loosening the Grip: a handbook of Alcohol Information 9th

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Nelson TF, Wechsler H. Alcohol and college athletes. Medicine and Science in Sports and Exercise 33(1): 43–47, 2001. (14 refs.)
Purpose: This study examines heavy episodic alcohol consumption and associated harms in collegiate athletes in the United States. The factors which may promote or deter such use are explored. Methods: Randomly selected students in a nationally representative sample of 4- yr colleges in the United States completed self-report questionnaires in the spring of 1997. Athletes were defined as students who participated in one or more hours of intercollegiate athletics per day. Heavy episodic or "binge" drinking for men was defined as consuming five or more alcoholic drinks on at least one occasion in the past 2 wk and four or more for women. Athletes were compared with other students at their colleges. Results: Athletes reported more binge drinking, heavier alcohol use, and a greater number of drinking- related harms. Athletes are more likely to exhibit the strong social ties found to be associated with binge drinking. Athletes, despite drinking more heavily than other students, report greater exposure to alcohol prevention efforts and possess unique motivations to limit their alcohol use. Conclusions: Athletes are a high-risk group for binge drinking and alcohol-related harms. Although special educational programs have targeted this group they have not sufficiently impacted the problem. Future prevention efforts targeted for athletes should address the unique social and environmental influences on athletes. Programs should also take advantage of motives of athletes for self-limiting alcohol intake. Colleges, athletic departments, coaches, and sports medicine professionals are urged to act to help reduce athletes risk of alcohol-related harms. Copyright 2001, American College of Sports Medicine

O’Brien MC, Mccoy TP, Champion H, Mitra A, Robbins A, Teuschlser H, et al. Single question about drunkenness to detect college students at risk for injury. Academic Emergency Medicine 13(6): 629–636, 2006. (81 refs.)

Objectives: To examine the frequency of injuries reported by college students who replied affirmatively to the question, "In a typical week, how many days do you get drunk?" Methods: In Fall 2003, a Web-based survey was administered to a stratified random sample of 3,909 college students from ten North Carolina (NC) universities. Students answered questions regarding alcohol use and its consequences. Data were analyzed using multiple logistic regression, controlling for within-school clustering of drinking behaviors and adjusting for other significant covariates. Adjusted odds ratios (AORs) and 95% confidence intervals (CI) were calculated for significant predictors (p < 0.05). Results: Two thousand four hundred eighty-eight students reported that they are current drinkers; 1,353 (54.4%) reported getting drunk at least once in a typical week. Compared with students who did not report getting drunk at least once a week, these students had higher odds of being hurt or injured at least once as a result of their own drinking (AOR = 4.97; 95% Cl = 3.47 to 7.09), experiencing a fall from a height that required medical treatment (AOR = 2.16; 95% Cl = 1.36 to 3.43), and being taken advantage of sexually as a result of another's drinking (AOR = 2.59; 95% Cl = 1.72 to 3.89). Students who reported getting drunk at least one day in a typical week also were more likely to cause an injury requiring medical treatment to someone else. They had higher odds of causing injury in an automobile crash (AOR = 1.84; 95% Cl = 1.01 to 3.40), of causing a burn that required medical treatment (AOR = 2.85; 95% Cl = 1.51 to 5.39), and of causing a fall from a height that required medical treatment (AOR = 2.02; 95% Cl = 1.01 to 4.04). Getting drunk was a better indicator of "self-experienced injury" and of "injury caused to someone else" than was binge drinking, for all outcomes (p < 0.05). Conclusions: The single question, "In a typical week, how many days do you get drunk?" identifies college students who are at higher than normal risk of injury as a result of their own drinking and the drinking of others. Future research should assess this question's effectiveness as a screening tool in campus health centers and in emergency departments. (Copyright 2006, Society for Academic Emergency Medicine)

Park CL. Positive and negative consequences of alcohol consumption in college students. Addictive Behaviors 29(3): 311–321, 2004. (20 refs.)

While the negative consequences of alcohol use in college students are well known, less is known about the relationships of these consequences to alcohol consumption patterns. Further, almost no research has been conducted examining students' positive alcohol-related consequences. The current study examines the nature and frequency of positive and negative alcohol-related consequences, the relationship of these consequences to alcohol consumption patterns, and the impact of these consequences on subsequent drinking intentions. Findings indicate that college student drinking does indeed involve many negative consequences, some of which are quite serious, but that students also experience many positive consequences. In fact, they report their encounters with positive consequences as being more extreme and more frequent than their encounters with negative consequences. Further, consuming more alcohol is related to experiencing more positive and more negative consequences, as well as more extremely positive positive encounters, but not more extremely negative negative ones. Finally, participants reported that their positive and negative consequences would influence their future drinking decisions in a number of different ways. Future research directions and implications for interventions are discussed. (Copyright 2004, Elsevier Science)

Pedersen ER, LaBrie J. Drinking game participation among college students: Gender and ethnic implications. Addictive Behaviors 31(11): 2105–2115, 2006. (30 refs.)

Participation in drinking games by college students has recently sparked research attention. While previous research indicates that women play drinking games at lower frequencies than men, the current study reveals that college women may be playing games at rates similar to college men. In a sample of 105 coed college students, participants completed a 3-month Timeline Followback recording every drinking event and quantity consumed. They then were prompted to identify which drinking events involved drinking games and how much alcohol was consumed during game playing. Both men and women engaged in drinking games at similar rates and consumed more drinks on game playing days than on non-game drinking days. However, drinking game participation was related to alcohol-related consequences in women only. Further, while Caucasian participants played drinking games more often than non-Caucasian participants, an association between game participation and alcohol-related consequences emerged in non-Caucasian participants. (Copyright 2006, Elsevier Science)

Rimal RN, Real K. Understanding the influence of perceived norms on behaviors. Communication Theory 13(2): 184–203, 2003. (62 refs.)

