Younger Alcoholics Research Articles

Impact of Medical Comorbidity and Risk of Death in 680 Patients with Alcohol Use Disorders

The association between alcohol use disorders and increased risk of mortality is well known; however, there have been few systematic evaluations of alcohol-related organ damage and its impact on survival in younger alcoholics. Therefore, we assessed medical comorbidity with a clinical index to identify subgroups of alcoholic patients at high risk of premature death. Hospital-based cohort of alcohol-dependent patients admitted for detoxification between 1999 and 2008 in Barcelona, Spain. At admission, sociodemographic characteristics and a history of alcohol dependence and abuse of illegal drugs were obtained through clinical interviews and questionnaires. Medical comorbidity was assessed with the Cumulative Illness Rating Scale (Substance Abuse) (CIRS-SA). Dates and causes of death were obtained from clinical records and death registers. Survival was analyzed using Kaplan-Meier methods, and Cox regression models were used to analyze the risk factors for premature death. Median age of the patients (686 total, 79.7% men) was 43.5 years (interquartile range [IQR], 37.8 to 50.4), average alcohol consumption was 200 g/d (IQR, 120 to 280 g/d), and duration of alcohol use disorder was 18 years (IQR, 11 to 24). Medical comorbidity by CIRS-SA at admission showed that the organs/systems most affected were liver (99%), respiratory (86%), and cardiovascular (58%). After median follow-up of 3.1 years (IQR, 1.5 to 5.1), 78 (11.4%) patients died with a mortality rate of 3.28 × 100 person-years; according to Kaplan-Meier estimates, 50% (95% confidence interval [95% CI], 24 to 69%) of patients with severe medical comorbidity died in the first decade after treatment. In multivariate analysis, severe medical comorbidity (hazard ratio [HR], 5.5; 95% CI, 3.02 to 10.07) and being treated with methadone at admission (HR, 2.60; 95% CI, 1.50 to 4.51) were independent risk factors for premature death. Systematic assessment of alcohol-related organ damage is relevant for the identification and treatment of those at increased risk of death.

Dysmorphology and microstructural degradation of the corpus callosum: Interaction of age and alcoholism

Chronic alcohol abuse is a ubiquitous health and societal problem, with a growing prevalence in the older population. Alcoholism is a source of substantial deterioration in brain tissue and has been consistently observed in vivo and postmortem in white matter. To quantify the potential compounded effect of age and alcoholism, we used conventional structural MRI and diffusion tensor imaging (DTI) to examine the macrostructural and microstructural integrity of the corpus callosum, one of the most prominent white matter structures of the brain, in 131 adults, age 27–75 years. Compared with the 74 controls, the 40 alcoholic men and 17 alcoholic women, who were abstinent from alcohol for an average of 3 months, showed similar patterns and extents of callosal shrinkage, which was greatest in the genu and body and less prominent in the splenium. Microstructural integrity was measured with DTI as fractional anisotropy, an index of intravoxel orientational coherence of white matter fibers, and bulk mean diffusivity, an index of the amount of intravoxel water motility. The macrostructural shrinkage was accompanied by abnormalities in anisotropy and diffusivity of the microstructural environment of these callosal regions, indicative of disruption of structural constituents of local brain white matter. Correlational analyses revealed an age–alcohol interaction, where older alcoholics had smaller genu and splenium and higher diffusivity in these regions than younger alcoholics. Significant correlations between regional MRI and DTI measures and performance on working memory, visuospatial ability, and gait and balance provided evidence for the functional ramifications of the callosal abnormalities in the alcoholics. Thus, despite abstinence from alcohol, the interaction of age and recent alcoholism history exerted a compounded untoward effect on callosal macrostructure and microstructure.

Parallel interhemispheric processing in aging and alcoholism: relation to corpus callosum size

We tested parallel processing of visual information using the redundant targets effect (RTE) in 12 alcoholics and 13 matched controls. The paradigm was a simple reaction time (RT) task with targets presented in the same (uncrossed), opposite (crossed), or both (redundant) visual-fields. In older alcoholics (>50 years) the RT gain invoked by redundant targets did not exceed probability measures, suggesting compromised interhemispheric processing of parallel information in this subgroup compared with controls or younger alcoholics. The difference between crossed and uncrossed reaction times (CUD), an index of interhemispheric transfer time (ITT), was greater in older than younger subjects. Moreover, the CUD was negatively correlated with the corpus callosum (CC) total area and body in controls, supporting the concept of a structure-function relationship of interhemispheric transfer. This relationship was not found in alcoholics, although the midsagittal area of the CC, genu, and body but not intracranial volume (ICV), was significantly smaller in alcoholics than controls. These results suggest that chronic alcohol abuse together with advancing age exert subtle disruption on parallel interhemispheric processing reliant on callosal connections.

