Heavy Drinking Trajectories Research Articles

Influence of social rank on the development of long-term ethanol drinking trajectories in cynomolgus monkeys.

Chronic stress contribute to the development of alcohol use disorder (AUD). However, characterizing the role of chronic social stressors in the development of problematic drinking trajectories in humans is complicated by practical and ethical constraints. Group-housed nonhuman primates develop social dominance hierarchies that represent a continuum of social experiences from enrichment in higher-ranked (dominant) monkeys to chronic social stress in lower-ranked (subordinate) individuals. This framework provides a translationally relevant model of chronic social stress that can be used to characterize its effects on vulnerability to AUD. Twelve male cynomolgus monkeys living in three social groups with established social dominance hierarchies were provided access to ethanol and water for 22 h/day, 4-5 days/week, for 1 year. Ethanol-free periods (2- or 3-day "weekends" or longer periods up to 10 days) were spent in social groups to maintain the stability of the social hierarchies. Observational studies conducted 6 months into the year of drinking assessed signs of ethanol withdrawal. After 1 year, monkeys were individually housed 24 h/day, 7 days/week for four consecutive weeks to examine the effect of eliminating the "weekends" spent socially housed. Subordinate monkeys had significantly higher mean daily ethanol intakes than dominant monkeys across 1 year of open access. Subordinates also had higher intakes on the first day back drinking following ethanol-free periods of 9-10 days. Moreover, during the last 4 weeks of open access, intakes on the first drinking day after an ethanol-free weekend increased significantly in subordinate monkeys. This effect diminished when all monkeys were individually housed for 4 weeks, indicating that the increased intake in subordinates was driven by the social environment. These data demonstrate that social subordination, which is associated with chronic social stress, results in increased vulnerability to the development and maintenance of heavy drinking trajectories.

Syndemic trajectories of heavy drinking, smoking, and depressive symptoms are associated with mortality in women living with HIV in the United States from 1994 to 2017

BackgroundHeavy drinking, smoking, and depression are common among people with HIV. Little is known about the co-occurring, synergistic effect of having two or more of these conditions long-term –a sustained syndemic – on mortality among women with HIV (WWH). MethodsData from 3282 WWH of the Women’s Interagency HIV Study from 1994 to 2017 were utilized. National Death Index review identified cause of death (n=616). Sustained syndemic phenotypes were based on membership in high-risk groups defined by group-based trajectory models of repeated self-reported alcohol use, smoking, and depressive symptoms and their co-occurrence. Cox proportional hazard models estimated associations of sustained syndemic phenotypes with all-cause, non-AIDS, and non-overdose mortality, adjusting for age, race/ethnicity, education, enrollment wave, illicit drug use, and time-varying HIV viral load and CD4+ T-cell count. ResultsWWH were 58% Black and 26% Hispanic, with a mean baseline age of 36.7 years. Syndemic phenotypes included zero (45%, n=1463), heavy drinking only (1%, n=35), smoking only (28%, n=928), depressive symptoms only (9%, n=282), and 2+ trajectories (17%, n=574). Compared to zero trajectories, having 2+ trajectories was associated with 3.93 times greater all-cause mortality risk (95% CI 3.07, 5.04) after controlling for confounders and each high-risk trajectory alone. These findings persisted in sensitivity analyses, removing AIDS- and overdose-related mortalities. ConclusionsClustering of 2+ conditions of heavy drinking, smoking, and depression affected nearly one in five WWH and was associated with higher mortality than zero or one condition. Our findings underscore the need for coordinated screening and parsimonious treatment strategies for these co-occurring conditions.