Although a number of studies demonstrate the impact of perceived norms on human behavior, we know little about how this relation works. Extant norms-based campaigns to reduce alcohol consumption among U.S. college students fail to distinguish between descriptive and injunctive norms. In this article, we make this distinction, and we develop a model of normative influences that also includes the impact of group identity and communication patterns on students' alcohol consumption. Based on a survey of college students (N = 353), we found that descriptive and injunctive norms were different in terms of their impact on behavior. Furthermore, the inclusion of group identity and communication patterns significantly added to the explanatory power of our model. Overall, we were able to explain roughly 53% of the variance in consumption. (Copyright 2003, Oxford University Press)

Turner JC, Shu JF. Serious health consequences associated with alcohol use among college students: Demographic and clinical characteristics of patients seen in an emergency department. Journal of Studies on Alcohol 65(2): 179–183, 2004. (12 refs.)

Objective: Heavy episodic alcohol use has been associated with numerous consequences among college students. However, neither the incidence nor the demographic and clinical characteristics of serious health consequences have been clearly defined in this population. This study is conducted to better understand clinical outcomes associated with alcohol use in college students. Method: In a prospective observational study, medical records of students presenting to a large university medical center emergency department were examined. Demographic and clinical features of alcohol-related visits were gathered on patients who were enrolled as undergraduates at a 4-year public institution during 2 academic years from July 2000 through June 2002. Enrollment was similar to 12,500 undergraduates per year. Results: Of all emergency visits,13% were alcohol related; and of all undergraduate students, 0.7% presented with alcohol-related medical conditions each year. Injuries accounted for 53% of all visits, and acute intoxication accounted for 34%. Nine of 185 patients were hospitalized. Men aged 21 years and older had the highest odds of visiting the emergency department. Trauma occurred more frequently among men, students >18 years of age and white students. Accidents (84%) and fights (16%) were the sources of injuries. Acute intoxication occurred more frequently among women, students less than or equal to18 years of age and nonwhite students. Conclusions: Alcohol use contributes to a small yet significant proportion of emergency room visits for college students. Distinctive subgroups of college students, including legal-age drinkers, experience patterns of serious health consequences as a result of problem use of alcohol. (Copyright 2004, Alcohol Resarch Documentation, Inc.)

Turrisi R, Mallett KA, Mastroleo NR, Larimer ME. Heavy drinking in college students: Who is at risk and what is being done about it? (review). Journal of General Psychology 133(4): 401–420, 2006. (101 refs.)

Problem drinking and related consequences are a major social issue plaguing college campuses across the United States. Each year, alcohol is responsible for fatalities, assaults, serious injuries, and arrests that occur among college students. The authors review and discuss the risk factors, drinking patterns, and consequences that are relevant to the general student population. In addition, the authors highlight individuals at an increased risk of experiencing alcohol-related problems, such as Greek-letter social organization members and student athletes. The authors also discuss the interventions that attempt to reduce risky drinking and related problems in these subgroups as well as the future directions for research. (Copyright

Walker ET. Missing the target: How performance-enhancing drugs go unnoticed and endanger the lives of athletes. Villanova Sports and Entertainment Law Journal 20(1): 181–209, 2003. (180 legal refs.)

This Comment focuses on the anti-doping policies of different athletic organizations and groups within both the amateur and professional ranks. Section II examines the drug testing policies of assorted athletic settings, using high school athletics, the National Collegiate Athletic Association ("NCAA"), and the World Anti-Doping Agency ("WADA") as examples of amateur sports, as well as the NFL and MLB to contrast the anti-doping policies that exist within the professional sports arena. Section III discusses the frustrations encountered by these policies, using the field of available performance-enhancing drugs as a gauge for the policies' successes and failures. Section IV briefly summarizes the shortcomings of contemporary anti-doping policies, and suggests ways organizations can improve their efforts to eradicate the use of performance-enhancing drugs. (Copyright 2003, Villanova University)

Wechsler H, Lee JE, Gledhill-Hoyt J, Nelson TF. Alcohol use and problems at colleges banning alcohol: Results of a national survey. Journal of Studies on Alcohol 62(2): 133–141, 2001. (21 refs.)

Objective: This study examines student alcohol use and associated problems, including drinking and driving, at U.S. colleges that ban alcohol for all students on campus. Method: A nationally representative sample of students (N = 11,303, 61% women) attending U.S. colleges completed questionnaires regarding alcohol use and related behaviors in the spring of 1999. The responses of 2,252 students at 19 ban schools were compared with those of 9,051 students at 76 nonban schools. Results: Students at ban colleges were 30% less likely to be heavy episodic drinkers and more likely to abstain from alcohol. The lower rates of heavy episodic drinking apply to students whether or not they were heavy episodic drinkers in high school. However, among drinkers, students at ban schools engaged in as much extreme drinking as drinkers at schools that do not ban alcohol and experienced the same rate of alcohol-related problems. At schools that ban alcohol, fewer students experienced secondhand effects of the drinking of others than did students at nonban schools. Students at ban schools were not more likely to drink and drive than were students at nonban schools. Conclusions: A campus ban on alcohol may support abstention from alcohol use and reduce heavy episodic drinking and the associated secondhand effects in college. Since this is a correlational study, we cannot determine whether the lower rates of heavy episodic drinking are due to the ban or to other factors (e.g., self-selection of students to these schools). Ban schools do not enroll fewer high school heavy episodic drinkers. Copyright 2001, Alcohol Research Documentation, Inc. Used with permission

Wechsler H, Lee JE, Nelson TF, Lee H. Drinking levels, alcohol problems and secondhand effects in substance-free college residences: Results of a national study. Journal of Studies on Alcohol 62(1): 23–31, 2001. (28 refs.)

