The Epidemiology of Alcohol Use Disorders and Subthreshold Dependence in a Middle-Aged and Elderly Community Sample

doi:10.1097/JGP.0b013e3182006a96

The American Journal of Geriatric Psychiatry

Volume 19, Issue 8, August 2011, Pages 685-694

https://doi.org/10.1097/JGP.0b013e3182006a96 Get rights and content

Objective:

To estimate 1-year prevalence and correlates of alcohol abuse, dependence, and subthreshold dependence (diagnostic orphans) among middle-aged and elderly persons in the United States.

Design:

2005–2007 National Surveys on Drug Use and Health.

Method:

Sample included 10,015 respondents aged 50–64 years and 6,289 respondents older than 65 years. Data were analyzed by bivariate and multinomial regression analyses.

Measurements:

Sociodemographic variables; alcohol use; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition abuse and dependence; major depression; nicotine dependence; illicit drug use; and nonmedical use of prescription drugs.

Results:

Fifty-one percent of the sample used alcohol during the past year (56% in the 50–64 age group and 43% in the older than 65 age group). Overall, 11% (dependence 1.9%, abuse 2.3%, and subthreshold dependence 7.0%) of adults aged 50–64 and about 6.7% (dependence 0.6%, abuse 0.9%, and subthreshold dependence 5.2%) of those older than 65 reported alcohol abuse, dependence or dependence symptoms. Among past-year alcohol users, 20% (dependence 3.4%, abuse 4.0%, and subthreshold dependence 12.5%) of adults aged 50–64 and 15.4% (dependence 1.3%, abuse 2.1%, and subthreshold dependence 12.0%) of those older than 65 endorsed alcohol abuse or dependence symptoms. “Tolerance” (48%) and “time spent using” (37%) were the two symptoms most frequently endorsed by the subthreshold group. Compared with alcohol users without alcohol abuse or dependence symptoms, blacks or Hispanics and those who had nicotine dependence or used nonmedical prescription drugs had increased odds of subthreshold dependence. Diagnostic orphans also were more likely to engage in binge drinking than the asymptomatic group.

Conclusions:

Diagnostic orphans among middle-aged and elderly community adults show an elevated rate for binge drinking and nonmedical use of prescription drugs that require attention from healthcare providers.

Section snippets

Sample

This study is drawn from the public-use files of the 2005–2007 NSDUH,19., 20., 21. an annual survey providing population estimates of substance use and health status of the civilian, noninstitutionalized population aged 12 years or older in the United States. Its sampling frame covers approximately 98% of the total U.S. population aged 12 years or older, and uses multistage area probability sampling methods to select a representative sample of the civilian noninstitutionalized population

Prevalence of AUDs among All Adult Respondents

As shown in Table 1, of all adults aged 50 years or older (N = 16,304), 9.3% reported some DSM-IV AUD symptoms in the past year (dependence: 1.4%; abuse: 1.7%; subthreshold dependence: 6.3%). Adults aged 50–64 years had a higher prevalence of AUDs than those aged 65 years or older (4.2% versus 1.5%), and men had a higher prevalence than women (5.0% versus 1.4%). In addition, subthreshold dependence was found in 8.4% of men, 4.4% of women, 7.0% the 50–64 age group, and 5.2% of the older than 65

DISCUSSION

Overall, 59% of male respondents and 44% of female respondents reported alcohol use during the past year. Approximately 6% of past-year alcohol users aged ≥50 years had an AUD, and AUDs were more frequent in respondents aged 50–64 and among men. Symptoms of tolerance (requiring more alcohol to get “high”) and time spent (a lot of time spent in activities necessary to use or recover from alcohol's effects) were the most frequent AUD symptoms. This national study also identified several subsets

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The Substance Abuse and Mental Health Data Archive provided the public use data files for the National Survey on Drug Use and Health, which was sponsored by the Office of Applied Studies of Substance Abuse and Mental Health Services Administration. The authors thank Amanda McMillan for her editorial assistance.

This work was supported by research grants from the U.S. National Institute on Drug Abuse of the National Institutes of Health (R01DA019623, R01DA019901, R21DA027503 to Li-Tzy Wu), a contract for the Data and Statistics Center for the Clinical Trials Network of the National Institute on Drug Abuse (HSN271200522071C to Dan G. Blazer), and the Department of Psychiatry and Behavioral Sciences of Duke University Medical Center. The opinions expressed in this article are solely those of the authors, not of any sponsoring agency.

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Regular Research ArticlesThe Epidemiology of Alcohol Use Disorders and Subthreshold Dependence in a Middle-Aged and Elderly Community Sample

Objective:

Design:

Method:

Measurements:

Results:

Conclusions:

Section snippets

Sample

Prevalence of AUDs among All Adult Respondents

DISCUSSION

Drug Alcohol Depend

Drug Alcohol Depend

Drug Alcohol Depend

Drug Alcohol Depend

Addict Behav

J Subst Abuse

Drug Alcohol Depend

The NSDUH Report: Substance Use Among Older Adults, 2002 & 2003 Update

The DASIS Report: Older Adults in Substance Abuse Treatment, 2005

Clinical guidelines for alcohol use disorders in older adults

Substance misuse among older adults: a neglected but treatable problem

Addiction

Results from the 2008 National Survey on Drug Use and Health: National Findings Detailed Tables. Rockville, MD, Office of Applied Studies, Substance Abuse and Mental Health Services

Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text revision

A five-year prospective study of diagnostic orphans for alcohol use disorders

J Stud Alcohol

Subthreshold conditions as precursors for full syndrome disorders: a 15-year longitudinal study of multiple diagnostic classes

J Child Psychol Psychiatry

Regular Research Articles
The Epidemiology of Alcohol Use Disorders and Subthreshold Dependence in a Middle-Aged and Elderly Community Sample