A Bayesian mixed effects support vector machine for learning and predicting daily substance use disorder patterns

ABSTRACT Background: Substance use disorder (SUD) is a heterogeneous disorder. Adapting machine learning algorithms to allow for the parsing of intrapersonal and interpersonal heterogeneity in meaningful ways may accelerate the discovery and implementation of clinically actionable interventions in SUD research. Objectives: Inspired by a study of heavy drinkers that collected daily drinking and substance use (ABQ DrinQ), we develop tools to estimate subject-specific risk trajectories of heavy drinking; estimate and perform inference on patient characteristics and time-varying covariates; and present results in easy-to-use Jupyter notebooks. Methods:We recast support vector machines (SVMs) into a Bayesian model extended to handle mixed effects. We then apply these methods to ABQ DrinQ to model alcohol use patterns. ABQ DrinQ consists of 190 heavy drinkers (44% female) with 109,580 daily observations. Results:We identified male gender (point estimate; 95% credible interval: −0.25;-0.29,-0.21), older age (−0.03;-0.03,-0.03), and time varying usage of nicotine (1.68;1.62,1.73), cannabis (0.05;0.03,0.07), and other drugs (1.16;1.01,1.35) as statistically significant factors of heavy drinking behavior. By adopting random effects to capture the subject-specific longitudinal trajectories, the algorithm outperforms traditional SVM (classifies 84% of heavy drinking days correctly versus 73%). Conclusions: We developed a mixed effects variant of SVM and compare it to the traditional formulation, with an eye toward elucidating the importance of incorporating random effects to account for underlying heterogeneity in SUD data. These tools and examples are packaged into a repository for researchers to explore. Understanding patterns and risk of substance use could be used for developing individualized interventions.

Heavy alcohol consumption before and after negative life events in late mid-life: longitudinal latent trajectory analyses

BackgroundPeople who experience negative life events report more heavy alcohol consumption compared with people without these experiences, but little is known about patterns of change within this group. This study...

Gender differences in trajectories of alcohol use from ages 13 to 33 across Latina/o ethnic groups

BackgroundResearch examining alcohol use trajectories among Latina/os is scarce. Further, prior findings on alcohol use by ethnic group and gender is mixed. The purpose of this study was twofold: (a.) to examine developmental trajectories for two types of alcohol (drunkenness and heavy drinking) use across four Latina/o ethnic groups (Cubans, Puerto Ricans, Central/South American, and Mexican Americans) and, (b.) to examine the role of gender and ethnicity in developmental trajectories of drunkenness and heavy drinking among Latina/os. MethodsData were drawn from Waves I–IV of the National Longitudinal Study of Adolescent to Adult Health. The sample consisted of 1670 Latina/os that were followed from adolescence into adulthood. Multi-level logistic regression models were used to estimate drunkenness and heavy drinking trajectories and trajectories by gender. Resultsindicate that, for all four ethnic groups examined, the probability of drunkenness and heavy drinking gradually increased in adolescence, peaked in “emerging adulthood”, and decreased as they transitioned into adulthood. Findings also show divergent age trajectories by gender, but patterns varied across ethnicity and alcohol use outcome. ConclusionsKey findings from this study demonstrate that among Latina/os, there are critical developmental periods for reported drunkenness and heavy drinking in the last 12 months, and that ethnicity and gender play substantial roles in the development of hazardous alcohol use over the life course.

Does change in self-perceived problem drinker identity relate to change in alcohol use? An examination of nontreatment seeking hazardous drinkers.

Identity change is related to reductions in alcohol use among treatment seekers, but it is unclear the extent to which identity change is associated with reductions in alcohol use among nontreatment seeking hazardous drinkers. The goal of the current study was to examine whether change in problem drinker identity (i.e., self-reported identification as a problem or nonproblem drinker) was associated with reductions in heavy drinking among nontreatment seeking hazardous drinkers. Participants (n = 149) completed measures to assess alcohol use and were asked if they identified as a problem drinker at baseline and at 6-, 12-, 18-, and 24-month follow-ups. Two groups were compared: (a) those who identified as a problem drinker at baseline but identified as a nonproblem drinker at 12 months and (b) those who did not make the same transition. Latent mixture modeling was conducted to examine whether change in problem drinker identity was predictive of heavy drinking latent class growth trajectories. The results indicated that a self-reported transition from identification as a problem drinker to identification as a nonproblem drinker was associated with greater reductions in heavy drinking over the assessment period and a 7 times greater likelihood of being in a rapidly decreasing heavy drinking latent trajectory class compared with participants who did not make the same transition. Self-reported transitions in identity appear to be a good predictor of heavy drinking trajectories among nontreatment seekers. A better understanding of what predicts transitions in drinking identity among non-treatment and treatment seekers is needed. (PsycINFO Database Record