Objective: This study examines alcohol use, associated problems and secondhand effects among residents of substance-free and alcohol-free housing on U.S, college campuses. Method: In the spring of 1999, a nationally representative sample of students completed survey questionnaires regarding alcohol use and related behaviors. The responses of 2,555 (61.25% female) students living in different types of residences (substance-free, alcohol-free and unrestricted) at the 52 campuses at which these housing options existed were compared. Results: Substance-free residences were not substance-free; however, residents drank less heavily and experienced fewer alcohol-related problems and secondhand effects than students Living in unrestricted housing. They were less likely (three fifths) to engage in heavy episodic drinking. The difference between students in substance-free and unrestricted housing was greatest for students who had not been heavy episodic drinkers in high school and for those on campuses with lower overall levels of heavy episodic drinking. In contrast, students who lived in alcohol-free halls were no less likely to be heavily involved in alcohol use than were students in unrestricted housing. Conclusions: Residence in substance-free housing was associated with lower likelihood of heavy episodic drinking in college for students who were not heavy episodic drinkers in high school. Whether or not this is a causal relationship or a result of self-selection needs to be examined in a prospective study. These living arrangements are also associated with lower levels of secondhand effects. College administrators may want to consider offering or increasing their substance-free housing options as one possible method of decreasing heavy student drinking. Copyright 2001, Alcohol Research Documentation, Inc. Used with permission

Wechsler H, Lee JE, Nelson TF, Lee H. Drinking and driving among college students: The influence of alcohol-control policies. American Journal of Preventive Medicine 25(3): 212–218, 2003. (31 refs.)

Studies have reported high rates of heavy episodic drinking and alcohol-related problems, including drinking and driving, among college students. However, most studies have been conducted in single colleges or states. This study used a national sample to examine policy factors associated with alcohol-involved driving. Methods: A random sample of full-time students (N=10,904) attending a nationally representative sample of 4-year colleges in 39 states (n=119) completed self-administered questionnaires. The questionnaire examined driving after consuming any alcohol, driving after greater-than or equal to5 drinks, and riding with a high or drunk driver. Individual-level data about driving after greater-than or equal to5 drinks were linked to information on the policy environment at both local and state levels and to ratings of enforcements for drunk driving laws. Results: Drinking and driving behaviors are prevalent among a minority of college students and differ significantly among student subgroups. Students who attend colleges in states that have more restrictions on underaged drinking, high volume consumption, and sales of alcoholic beverages, and devote more resources to enforcing drunk driving laws, report less drinking and driving. Conclusion: The occurrence of drinking and driving among college students differs significantly according to the policy environment at local and state levels and the enforcement of those policies. Comprehensive policies and their strong enforcement are promising interventions to reduce drinking and driving among college students. (Copyright 2003, American College of Preventive Medicine)

Weitzman ER, Folkman A, Folkman KL, Wechsler H. The relationship of alcohol outlet density to heavy and frequent drinking and drinking-related problems among college students at eight universities. Health & Place 9:1–6, 2003. (14 refs.

To determine whether alcohol outlet density was correlated with heavy and frequent drinking and drinking-related problems, we compared ecological measures of outlet density with survey measures of drinking using a geographic information system and the Harvard School of Public Health College Alcohol Survey (n=3,421, site n=8). We identified 966 outlets within 8 2-mile study areas. Densities/site ranged from 32 to 185. Density was correlated with heavy drinking (r=0.82, p=0.01), frequent drinking (r-0.73, p=0.04) and drinking-related problems (r=0.79, p=0.02). Women, underage students and students who picked up binge drinking in college were affected. Implication for prevention and research are discussed. Copyright 2003, Pergamon-Elsevier Science Ltd

Weitzman ER, Kawachi I. Giving means receiving: The protective effect of social capital on binge drinking on college campuses. American Journal of Public Health 90(12): 1936–1939, 2000. (27 refs.

Objectives. We tested whether higher levels of social capital on college campuses protected against individual risks of binge drinking. Methods. We used a nationally representative survey of 17 592 young people enrolled at 140 4-year colleges. Social capital was operationalized as individuals' average time committed to volunteering in the past month aggregated to the campus level. Results. In multivariate analyses controlling for individual volunteering, sociodemographics, and several college characteristics, individuals from campuses with higher-than-average levels of social capital had a 26% lower individual risk for binge drinking (P<.001) than their peers at other schools. Conclusions. Social capital may play an important role in preventing binge drinking in the college setting. Copyright 2000, American Public Health Association.

Yanovitzky I, Stewart LP, Lederman LC. Social distance, perceived drinking by peers, and alcohol use by college students. Health Communication 19(1): 1–10, 2006. (52 refs.)

