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Original Paper

DSM-5 alcohol use disorder features among treatment-seeking older adults

Published Online:November 26, 2018https://doi.org/10.1024/0939-5911/a000550

Abstract

Abstract.Background: The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial “ELDERLY-Study” with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims: To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results: Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion: European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors.


Klinische Charakteristika von DSM-5 Alkoholkonsumstörungen bei behandlungssuchenden älteren Erwachsenen

Zusammenfassung.Hintergrund: Für die Zukunft wird ein Anstieg des Anteils älterer Menschen mit Alkoholkonsumstörung (AKS) in westlichen Ländern erwartet. An die Bedürfnisse dieser Gruppe angepasste Interventionen fehlen bislang. Über die klinischen Merkmale behandlungssuchender Senioren mit AKS ist wenig bekannt. In der internationalen, multizentrischen, randomisiert-kontrollierten Therapiestudie „ELDERLY-Study” mit wenigen Ausschlusskriterien wurden zwei kurze ambulante Interventionen für Erwachsene im Alter 60+ mit AKS nach DSM-5 untersucht. Ziele: 1) Die Informationen zur Methodik der ELDERLY-Studie um Informationen zu den klinischen Merkmalen der AKS in der Stichprobe und in Subgruppen nach Geschlecht und Land zu ergänzen und 2) Informationen über AKS-Merkmale bei behandlungssuchenden älteren Menschen bereitzustellen . Methoden: Verwendet wurden Baselinedaten der dänischen und deutschen Studienteilnehmer (n=544). DSM-5 AKS-Diagnosen wurden mit dem Mini International Neuropsychiatric Interview, Alkoholkonsum mit der Form 90 erhoben. Ergebnisse: Kontrollverlust, erfolglose Kontrollversuche, Konsum trotz körperlicher und/oder seelischer Konsequenzen und Craving waren die häufigsten AKS-Symptome (> 70 %). 54.9 % berichteten eine schwergradige AKS, (mittelgradig: 28.2 %, leichtgradig: 16.9 %). Die durchschnittliche tägliche Trinkmenge betrug 6.3 Standardgetränke á 12 Gramm Ethanol. 93.9 % berichteten Rauschtrinken. Ein stärker ausgeprägtes Konsumverhalten war mit höherem AKS-Schweregrad und männlichem Geschlecht assoziiert. Unterschiede zwischen den Ländern zeigten sich für Konsummuster und Schweregrad. Schlussfolgerungen: ELDERLY-Teilnehmer aus zwei europäischen Ländern zeigten typische Abhängigkeitssymptome, intensive Konsummuster und alle AKS-Schweregrade. Diese Befunde unterstreichen die klinische Bedeutsamkeit von Symptomberichten bei behandlungssuchenden Senioren mit AKS.

Literature

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Arlington, VA: American Psychiatric Publishing. First citation in articleGoogle Scholar

  • Andersen, K., Bogenschutz, M. P., Buehringer, G., Behrendt, S., Bilberg, R. & Braun, B. et al., (2015). Outpatient treatment of alcohol use disorders among subjects 60+years: design of a randomized clinical trial conducted in three countries (Elderly Study). Bmc Psychiatry, 15. First citation in articleGoogle Scholar

  • Andreas, S., Schulz, H., Volkert, J., Dehoust, M., Sehner, S. & Suling, A. et al., (2017). Prevalence of mental disorders in elderly people: the European MentDis_ICF65+study. British Journal of Psychiatry, 210(2), 125–131. First citation in articleCrossref, Google Scholar

  • Arciniega, L. T., Arroyo, J., Barrett, D., Brief, D., Carty, K. & Bird Gulliver, S. et al., (2004). Combined Behavioral Intervention Manual. A clinical research guide for therapists treating people with alcohol abuse and dependence (W. R. Miller Ed. Vol. 1): National Institute on Alcohol Abuse and Alcoholism, U. S. Department of Health and Human Services, National Institutes of Health. First citation in articleGoogle Scholar

  • Barry, K. L. & & Blow, F. C. (2016). Drinking Over the Lifespan: Focus on Older Adults. Alcohol Research-Current Reviews, 38(1), 115–120. First citation in articleGoogle Scholar

  • Berner, M. M., Harter, M., Kriston, L., Lohmann, M., Ruf, D., Lorenz, G. & & Mundle, G. (2007). Detection and management of alcohol use disorders in German primary care influenced by non-clinical factors. Alcohol and Alcoholism, 42(4), 308–316. First citation in articleCrossref, Google Scholar

  • Bhatia, U., Nadkarni, A., Murthy, P., Rao, R. & & Crome, I. (2015). Recent advances in treatment for older people with substance use problems: An updated systematic and narrative review. European Geriatric Medicine, 6(6), 580–586. First citation in articleCrossref, Google Scholar