Racial/ethnic differences in life-course heavy drinking from adolescence to midlife

ABSTRACTInformation on heavy drinking over the life course might help to explain racial/ethnic disparities in alcohol-related problems, morbidity, and mortality. Using data from the 2009–2010 U.S. National Alcohol Survey (n = 3,026), we analyzed retrospective decades-based measures of heavy drinking during respondents’ teens, 20s, 30s, and 40s. Results indicate that Latino men and African American women have greater risk for persistent-high (vs. declining) heavy-drinking trajectories than Caucasian men and women, and that socioeconomic disadvantage partly accounts for this disparity in women. Prospective longitudinal studies are needed to confirm these results and to elucidate the relationship of life-course heavy-drinking patterns with health-related outcomes, and disparities in these.

Racial/ethnic differences in 30-year trajectories of heavy drinking in a nationally representative U.S. sample

BackgroundRacial/ethnic minorities bear a disproportionate burden of alcohol-related problems in the U.S. It is unknown whether this reflects harmful patterns of lifecourse heavy drinking. Prior research shows little support for the latter but has been limited to young samples. We examine racial/ethnic differences in heavy drinking trajectories from ages 21 to 51. MethodsData on heavy drinking (6+ drinks/occasion) are from the 1979 National Longitudinal Survey of Youth (N=9468), collected between 1982 and 2012. Sex-stratified, generalized estimating equations (GEE) were used to model heavy drinking frequency trajectories as a function of age with a cubic curve, and interactions of race with age terms were tested to assess racial/ethnic differences. Models adjusted for time-varying socioeconomic status and marital and parenting status; predictors of trajectories were examined in race- and sex-specific models. ResultsWhite men and women had similarly steep declines in heavy drinking frequency throughout the 20s, contrasting with slower declines (and lower peaks) in Black and Hispanic men and women. During the 30s there was a Hispanic-White crossover in men’s heavy drinking curves, and a Black-White female crossover among lifetime heavy drinkers; by age 51, racial/ethnic group trajectories converged in both sexes. Greater education was protective for all groups. ConclusionObserved racial/ethnic crossovers in heavy drinking frequency following young adulthood might contribute to disparities in alcohol-related problems in middle adulthood, and suggest a need for targeted interventions during this period. Additionally, interventions that increase educational attainment may constitute an important strategy for reducing heavy drinking in all groups.

Marital Histories and Heavy Alcohol Use among Older Adults.

We develop a gendered marital biography approach-which emphasizes the accumulating gendered experiences of singlehood, marriage, marital dissolution, and remarriage-to examine the relationship between marital statuses and transitions and heavy alcohol use. We test this approach using individual-level (n = 10,457) and couple-level (n = 2,170) longitudinal data from the Health and Retirement Study, and individual-level (n = 46) and couple-level (n = 42) in-depth interview data. Quantitative results show that marriage, including remarriage, reduces men's but increases women's drinking relative to being never married and previously married, whereas divorce increases men's but decrease women's drinking, with some variation by age. Our qualitative findings reveal that social control and convergence processes underlie quantitative results. We call attention to how men's and women's heavy drinking trajectories stop, start, and change direction as individuals move through their distinctive marital biography.

Interactions between parental alcohol-specific rules and risk personalities in the prediction of adolescent alcohol use.