Many colleges in the United States are employing social norms marketing campaigns with the goal of reducing college students' alcohol use by correcting misperceptions about their peers' alcohol use. Although the typical message used in these campaigns describes the quantity and frequency of alcohol use by the average student on campus, many students may find such a vague comparison to others to be socially irrelevant. This study compares the relative weight of perceptions about alcohol use by distant versus proximate peers in the prediction of college students' personal drinking behavior. The results of analyzing data collected from a sample of college students at a large public northeastern university (N = 276) show that, as hypothesized, perceived alcohol use by proximate peers (best friends and friends) was a stronger predictor of students' personal alcohol use than perceived alcohol use by more distant peers (such as students in general), controlling for other strong predictors of alcohol use by college students (age, gender, race, off-campus residency, and sensation-seeking tendencies). The implications of these findings for the design of more effective social norms messages are discussed. Copyright 2006, Lawrence Erlbaum Associates Inc.

The Elderly

Abdullah ASM, Simon JL. Health promotion in older adults: Evidence-based smoking cessation programs for use in primary care settings. Geriatrics 61(3): 30–34, 2006. (31 refs.)

Tobacco dependency is a growing problem among older adults. Given the addictive nature of tobacco use, smokers need a multifactorial treatment program to help stop smoking. Health care professionals can play a pivotal role in the promotion of a smoking cessation treatment program to people of all ages, including the elderly. This paper presents important evidence that smoking cessation services for the elderly are effective, and describes how primary care physicians can support elderly people quit smoking. (Copyright 2006, CIBA)

Appel DW, Aldrich TK. Smoking cessation in the elderly. Clinics in Geriatric Medicine 19(1): 77+, 2003. (96 refs.)

The risks of smoking are multiple and serious, resulting in premature death for at least 50% of long-time smokers. Although smoking is less prevalent among people over age 65 than among younger people, there are well over 3 million geriatric smokers in the United States. The firmly established habituation and fatalism of many older smokers create special challenges for those who try to encourage them to quit, but there is substantial and growing evidence that smoking cessation yields important benefits in quality and length of life, even for long-term, elderly smokers. Obstacles to smoking cessation include erroneous belief systems, misinformation, habituation, nicotine addiction, and short-term physical and psychological benefits of smoking. Geriatricians can improve the chances that their patients will quit smoking by regarding every patient contact as an opportunity to encourage smoking cessation by offering at least brief interventions to all, and, for those who agree to attempt to quit, by arranging brief or (more effectively) intense smoking cessation programs. Effective programs include behavioral modification techniques, nicotine replacement therapy, and, if indicated, bupropion therapy. The authors review in detail their approach to behavioral modification, usually in combination with nicotine replacement, an approach that results in substantial smoking cessation rates for geriatric patients. Clinicians can influence their patients to quit smoking, and they should. Copyright 2003, W.B. Saunders Co.

Atkinson RM. Late onset problem drinking in older adults (review). International Journal of Geriatric Psychiatry 9(4): 321–326, 1994. (28 refs.)

After the first descriptions of late onset alcoholism in the early 1970s, no systematic attention followed for more than a decade. In the past 10 years, however, that has changed, and this report seeks to summarize recently acquired knowledge about late onset problem drinking, including the author's own work on this phenomenon. The incidence of new alcoholism cases does decline with age but remains appreciable in the late sixties. Samples of ageing alcoholics in treatment show that as many as 1/4 to 2/3 of cases had onset after age 60. Risk factors for late onset alcoholism include female gender, higher socioeconomic status and (in some but not all studies) life stressors, but neither psychiatric comorbidity nor positive family history of alcoholism appears to contribute in a majority of cases. Compared to longstanding alcoholics, late onset cases tend to be milder and more circumscribed, and they may also fluctuate more, with an apparently high likelihood of spontaneous remission, at least over the short term. These characteristics have implications for the use of brief and informal interventions to prevent and reduce late onset problem drinking, but also suggest caution in interpreting the response of late onset cases to treatment in uncontrolled studies. Present knowledge of late onset alcoholism is fragmentary; more systematic clinical research on its characteristics and treatment is needed. Copyright 1994, John Wiley & Sons, Ltd.

Barrick C, Connors GJ. Relapse prevention and maintaining abstinence in older adults with alcohol-use disorders. Drugs & Aging 19(8): 583–594, 2002. (71 refs.)

Although older adults are sometimes believed to have the lowest rates of alcohol abuse as an age cohort, the prevalence of alcohol use and abuse in this group is clearly underestimated. The under-diagnosis of alcohol abuse is due, in part, to the facts that the effects of alcohol use among older adults tend to be less clearly visible than among other age groups and that older adults are less likely to seek treatment than younger age groups. An additional challenge to diagnosis may be a lack of previous alcohol abuse by the patient, as approximately one-third of older adults with alcohol-use problems first develop their drinking problem after the age of 60 years. With a demographic shift that is expected to increase the number of older adults with alcohol problems, the awareness and understanding of this problem becomes increasingly important. Under-diagnosis of problem drinking in older adults is particularly unfortunate because the risks associated with alcohol abuse and relapse for the elderly are significant. Relapse, or the return to drinking following abstinence, may follow situations that are of particularly high risk for older adults. These include situations related to anxiety, interpersonal conflict, depression, loneliness, loss or social isolation. By helping patients to monitor these high- risk situations, to identify strategies that have been successful in promoting abstinence in the past, and to become engaged in treatment, relapse may be avoided and abstinence maintained. Treatments such as cognitive-behavioural therapy, group and family therapies and self-help groups are just as effective for older adults as they are for other age groups. In fact, group and family therapies and self-help groups may be of particular benefit to older adults because of the emphasis on social support. Medicinal adjuncts are also equally effective in the elderly, but strict compliance and careful monitoring of adverse effects are especially important in patients who take multiple medications. Because of their benign adverse effect profiles, naltrexone and acamprosate are particularly good pharmacological agents for relapse prevention in older adults. Copyright 2002, Adis International Ltd.