  • Blazer, D. G. & & Wu, L.-T. (2009). The Epidemiology of At-Risk and Binge Drinking Among Middle-Aged and Elderly Community Adults: National Survey on Drug Use and Health. American Journal of Psychiatry, 166(10), 1162–1169. First citation in articleCrossref, Google Scholar

  • Blazer, D. G. & & Wu, L.-T. (2011). The Epidemiology of Alcohol Use Disorders and Subthreshold Dependence in a Middle-Aged and Elderly Community Sample. American Journal of Geriatric Psychiatry, 19(8), 685–694. First citation in articleCrossref, Google Scholar

  • Blow, F. C., Walton, M. A., Chermack, S. T., Mudd, S. A. & & Brower, K. J. (2000). Older adult treatment outcome following elder-specific inpatient alcoholism treatment. Journal of Substance Abuse Treatment, 19(1), 67–75. First citation in articleCrossref, Google Scholar

  • Bottlender, M., Spanagel, R. & & Soyka, M. (2007). One drink, one drunk – Controlled drinking by alcoholics? 3-year-outcome after intensive outpatient treatment. Psychotherapie Psychosomatik Medizinische Psychologie, 57(1), 32–38. First citation in articleCrossref, Google Scholar

  • Caputo, F., Vignoli, T., Leggio, L., Addolorato, G., Zoli, G. & & Bernardi, M. (2012). Alcohol use disorders in the elderly: A brief overview from epidemiology to treatment options. Experimental Gerontology, 47(6), 411–416. First citation in articleCrossref, Google Scholar

  • Choi, N. G., DiNitto, D. M. & & Marti, C. N. (2014). Treatment use, perceived need, and barriers to seeking treatment for substance abuse and mental health problems among older adults compared to younger adults. Drug and Alcohol Dependence, 145, 113–120. First citation in articleCrossref, Google Scholar

  • Chou, K.-L., Liang, K. & & Mackenzie, C. S. (2011). Binge Drinking and Axis I Psychiatric Disorders in Community-Dwelling Middle-Aged and Older Adults: Results From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry, 72(5), 640–647. First citation in articleCrossref, Google Scholar

  • Christie, M. M., Bamber, D., Powell, C., Arrindell, T. & & Pant, A. (2013). Older adult problem drinkers: Who presents for alcohol treatment? Aging & Mental Health, 17(1), 24–32. First citation in articleCrossref, Google Scholar

  • Crome, I., Li, T. K., Rao, R. & & Wu, L. T. (2012). Alcohol limits in older people. Addiction, 107(9), 1541–1543. First citation in articleCrossref, Google Scholar

  • Cross, C. P., Copping, L. T. & & Campbell, A. (2011). Sex Differences in Impulsivity: A Meta-Analysis. Psychological Bulletin, 137(1), 97–130. First citation in articleCrossref, Google Scholar

  • Drummond, C., Gilburt, H., Burns, T., Copello, A., Crawford, M. & Day, E. et al., (2017). Assertive Community Treatment For People With Alcohol Dependence: A Pilot Randomized Controlled Trial. Alcohol and Alcoholism, 52(2), 234–241. First citation in articleGoogle Scholar

  • Edwards, G. & & Gross, M. M. (1976). Alcohol dependence: provisional description of a clinical syndrome. British Medical Journal, 1, 1058–1061. First citation in articleCrossref, Google Scholar

  • Emiliussen, J., Andersen, K. & & Nielsen, A. S. (2017). How Do Older Adults with Very-Late-Onset Alcohol Use Disorder Define Alcohol Problems? Results from an Interpretative Phenomenological Study. Alcoholism Treatment Quarterly, 35(2), 151–164. First citation in articleCrossref, Google Scholar

  • Geels, L. M., Vink, J. M., van Beek, J. H. D. A., Bartels, M., Willemsen, G. & & Boomsma, D. i. (2013). Increases in alcohol consumption in women and elderly groups: evidence from an epidemiological study. Bmc Public Health, 13. First citation in articleCrossref, Google Scholar

  • German Federal Center for Health Education. (2017). http://www.kenn-dein-limit.info/alkohol-in-zahlen.html. First citation in articleGoogle Scholar

  • Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, S. P., Jung, J. & Zhang, H. T. et al., (2015). Epidemiology of DSM-5 Alcohol Use Disorder Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. Jama Psychiatry, 72(8), 757–766. First citation in articleCrossref, Google Scholar

  • Han, B. H., Moore, A. A., Sherman, S., Keyes, K. M. & & Palamar, J. J. (2017). Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005–2014. Drug and Alcohol Dependence, 170, 198–207. First citation in articleGoogle Scholar