To examine the impact of an important context variable (alcohol-specific parental rules) and an important person variable (risky personality traits) and their interaction on prospective adolescent drinking. Participants were 252 adolescents, 67.9% female, between 13 and 16 years old. Data were collected via online assessments during 2 years with four time points of assessments. We examined membership of alcohol use trajectories as a function of parental alcohol-specific rules, moderated by risk-associated personality traits. Permissive parental rules predicted early onset and trajectories of heavy drinking. High scores on Sensation Seeking and Hopelessness also predicted early onset and heavy drinking, but there was no evidence for moderation. The influence of parental rule setting and risk personality was confirmed, but no evidence was found that the impact of risk personality on adolescent drinking is moderated by parental rules. Implications of these findings, and limitations of the study, are discussed.

Historical variation in drug use trajectories across the transition to adulthood: the trend toward lower intercepts and steeper, ascending slopes.

This study examines historical variation in individual trajectories of heavy drinking and marijuana use from age 18 to 22. Unlike most studies that have examined cohort differences in drug use, it focuses on differences in both level of use and rates of change (growth). Nearly 39,000 youths from the high school classes of 1976-2004 were surveyed at biennial intervals between the ages of 18 and 22 as part of the national Monitoring the Future study. Between 1976 and 2004, adolescent heavy drinking decreased substantially. However, because the age 18-22 heavy drinking growth rate increased threefold for males and sixfold for females during this period, heavy drinking among 21- to 22-year-olds remained largely stable. The growth rate for marijuana use was more stable across cohorts, and historical declines in use were sizable across the entire 18-22 age band. Generally, historical variation in use was unrelated to college status and living arrangements as well as to historical changes in the distribution of young adult social roles. Findings suggest that historical fluctuations in use were less the result of proximal young adult factors and more the result of historical variation in distal adolescent factors, the effect of which diminished with age, especially for heavy drinking.

A 26-Year Follow-Up Study of Heavy Drinking Trajectories from Adolescence to Mid-Adulthood and Adult Disadvantage

The aim of the study was to identify heavy drinking trajectories from age 16 to 42 years and to examine their associations with health, social, employment and economic disadvantage in mid-adulthood. Finnish cohort study's participants who were 16 years old in 1983 were followed up at age 22, 32 and 42 (n = 1334). Heavy drinking was assessed at every study phase and based on these measurements trajectories of heavy drinking were identified. The trajectory groups were then examined as predictors of disadvantage at age 42. Five distinct heavy drinking trajectories were identified: moderate (35%), steady low (22%), decreasing (9%), increasing (11%) and steady high (23%). Frequencies of the trajectory groups differed by gender. Using the moderate trajectory as a reference category, women in the steady high trajectory had an increased risk of experiencing almost all disadvantages at age 42. In men, increasing and steady high groups had an increased risk for experiencing health and economic disadvantage. Steady high female drinkers and steady high and increasing male drinkers had the highest risk for disadvantage in mid-adulthood. By identifying heavy drinking trajectories from adolescence to mid-adulthood we can better predict long-term consequences of heavy alcohol use and plan prevention and intervention programmes.

Age of First Use and Delay to First Intoxication in Relation to Trajectories of Heavy Drinking and Alcohol-Related Problems During Emerging Adulthood

Using alcohol at an early age is a well-documented risk factor for heavy drinking and the experience of a range of negative social and health consequences. However, it remains unclear if early consumption of any alcohol or early drinking to intoxication confers the greatest risk. Age of onset (AO) and delay to first intoxication (delay) were examined as independent predictors of heavy drinking and the experience of alcohol-related problems (problems) in a sample of incoming college freshmen (n=1,160) who completed biannual assessments from the summer following senior year of high school through senior year of college. The sample included more women (66%) than men and a majority were Caucasian (59%). We employed latent growth curve modeling to examine self-reported AO and delay to self-defined first intoxication as predictors of the frequency of heavy drinking and problems during year 4 of college, as well as changes in these alcohol-related outcomes from high school through college. An earlier AO and/or a shorter delay was associated with increased frequency of heavy drinking and problems during senior year of college. Although individuals with a later AO and/or a longer delay were at lower risk overall, they showed larger increases in heavy drinking and problems over time. The findings highlight the importance of distinguishing between AO and delay to first intoxication. Delay accounted for unique variance in drinking outcomes relative to AO, and the effects of AO were stronger when delay was included as a predictor variable. Results are discussed with regard to potential mechanisms through which an early age of intoxication may confer unique risk relative to AO. The implications for cross-cultural differences in risk for problems attributable to early drinking are also discussed.