Blow FC. Substance Abuse among Older Adults. Treatment Improvement Protocol. (TIP) Series 26. Rockville MD: Center for Substance Abuse Treatment, 1998. (418 book refs.)

This report brings together the literature on substance abuse and gerontology to recommend best practices for identifying screening, assessing, and treating alcohol and prescription drug abuse among people ae 60 and older. The initial chapter provides an Executive Summary and Recommendations. Chapter 1 discusses the dimensions of substance abuse among older adults. Chapter 2 focuses on alcohol use, and chapter 3 the use of psychoactive prescription drugs and over-the-counter medications. Chapter 4 considers identification, screening, and assessment. Chapter 5 examines referral and treatment approaches. Chapter 6 reviews outcomes and cost issues in alcohol treatment. Appendix A is devoted to legal and ethical concerns. Appendix B reproduces copies of screening and assessment instruments. Copyright 2000, Project Cork

Brower KJ, Mudd S, Blow FC, Young JP, Hill EM. Severity and treatment of alcohol withdrawal in elderly versus younger patients. Alcoholism: Clinical and Experimental Research 18(1): 196–201, 1994. (12 refs.)

The authors conducted a retrospective chart review of older (n = 48; mean age = 69) and younger (n = 36; mean = 30) patients who were admitted to residential/inpatient treatment for alcohol withdrawal and dependence. Although the two age groups did not differ in terms of recent drinking history, the elderly group had significantly more withdrawal symptoms for a longer duration than the younger group. The elderly group also had more symptoms of cognitive impairment, daytime sleepiness, weakness, and high blood pressure. Finally, no significant differences were found between age groups in either the dosage or number of days of detoxification medication, although a trend was found for more days of medication in the elderly. The authors conclude that alcohol withdrawal may be more severe in elderly than in younger persons. Accordingly, treatment may take longer and should target the specific profile of symptoms that characterize alcohol withdrawal in the elderly. Copyright 1994, Research Society on Alcoholism.

Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL. National surveillance of emergency department visits for outpatient adverse drug events. Journal of the American Medical Association 296(15): 1858–1866, 2006. (48 refs)

Context:  Adverse drug events are common and often preventable causes of medical injuries. However, timely, nationally representative information on outpatient adverse drug events is limited. Objective  To describe the frequency and characteristics of adverse drug events that lead to emergency department visits in the United States. Design, Setting, and Participants  Active surveillance from January 1, 2004, through December 31, 2005, through the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project. Main Outcome Measures  National estimates of the numbers, population rates, and severity (measured by hospitalization) of individuals with adverse drug events treated in emergency departments. Results  Over the 2-year study period, 21 298 adverse drug event cases were reported, producing weighted annual estimates of 701 547 individuals (95% confidence interval [CI], 509 642-893 452) or 2.4 individuals per 1000 population (95% CI, 1.7-3.0) treated in emergency departments. Of these cases, 3487 individuals required hospitalization (annual estimate, 117 318 [16.7%]; 95% CI, 13.1%-20.3%). Adverse drug events accounted for 2.5% (95% CI, 2.0%-3.1%) of estimated emergency department visits for all unintentional injuries and 6.7% (95% CI, 4.7%-8.7%) of those leading to hospitalization and accounted for 0.6% of estimated emergency department visits for all causes. Individuals aged 65 years or older were more likely than younger individuals to sustain adverse drug events (annual estimate, 4.9 vs 2.0 per 1000; rate ratio [RR], 2.4; 95% CI, 1.8-3.0) and more likely to require hospitalization (annual estimate, 1.6 vs 0.23 per 1000; RR, 6.8; 95% CI, 4.3-9.2). Drugs for which regular outpatient monitoring is used to prevent acute toxicity accounted for 41.5% of estimated hospitalizations overall (1381 cases; 95% CI, 30.9%-52.1%) and 54.4% of estimated hospitalizations among individuals aged 65 years or older (829 cases; 95% CI, 45.0%-63.7%). Conclusions  Adverse drug events among outpatients that lead to emergency department visits are an important cause of morbidity in the United States, particularly among individuals aged 65 years or older. Ongoing, population-based surveillance can help monitor these events and target prevention strategies.

Center for Substance Abuse Treatment, Dupree LW, Schonfeld L. Substance Abuse Relapse Prevention for Older Adults: A Group Treatment Approach. Rockville MD: Center for Substance Abuse Treatment, 2005. (29 refs.)

This workbook is not a comprehensive substance abuse treatment guide, but a set of how-to instructions for introducing established relapse prevention techniques to treatment with the elderly. The relapse prevention approach uses cognitive-behavioral and self-management interventions that have been widely used in substance abuse treatment. The workbook begins with a brief introduction to this approach, and summarizes key components. The bulk of the volume is a presentation of how to implement the approach, including staffing, general planning, and how to conduct the group sessions. Nine group modules are then outlined for use by program counselors, which are intended to be presented in a total of sixteen different group sessions, of approximately 75 minutes each. Each of the modules begins with a brief overview of the topic followed by an outline and written presentation for the counselor, along with a variety of tools, such as client handouts, home work assignments, and client checklists. Copyright 2005, Project Cork

Colliver JD, Compton WM, Gfroerer JC, Condon T. Projecting drug use among aging baby boomers in 2020. Annals of Epidemiology 16(4): 257–265, 2006. (24 refs.)