Severe Community-Acquired Pneumonia due to Acinetobacter baumannii

To investigate the clinical, epidemiologic, and microbiological characteristics of community-acquired pneumonia (CAP) due to Acinetobacter baumannii. Retrospective chart and radiographic reviews of all patients who were admitted to National Taiwan University Hospital from January 1993 to August 1999, fulfilled the criteria for CAP, and had an isolate of A. baumannii from blood or pleural fluid at hospital admission. Thirteen patients (9 men and 4 women; age range, 37 to 85 years) met the criteria. Conditions associated with the infection included male gender, old age, alcoholism, malignancy, cerebrovascular disease, diabetes mellitus, renal disease, and liver cirrhosis. Eleven patients (85%) acquired the infection during the warmer months of April to October. Twelve patients (92%) had a fulminant course presenting with septic shock and respiratory failure, and 11 patients (85%) needed ventilator support and were treated in an ICU. Six patients (46%) had leukopenia. Lobar consolidations were found in 12 patients (92%), and pleural effusions were present in 4 patients (31%). All patients had positive blood culture results, two patients (15%) had positive pleural effusion culture findings, and nine patients (69%) positive sputum culture results. All the isolates were susceptible to imipenem, and most were susceptible to aminoglycosides, ceftazidime, ciprofloxacin, and extended-spectrum penicillins. Eight patients (62%) died. Four of the five survivors were initially treated with combination of a third-generation cephalosporin and an aminoglycoside. A. baumannii should be considered as a possible etiologic agent in community-acquired lobar pneumonia when (1) patients with a fulminant course present during the warmer and more humid months of the year, and (2) patients are younger alcoholics. A good sputum smear, defined as a Gram stain smear of an adequate sputum specimen that comes from the lower respiratory tract and contains > 25 leukocytes per high-power (100x) field on microscopic examination, can help early diagnosis and treatment. A combination of a third-generation cephalosporin and an aminoglycoside may be appropriate empirical therapy.

The severity of alcohol withdrawal is not age dependent.

Age has been considered to contribute to the severity of the alcohol withdrawal syndrome (AWS). To evaluate the relationship between age and the severity of the AWS, we examined 723 alcoholics [518 males, 205 females, mean age (+/- SD): 42.8 +/- 10.5 years, mean duration of alcohol dependence: 11.0 +/- 8.0 years] consecutively referred to a unit for detoxification of alcoholics in a general hospital. The severity of the AWS was assessed by the AWS scale of Wetterling et al. (1997; Alcohol and Alcoholism 32, 753-760). The history of alcohol abuse as well as drinking behaviour in the last 6 months was assessed by a semi-structured interview. There were 41 alcoholics aged > or =60 years; they were compared with younger patients. The average severity of AWS did not differ between age groups. Daily alcohol intake and frequency of drinking were higher in younger alcoholics, but even when adjustment was made for this, severity of AWS was equal in both age groups. A relationship between severity of AWS and age was not detected.

Older and younger male alcoholics in outpatient treatment

In the coming decades, the proportion of the older age groups in the total population, and, therefore, in the alcoholic population, will be increasing. The aim of the study is to assess to what extent older alcoholics form a distinct group within the problem-drinking population. Alcoholics in outpatient treatment of over 50 years of age ( n = 52) are compared with those from the modal age group (ages 35–44, n = 55). Results indicate that problems with alcohol are less severe among older alcoholics. Contrary to expectation, older alcoholics did not report more health problems. No differences were observed in the duration of the treatment career. It is concluded that older alcoholics show the same types of problems, but less so than younger alcoholics. Further research is indicated regarding late onset, older alcoholics with multiple diagnosis, and drinking problems in the age group over 70.

Association learning and recognition memory in alcoholic Korsakoff patients.

Association learning and recognition memory were examined in 8 male alcoholic Korsakoff patients (mean age 58), and in the following 4 groups of 10 men: non-Korsakoff alcoholics (mean age 59), nonalcoholic controls (mean age 64), younger alcoholics (mean age 36), and nonalcoholic controls (mean age 37). The tasks were modeled after those used for testing memory functioning in nonhuman primates. Association learning, defined as the ability to distinguish rewarded from equally familiar nonrewarded visual stimuli, was impaired in Korsakoff patients. Korsakoff patients also were impaired on recognition memory-the ability to discriminate familiar from novel items. Results support the view of loss of multiple memory functions in alcoholic amnesia. An effect of aging was indicated by differences in performance levels between younger and older groups of non-Korsakoff participants, although the latter were superior to the Korsakoff patients.

Sex hormones and alcohol withdrawal: Does a good supply of testosterone prevent serious symptoms during detoxification?