Baseline trajectories of heavy drinking and their effects on postrandomization drinking in the COMBINE Study: empirically derived predictors of drinking outcomes during treatment

Baseline trajectories of heavy drinking and their effects on postrandomization drinking in the COMBINE Study: empirically derived predictors of drinking outcomes during treatment

Protective Predictors of Alcohol Use Trajectories Among Canadian Aboriginal Youth

Some Aboriginal youth are at disproportionate risk of using substances and developing abuse and dependence disorders. However, not all Aboriginal youth misuse substances and limited research has examined the protective factors conferring against substance use among these youth. The present study aimed to identify protective factors related to the alcohol use trajectories from early adolescence to emerging adulthood among off-reserve Canadian Aboriginal youth. Participants (N = 330; 50.3% male) aged 12-23 were selected from cycles 2-7 of Statistics Canada's NLSCY. Multilevel modeling was employed to identify protective factors for two constructs of alcohol use. Participation in weekly activities and optimism were found to be protective for both the frequency of alcohol use and heavy drinking trajectories. Attendance of religious services was also found to be protective for heavy drinking behaviors. In contrast, positive peer relationships were a risk factor for frequency of alcohol use, but not heavy drinking. The results provide preliminary evidence of important developmental factors to integrate into substance use intervention programs targeting Aboriginal youth.

Baseline trajectories of heavy drinking and their effects on postrandomization drinking in the COMBINE Study: empirically derived predictors of drinking outcomes during treatment

The Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study sought to answer questions about the benefits of combining behavioral and pharmacological interventions (naltrexone and acamprosate) in alcohol-dependent patients. Our goals were to identify trajectories of heavy drinking before randomization in COMBINE, to characterize patients in these trajectories, and to assess whether prerandomization trajectories predict drinking outcomes. We analyzed daily indicators of heavy drinking 90 days before randomization using a trajectory-based approach. Each patient was assigned to the most likely prerandomization heavy-drinking trajectory, and the baseline characteristics of participants in the baseline trajectories were compared. The main and interactive effects of these trajectories and treatment factors (acamprosate, naltrexone, or combined behavioral intervention) on summary drinking measures during active treatment (16 weeks) were assessed. We identified five trajectories of heavy drinking prerandomization: “T1: frequent heavy drinkers”; “T2: very frequent heavy drinkers”; “T3: nearly daily heavy drinkers”; “T4: daily heavy drinkers”; and “T5: daily heavy drinkers stopping early” before randomization. Trajectory membership was significantly associated with all drinking outcomes. Patients in “T5: daily heavy drinkers stopping early” had comparable drinking outcomes to those in “T1: frequent heavy drinkers,” whereas the remaining trajectories were associated with significantly worse outcomes. The baseline trajectory did not interact significantly with the treatment condition. These exploratory analyses confirmed the hypothesis that baseline trajectories predict postrandomization drinking outcomes. Interestingly, “T5: daily heavy drinkers stopping early” had outcomes that were comparable to the least severe baseline trajectory “T1: frequent heavy drinkers,” and baseline trajectories of heavy drinking did not moderate the treatment effects.