PURPOSE: Greater rates of lifetime drug use among the baby-boom generation, combined with the size of that generation, suggest that the number of elderly persons using drugs will increase in the next two decades. Given the potential public health demands implied by increasing numbers of elderly drug users, the goal is to project the numbers of current drug users aged 50 years and older in 2020. METHODS: Using the modeling and projection methods of Gfroerer et al (2003) applied to data from the 1999 to 2001 National Household Surveys on Drug Abuse, projections were developed for the use of marijuana, nonmedical use of any prescription-type psychotherapeutic drug, and any illicit drug use. RESULTS: From 1999 to 2001 to 2020, past-year marijuana use in persons 50 years and older is forecast to increase from 1.0% to 2.9%. The number of users is expected to increase from 719,000 to almost 3.3 million, reflecting the combined effects of the increase in rate of use and a projected 51.9% increase in the civilian nininstutionalised population in this age group. Use of any illicit drug Will increase from 2.2% (1.6 million) to 3.1% (3.5 million), and nonmedical use of psychotherapeutic drugs Will increase from 1.2% (911,000) to 2.4% (almost 2.7 million). CONCLUSIONS: These projections call attention to changes to be considered in planning and to the need for improved knowledge of the biomedical and psychosocial effects of nonmedical drug use on aging and elderly individuals. Copyright 2006, Elsevier Science Ltd.

Fingerhood M. Substance abuse in older people (review). Journal of the American Geriatrics Society 48(8): 985–995, 2000. (125 refs.)

This review presents current information on substance abuse in older people, highlighting recent studies on epidemiology, screening techniques, brief intervention, and treatment issues. Studies show that substance abuse in older people is common, but frequently goes undiagnosed. Although alcohol abuse is most common, abuse of narcotic and sedative drugs also occurs. Older adults are particularly susceptible to adverse medical outcomes from substance abuse, and recent studies show that brief interventions by primary care providers can have a major impact on preventing medical morbidity and improving quality of life. Effective treatment modalities for substance abuse in older people exist and should be individualized to optimize success. Copyright 2000, American Geriatrics Society

Flaherty JH. Commonly prescribed and over-the-counter medications: Causes of confusion (review). Clinics in Geriatric Medicine 14(1): 101–121, 1998. (281 refs.)

Acute confusion is associated with significant morbidity and mortality among older persons. Among the common causes of confusion, medications are at the top of the List. Since virtually any drug can cause confusion, it is helpful for the clinician to know which patients are at risk and which medications are risky. At particular risk are patients with dementia and patients whose pharmacokinetics or pharmacodynamics have been impaired by the aging process or diseases. The list of medications that can cause confusion is a long one, yet it can be remembered by the mnemonic ACUTE CHANGE IN MS (mental status). In addition to recognizing the offending agent, it is prudent for clinicians to prevent the chance of drug-induced confusion. One of the safest ways to do this is to avoid too many medications since the risk of adverse drug events rises exponentially with the number of medications prescribed. Copyright 1998, W.B. Saunders Co.

Gfroerer J, Penne M, Pemberton M, Folsom R. Substance abuse treatment need among older adults in 2020: The impact of the baby boom generation. Drug and Alcohol Dependence 69(2): 127–135, 2003. (36 refs.)

Background: There is concern that as the baby boom population ages in the US, there will be a substantial increase in the number of older adults needing treatment for substance abuse problems. To address this concern, projections of future treatment need for older adults (defined as age 50 and older) were made. Methods: Using data from the National Household Survey on Drug Abuse, regression models including predictors of treatment need in 2000 and 2001 were developed. Treatment need was defined as having a DSM-IV alcohol or illicit drug use disorder in the past year. Regression parameters from these models were applied to the projected 2020 population to obtain estimates of the number of older adults needing treatment in 2020. Results: The number of older adults in need of substance abuse treatment is estimated to increase from 1.7 million in 2000 and 2001 to 4.4 million in 2020. This is due to a 50 percent increase in the number of older adults and a 70 percent increase in the rate of treatment need among older adults. Conclusions: The aging baby boom cohort will place increasing demands on the substance abuse treatment system in the next two decades, requiring a shift in focus to address the special needs of an older population of substance abusers. There is also a need to develop improved tools for measuring substance use and abuse among older adults. Copyright 2003, Elsevier Science Ltd

Gordon AJ, Conigliaro J, Maisto SA, McNeil M, Kraemer KL, Kelley ME. Comparison of consumption effects of brief interventions for hazardous drinking elderly. Substance Use & Misuse 38(8): 1017–1035, 2003. (45 refs.)

We sought to determine if Brief Interventions [BIs, Motivational Enhancement (ME), and Brief Advice (BA)] reduced alcohol consumption among hazardous alcohol drinking elderly (65 years or older) and whether the elderly responded similarly to younger populations. In 12 primary care offices from October 1995 to December 1997, we screened 13,438 patients of whom 2702 were elderly (180 were hazardous drinkers). Forty-five elderly enrollees were randomized to receive ME (n = 18), BA (n = 12), and Standard Care (SC, n = 12). At baseline, the elderly drank more alcohol and abstained fewer days than the younger cohort (p < 0.05). During the year, the elderly in ME, BA, and SC intervention arms increased the number of days abstained, decreased the number of drinks per day, and reduced the number of total days per month drinking. There were trends toward decreases in the alcohol consumption measures in the ME and BA treatment arms compared to SC. The elderly's response to all interventions was similar to that of the younger cohort. This study suggests that hazardous alcohol consumption in the elderly is common and that BIs reduce alcohol consumption in the elderly similar to younger populations. Copyright 2003, Marcel Dekker, Inc

Hulse GK, Lautenschlager NT, Tait RJ, Almeida OP. Dementia associated with alcohol and other drug use. International Psychogeriatrics 17(Supplement 1): S109–S127, 2005. (90 refs.)