  • Hapke, U., Hanisch, C., Ohlmeier, C. & & Rumpf, H.-J. (2009). Epidemiologie des Alkoholkonsums bei älteren Menschen in Privathaushalten: Ergebnisse des telefonischen Gesundheitssurvey 2007. Epidemiology of alcohol consumption among elderly people living in private households: Results from the 2007 Telephone Health Survey. SUCHT, 55(5), 281–291. First citation in articleLink, Google Scholar

  • Hapke, U., v der Lippe, E. & & Gaertner, B. (2013). Alcohol consumption, at-risk and heavy episodic drinking with consideration of injuries and alcohol-specific medical advice. Results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 56(5–6), 809–813. First citation in articleCrossref, Google Scholar

  • Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N. & & Conde, J. G. (2009). Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform, 377–381. First citation in articleCrossref, Google Scholar

  • Hingson, R. W., Heeren, T. & & Winter, M. R. (2006). Age of Alcohol-Dependence Onset: Associations With Severity of Dependence and Seeking Treatment. Pediatrics, 118(3), 755–763. First citation in articleCrossref, Google Scholar

  • Jacobi, F., Hoefler, M., Strehle, J., Mack, S., Gerschler, A. & Scholl, L. et al., (2015). Twelve-months prevalence of mental disorders in the German Health Interview and Examination Survey for Adults – Mental Health Module (DEGS1-MH): a methodological addendum and correction. International Journal of Methods in Psychiatric Research, 24(4), 305–313. First citation in articleCrossref, Google Scholar

  • Johnson, T. P. & & Mott, J. A. (2001). The reliability of self-reported age of onset of tobacco, alcohol and illicit drug use. Addiction, 96, 1187–1198. First citation in articleCrossref, Google Scholar

  • Keyes, K. M., Hatzenbuehler, M. L., McLaughlin, K. A., Link, B., Olfson, M., Grant, B. F. & & Hasin, D. (2010). Stigma and Treatment for Alcohol Disorders in the United States. American Journal of Epidemiology, 172(12), 1364–1372. First citation in articleCrossref, Google Scholar

  • Kuerbis, A. N., Hagman, B. T. & & Sacco, P. (2013). Functioning of Alcohol Use Disorders Criteria Among Middle-Aged and Older Adults: Implications for DSM-5. Substance Use & Misuse, 48(4), 309–322. First citation in articleCrossref, Google Scholar

  • Lange, C., Manz, K. & & Kuntz, B. (2017). Alkoholkonsum bei Erwachsenen in Deutschland: Riskante Trinkmengen. Journal of Health Monitoring, 2(2), 66–73. First citation in articleGoogle Scholar

  • Lecrubier, Y., Sheehan, D., Weiller, E., Amorim, P., Bonora, I. & Sheehan, K. et al. (1997). The MINI International Neuropsychiatric Interview (M. I. N. I.) A Short Diagnostic Structured Interview: Reliability and Validity According to the CIDI. European Psychiatry, 12, 224–231. First citation in articleCrossref, Google Scholar

  • Lin, J. C., Karno, M. P., Grella, C. E., Warda, U., Liao, D. h., Hu, P. & & Moore, A. A. (2011). Alcohol, Tobacco, and Nonmedical Drug Use Disorders in US Adults Aged 65 Years and Older: Data From the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions. American Journal of Geriatric Psychiatry, 19(3), 292–299. First citation in articleCrossref, Google Scholar

  • Liu, X. (2016). Applied Ordinal Logistic Regression Using Stata. Thousand Oaks, CA: Sage Publications First citation in articleGoogle Scholar

  • Mack, S., Jacobi, F., Gerschler, A., Strehle, J., Hoefler, M. & Busch, M. A. et al. (2014). Self-reported utilization of mental health services in the adult German population – evidence for unmet needs? Results of the DEGS1-MentalHealthModule (DEGS1-MH). International Journal of Methods in Psychiatric Research, 23(3), 289–303. First citation in articleCrossref, Google Scholar

  • Marmet, S., Rehm, J. & & Gmel, G. (2016). The importance of age groups in estimates of alcohol-attributable mortality: impact on trends in Switzerland between 1997 and 2011. Addiction, 111(2), 255–262. First citation in articleCrossref, Google Scholar

  • Miller, W. R. & & Del Boca, F. K. (1994). Measurement of drinking behavior using the Form-90 family of instruments. Journal of Studies on Alcohol, 112–118. First citation in articleCrossref, Google Scholar

  • Mitchell, M. N. (2012). Interpreting and Visualizing Regression Models Using Stata. Retrieved from College Station, TX: First citation in articleGoogle Scholar

  • National Institutes of Health. (2016). ClinicalTrials.gov. Retrieved 08.11.2016 First citation in articleGoogle Scholar

  • NIAAA. (2016). http://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/older-adults. First citation in articleGoogle Scholar