Racial differences in trajectories of heavy drinking and regular marijuana use from ages 13 to 24 among African-American and White males

BackgroundAlthough there are significant differences in prevalence of substance use between African-American and White adolescents, few studies have examined racial differences in developmental patterns of substance use, especially during the important developmental transition from adolescence to young adulthood. This study examines racial differences in trajectories of heavy drinking and regular marijuana use from adolescence into young adulthood. MethodsA community-based sample of non-Hispanic African-American (n=276) and non-Hispanic White (n=211) males was analyzed to identify trajectories from ages 13 to 24. ResultsInitial analyses indicated race differences in heavy drinking and regular marijuana use trajectories. African Americans were more likely than Whites to be members of the nonheavy drinkers/nondrinkers group and less likely to be members of the early-onset heavy drinkers group. The former were also more likely than the latter to be members of the late-onset regular marijuana use group. Separate analyses by race indicated differences in heavy drinking for African Americans and Whites. A 2-group model for heavy drinking fit best for African Americans, whereas a 4-group solution fit best for Whites. For regular marijuana use, a similar 4-group solution fit for both races, although group proportions differed. ConclusionsWithin-race analyses indicated that there were clear race differences in the long-term patterns of alcohol use; regular marijuana use patterns were more similar. Extended follow ups are needed to examine differences and similarities in maturation processes for African-American and White males. For both races, prevention and intervention efforts are necessary into young adulthood.

Identification and Prediction of Drinking Trajectories in Early and Mid-Adolescence

The aim of this study was to identify subgroups of early and mid-adolescents with different drinking trajectories. In addition, we examined whether gender, parental, and peer factors predicted adolescents' membership of these drinking trajectories. We used longitudinal data of 428 families (fathers, mothers, mid-adolescents, and their younger siblings). Latent Class Growth Analyses were performed to identify drinking trajectories. Four drinking trajectories emerged for early adolescents: abstainers, light drinkers, increasers, and heavy drinkers. For mid-adolescents, we identified a fifth group (stable drinkers) in addition to the four trajectories identified for early adolescents. Our results showed that being a boy, having a best friend or father who drinks heavily, and having parents who are permissive toward adolescents' alcohol creates increased risk for both siblings to attend the more heavy drinking trajectories.

Longitudinal differences in alcohol use in early adulthood.

Research with college populations suggests that elevated levels of heavy drinking do not generally persist into later adulthood for most individuals. The aims of this study were to determine whether this pattern applies to the population as a whole and to identify those for whom heavy drinking in early adulthood does lead to continued high levels of consumption throughout the life course. Patterns of heavy drinking were assessed, and a mixture model was used to evaluate relationships between psychological profiles and trajectories of heavy drinking in early to middle adulthood for race-gender groups. Subjects (N = 5,115; 55% women) were drawn from the longitudinal study of Coronary Artery Risk Development in Young Adults (CARDIA) conducted in four major U.S. cities from 1985 to 1995. Patterns of heavy drinking differed by race and gender, with higher rates observed among whites and men. Heavy drinking was generally most common in the early 20s and dropped sharply thereafter. For a subset with psychological profiles characterized by elevated levels of hostility, anxiety, and depressive symptoms, high rates of heavy drinking persisted into later adulthood; 20% of whites and 50% of blacks in the overall sample were in this subset. Rates of heavy drinking in this group were similar for blacks and whites. At a population level, heavy drinking in early adulthood tends not to continue into later life. For a subset of psychologically vulnerable individuals, however, early adult heavy drinking persists into the middle adulthood years.

The Influence of Pubertal Timing on Alcohol Use and Heavy Drinking Trajectories

Early pubertal timing has been associated with increased alcohol use, drunkenness, and alcohol use disorders in both boys and girls during adolescence. It is not clear, however, whether the effect of early pubertal timing persists into late adolescence and young adulthood, whether its effect differs by gender, and if contextual factors (e.g., peer alcohol use) amplify such effect. This study attempts to address these questions by examining the trajectories of alcohol use and heavy drinking from early adolescence to young adulthood in males and females using data from the National Longitudinal Study of Adolescent Health (Add Health). Results show that for both males and females, early pubertal timing was associated with higher alcohol use and heavy drinking trajectories. These effects persisted into young adulthood and were found to be stronger for males than for females. Moreover, there was a significant interaction effect between friends’ drinking and pubertal timing on alcohol use and heavy drinking trajectories; but the interaction effect also differed for males and females. These findings suggest that early pubertal timing is a risk factor for alcohol use and has long-term implication for individuals’ health.