The acute use of alcohol and several other licit and illicit drugs can affect mental state and cognitive function. The chronic use of certain drugs may also increase the risk of cognitive impairment and perhaps dementia in later life. This paper focuses on the long-term cognitive consequences of using alcohol, benzodiazepines, tobacco and cannabis. Currently available evidence indicates that mild to moderate alcohol consumption is not associated with increased risk of cognitive decline and may in fact have a protective effect against dementia, although heavy, long-term consumption is likely to have a negative impact on cognitive function. The degree that alcohol-related cognitive impairment must reach to be classified as dementia is currently obscure. Longer-term smoking is associated with increased risk of cognitive impairment and possibly dementia. The chronic use of benzodiazepines has been associated with increased risk of cognitive impairment but information relating to dementia remains inconclusive. The chronic use of cannabis may impair intellectual abilities but data on this topic remain sparse and difficult to interpret. In conclusion, there is evidence that some drugs contribute to the causal pathway that leads to the development of cognitive impairment but currently available data do not support the introduction of a separate diagnostic category of drug-induced dementia (such as alcohol-related dementia). Health promotion programs designed to decrease tobacco smoking and "harmful" alcohol use (and possibly other drug use) may decrease the burden of cognitive impairment and perhaps dementia in later life. Copyright 2005, Cambridge University Press

Korper SP, Council CL, eds. Substance Use by Older Adults: Estimates of Future Impact on the Treatment System. Analytic Series: A-21. Rockville MD: Substance Abuse and Mental Health Services Administration, 2003. (chapter refs.)

This report provides evidence concerning the projected demand for substance abuse treatment (SAT) services for older Americans over the next 20 to 30 years and suggests approaches for refining these projections. It was developed in response to the aging of the U.S. population and the higher consumption of alcohol and illicit substances by people born between 1946 and 1964 (the baby boom generation). The report is the product of panels established by the Substance Abuse and Mental Health Services Administration (SAMHSA) to examine and assess the ability of available data to provide enough information to guide planning to address the possible doubling of the number of these older adults requiring SAT services. The report's chapters review the issues in anticipation of the substance treatment needs of the future elderly. To make reliable forecasts of demand for SAT services more updated and expanded, information is needed about the life course of persons who abuse substances and are in recovery, those who continue to abuse substances throughout their lives and may or may not be in treatment, and those who begin abusing substances later in life. Patterns of relapse and recovery must be better understood. The report highlights uses of available data and provides examples of analyses and methodological issues needed to refine forecasts of the demand for SAT services emerging over the next several decades. The final chapter discusses the implications and suggests approaches to extending knowledge in the area. Public Domain

Lemke S, Moose RH. Outcome at 1 and 5 years for older patients with alcohol use disorders. Journal of Substance Abuse Treatment 24(1): 43–50, 2003. (24 refs.)

Older patients with alcohol use disorders who had gone through residential treatment were compared with matched groups of young and middle-aged patients (N = 432 in each age group) on their 1- and 5-year outcomes, use of continuing care services, and outcome predictors. Older patients had better outcomes than did young and middle-aged patients but had comparable levels of continuing substance abuse care and 12-step self-help group involvement. Similar factors predicted outcomes across the age groups. Longer duration of continuing substance abuse care and greater self-help group involvement were related to better outcomes, as were patients' attitudes and coping strategies at program discharge. The findings indicate that older patients with alcohol use disorders respond to age-integrated substance abuse treatment programs at least as well as do younger patients and are equally involved in formal and informal continuing substance abuse care. Copyright 2003, Elsevier Science Ltd

Oslin DW. Evidence-based treatment of geriatric substance abuse. Psychiatric Clinics of North America 28(4): 897+, 2005. (73 refs.)

This article outlines the current state of knowledge regarding the magnitude of late-life addictions and considers interventions that target prevention, early intervention, or treatment. The focus is on late-life alcohol misuse but the discussion also introduces concepts regarding medication misuse and the potential emergence of problems related to illicit substance misuse and nicotine. Copyright 2005, W B Saunder

Pringle KE, Ahern FM, Heller DA, Gold CH, Brown TV. Potential for alcohol and prescription drug interactions in older people. Journal of the American Geriatrics Society 53(11): 1930–1936, 2005. (29 refs.)