  • Nixon, K. & & McClain, J. A. (2010). Adolescence as a critical window for developing an alcohol use disorder: current findings in neuroscience. Current Opinion in Psychiatry, 23(3), 227–232. First citation in articleCrossref, Google Scholar

  • Nuevo, R., Chatterji, S., Verdes, E., Naidoo, N., Luis Ayuso-Mateos, J. & & Miret, M. (2015). Prevalence of Alcohol Consumption and Pattern of Use among the Elderly in the WHO European Region. European Addiction Research, 21(2), 88–96. First citation in articleCrossref, Google Scholar

  • Oslin, D. W., Pettinati, H. & & Volpicelli, J. R. (2002). Alcoholism treatment adherence – Older age predicts better adherence and drinking outcomes. American Journal of Geriatric Psychiatry, 10(6), 740–747. First citation in articleCrossref, Google Scholar

  • Pabst, A., Kraus, L., Gomes de Matos, E. & & Piontek, D. (2013). Substance Use and Substance Use Disorders in Germany in 2012. SUCHT, 59(6), 321–331. First citation in articleLink, Google Scholar

  • Paksarian, D., Cui, L. H., Angst, J., Ajdacic-Gross, V., Rossler, W. & & Merikangas, K. R. (2017). Stability and change in reported age of onset of depression, back pain, and smoking over 29 years in a prospective cohort study. Journal of Psychiatric Research, 88, 105–112. First citation in articleCrossref, Google Scholar

  • Piontek, D., Gomes de Matos, E., Atzendorf, J. & & Kraus, L. (2016). Kurzbericht Epidemiologischer Suchtsurvey 2015 (Tabellenband: Alkoholkonsum, episodisches Rauschtrinken und Hinweise auf klinisch relevanten Alkoholkonsum nach Geschlecht und Alter im Jahr 2015). München: IFT Institut für Therapieforschung. First citation in articleGoogle Scholar

  • Piontek, D., Gomes de Matos, E., Atzendorf, J. & & Kraus, L. (2017). Substanzkonsum und Hinweise auf klinisch relevanten Konsum in Bayern, Hamburg, Hessen, Nordrhein-Westfalen, Sachsen und Thüringen. Ergebnisse des Epidemiologischen Suchtsurvey 2015. München: IFT Institut für Therapieforschung. First citation in articleGoogle Scholar

  • Reynolds, K., Pietrzak, R. H., El-Gabalawy, R., Mackenzie, C. S. & & Sareen, J. (2015). Prevalence of psychiatric disorders in US older adults: findings from a nationally representative survey. World Psychiatry, 14(1), 74–81. First citation in articleCrossref, Google Scholar

  • Royall, R. M. (1986). Model robust confidence intervals using maximum likelihood estimators. Statistical Review, 54, 221–226. First citation in articleCrossref, Google Scholar

  • Satre, D. D., Mertens, J. R., Arean, P. A. & & Weisner, C. (2004). Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program. Addiction, 99(10), 1286–1297. First citation in articleCrossref, Google Scholar

  • Schwarz, A.-S., Nielsen, B. & & Nielsen, A. S. (2017). Changes in profile of patients seeking alcohol treatment and treatment outcomes following policy changes. Journal of Public Health., DOI 10.1007/s10389-017-0841-0. First citation in articleGoogle Scholar

  • Skinner, H. A. & & Horn, J. L. (1984). Alcohol Dependence Scale: Users Guide. Toronto, Canada: Addiction Research Foundation. First citation in articleGoogle Scholar

  • Søgaard Nielsen, A., Nielsen, B., Andersen, K., Roessler, K. K., Bühringer, G. & Bogenschutz, M., … The RESCueH Research Group. (2016). The RESCueH Programme: Testing New Non-Pharmacologic Interventions for Alcohol Use Disorders: Rationale and Methods. European Addiction Research, 22(6), 306–317. First citation in articleCrossref, Google Scholar

  • StataCorp. (Ed.) (2017). Stata Statistical Software: Release 14.2 College Station, TX: StataCorp LP. First citation in articleGoogle Scholar

  • Weyerer, S., Schäufele, M., Eifflaender-Gorfer, S., Köhler, L., Maier, W. & Haller, F., … for the German AgeCoDe Study group. (2009). At-risk alcohol drinking in primary care patients aged 75 years and older. International Journal of Geriatric Psychiatry, 24(12), 1376–1385. First citation in articleCrossref, Google Scholar

  • White, I. R., Royston, P. & & Wood, A. M. (2011). Multiple imputation using chained equations: Issues and guidance for practice. Statistics in Medicine, 30(4), 377–399. First citation in articleCrossref, Google Scholar

  • Zucker, R. A. (2008). Anticipating problem alcohol use developmentally from childhood into middle adulthood: what have we learned? Addiction, 103(Supplement 1), 100–108. First citation in articleCrossref, Google Scholar