To examine the patterns and prevalence of concomitant alcohol and alcohol-interactive (AI) drug use in older people. Cross-sectional analysis of survey and prescription claims data. The Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PA-PACE) program, a state-funded program providing prescription benefits to older people with low to moderate incomes. A total of 83,321 PA-PACE cardholders (age range 65-106) who were using any prescription medications at the time of survey completion. All AI drugs were identified using a database of medication warning labels obtained from First DataBank. Prescription drug claims were used to characterize AI drug exposure according to therapeutic class of prescription drug use. A mail survey of PA-PACE cardholders was used to examine alcohol use, as well as sociodemographic and health factors associated with concomitant use of alcohol and AI drugs. Seventy-seven percent of all prescription drug users were exposed to AI medications, with significant variation in exposure and concomitant alcohol use according to therapeutic class. Overall, 19% of AI drug users reported concomitant alcohol use, compared with 26% of non-AI drug users (P <.001). Multinomial logistic regression analyses showed that certain groups of older people, including younger older people, men, and those with higher educational levels, were at greater risk for concomitant exposure to alcohol and AI drugs. Many older people use alcohol in combination with AI prescription drugs. Clinicians should warn every patient who is prescribed an AI drug about alcohol-drug interactions, especially those at high risk for concomitant exposure. Copyright 2005, Blackwell Publishing

Satre DD, Mertens JR, Arean PA, Weisner C. Five-year alcohol and drug treatment outcomes of older adults versus middleaged and younger adults in a managed care program. Addiction 99(10): 1286–1297, 2004. (47 refs.)

Aims: This study compared 5-year treatment outcomes of older adults to thoseof middle-aged and younger adults in a large managed care chemical dependency program. We examined age group differences in individual, treatment and extra-treatment factors, which may influence long-term outcome. Design: Seventy-seven per cent of original study participants completed a telephone interview 5 years after out-patient chemical dependency treatment at Kaiser Permanente. This sample (N = 925) included 65 patients aged 55-77, 296 patients aged 40-54 and 564 patients aged 18-39 (age at baseline). Measurements: Measures at follow-up included alcohol and drug use, Addiction Severity Index (ASI), Alcoholics Anonymous Affiliation Scale, social resource and self-reported health questions. Mortality data were obtained from contact with family members of patients as well as automated health plan records. Findings Older adults were less likely to be drug-dependent at baseline than younger and middle-aged adults, and had longer retention in treatment than younger adults. At 5 years, older adults were less likely than younger adults to have close family or friends who encouraged alcohol or drug use. Fifty-two per cent of older adults reported total abstinence from alcohol and drugs in the previous 30 days versus 40% of younger adults. Older women had higher 30-day abstinence than older men or younger women. Among participants dependent only on alcohol, there were no significant age differences in 30-day abstinence. In logistic regression analysis, age group was not significant. Variables associated with greater age that independently predicted 30-day abstinence in the logistic regression model included longer retention in treatment and having no close family or friends who encouraged alcohol or drug use at 5 years; female gender was also significant. Conclusions: Results indicate that older adults have favorable long-term outcome following treatment relative to younger adults, but these differences may be accounted for by variables associated with age such as type of substance dependence, treatment retention, social networks and gender. Age differences in these characteristics inform intervention strategies to support long-term recovery of older adults and provide direction for investigation of how age affects outcome. Copyright 2004, Marcel Dekker, Inc

Simoni-Wastila L, Zuckerman IH, Singhal PK, Briesacher B, Hsu VD. National estimates of exposure to prescription drugs with addiction potential in community-dwelling elders. Substance Abuse 26(1): 33–42, 2006. (46 refs.)

The use of prescription drugs with addiction potential is an overlooked and growing problem among today's elderly. This paper provides national prevalence estimates of exposure to prescription drugs with addiction potential among community-dwelling elders and explores risk factors for such exposure. Using the Medicare Current Beneficiary Survey, a nationally-representative database of Medicare eligibles, we calculated the prevalence of abusable prescription drug use, overall, by therapeutic class, and by drug. Nearly 22% (7.22 million) of all community-dwelling Medicare elders used at least one prescription medication with addiction potential. Opioid analgesics were used most frequently (14.9%; 95% CI 14.0, 15.8%); central nervous system (CNS) depressants were used by 10.4% of the nation's elders (95% CI 9.5, 10.8%). Using logistic regression analysis, we examined the association of explanatory variables with three outcome variables: any controlled substances use, any opioid analgesic use, and any CNS depressant use. We found that females, whites, those aged 65-79, and those with non-spousal others, were significantly more likely to use one or more prescription drugs with addiction potential, controlling for health status and severity-of-illness. The significance and magnitude of several explanatory variables, including age, race, ethnicity, living arrangement, and health status, varied by therapeutic category. This paper provides an important first step in acknowledging the widespread use of abusable prescription drugs in elders, and provides a foundation for future research and practical solutions to preventing subsequent problem use of prescription drugs. Copyright 2005, Association for Medical Education & Research in Substance Abuse

Whelan G. Alcohol: A much neglected risk factor in elderly mental disorders. Current Opinion in Psychiatry 16(6): 609–614, 2003. (30 refs.)

This review will provide an update on the role that alcohol plays in the presentation and management of mental disorders in the elderly. Recent community surveys from several countries have explored the relationship between the level of alcohol consumption or alcohol use disorder and the concurrence of mental health disorders in the elderly. A consistent finding is that mild to moderate alcohol consumption is protective against the development of dementia in the elderly. In other studies very heavy drinking or alcohol use disorders are associated with functional impairment, depression and suicide. Recent reviews indicate that the relationship between levels of alcohol consumption and problems such as falls and cognitive deterioration remains controversial. The elderly appear to respond to relapse prevention strategies and pharmacotherapy equally as well as those in the younger age groups. While mild to moderate levels of alcohol consumption have a protective effect on the occurrence of dementia, the concurrence of alcohol use disorders, depression and suicide in the elderly has important implications for prevention and treatment. Pharmacotherapy and relapse prevention strategies should be made available to the elderly with alcohol use disorders. Copyright 2003, Rapid Science Publishers

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