Owing to the clinical similarity between the male climacteric syndrome and the results of previous studies on the alcohol withdrawal syndrome in relation to sex hormones, we hypothesized that alcoholics with a poor supply of testosterone will develop more pronounced symptoms during alcohol withdrawal than alcoholics with high levels of testosterone. Fifty-two male alcoholics were studied. To test our hypothesis we entered the mean values of the hormones, the mean age, and the mean consumption of liquor (CL) the week before admittance as regressors in a multiple forward stepwise regression analysis with four subclass constructed from the CPRS as dependent variables. Our results indicate that patients with low levels of testosterone develop more neurotic-asthenic symptoms, such as indecision, worrying about trifles, fatigability, and lassitude during alcohol withdrawal. Further, high levels of SHBG were related to a history of seizures and younger alcoholics received higher ratings on the paranoid-aggressive subscale. It is concluded that there is a relation between levels of testosterone and symptoms during alcohol withdrawal. The question of a causal relationship remains to be answered, however. One way to illuminate this would be to add testosterone during detoxification, which may reduce the symptoms mentioned above analogous to the male climacteric syndrome, which could be prosperously treated by a supplement of testosterone. This treatment strategy would have obvious advantages compared to benzodiazepine detoxification as such drugs are potentially addictive.

Anterior hippocampal volume deficits in nonamnesic, aging chronic alcoholics.

Magnetic resonance imaging was used to quantify the volume of the hippocampus in 47 men with chronic alcoholism and 72 healthy male control subjects. The subjects ranged in age from 21 to 70 years, thus permitting a test of whether older alcoholics suffer greater brain tissue volume reduction than do younger ones. Comparison brain regions included temporal lobe gray matter, white matter, and cerebrospinal fluid, as well as measures of the lateral ventricles, third ventricle, and temporal horns. The results of this cross-sectional study showed that the anterior, but not the posterior, portions of the hippocampus in both hemispheres were significantly smaller in the alcoholic than the healthy control group. Furthermore, the bilateral anterior hippocampal volume loss was greater in older than younger alcoholics. Despite the hippocampal volume deficit, these alcoholics did not demonstrate an explicit memory impairment; furthermore, memory test scores did not correlate significantly with hippocampal volumes. In the alcoholics, the age-related volume loss, which was over and above that expected in normal aging, was also evident in the temporal cortex and white matter. Likewise, alcoholic ventricular enlargement was age-related. Analysis of covariance revealed that the anterior hippocampal deficit persisted after accounting for the temporal lobe gray matter volume deficit. Multiple regression analysis revealed that the age-related brain volume abnormalities observed in the alcoholics could not be attributed to duration of alcoholism or total lifetime consumption of alcohol.

Treatment approaches for older problem drinkers.

Recent research suggests that older adults with alcohol problems often drink in response to loneliness, depression, and poor social support networks. Although a variety of approaches such as psychodynamic, Twelve Step, social support, behavioral, and cognitive-behavioral, have been suggested, only those studies involving behavioral and cognitive-behavioral interventions have provided empirical support for treatment effectiveness. Some research also suggests that age-specific group treatment produces better outcomes than when older adults are placed in treatment with younger alcoholics.

Alcohol‐Induced Bone Disease: Relationship to Age and Parathyroid Hormone Levels

Alcohol abuse leads to osteopenia and fractures. Epidemiological evidence suggests that older alcoholics are at substantially greater risk of fractures than younger alcoholics. To examine the interaction of age and alcohol abuse on bone mineral homeostasis, we studied 27 subjects with a history of 10 more years of alcohol abuse ranging in age from 26-68 years. They were evaluated for disordered bone mineral homeostasis by assessing bone density (by quantitative computed tomography of the lumbar spine), histomorphometry of a transcortical biopsy from the iliac crest, serum levels of vitamin D metabolites and parathyroid hormone, and serum and urine levels of bone minerals. Seventeen of the subjects were found to have spinal compression fractures by routine radiologic procedures. The older the subject the more likely the subject was to have such a fracture. Bone densitometry indicated a marked reduction in spinal bone density with 15 subjects below 2 SD of normal aged-matched controls. Bone density fell sharply with the age of the subject. Histomorphometry of iliac crest bone biopsies revealed no evidence of osteomalacia, but total resorption surfaces were increased. Consistent with the lack of osteomalacia were the normal levels of the vitamin D metabolites. The increased total resorption surfaces were correlated with high normal or elevated levels of parathyroid hormone as indicated both by radioimmunoassay and by urinary cAMP levels. Bone formation and active bone resorption (resorption surfaces containing osteoclasts) did not correlate with parathyroid hormone levels, however, but correlated negatively with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of Older and Younger Alcoholics and Prescription Drug Abusers

This study compared 26 elderly patients with 33 younger patients with a diagnosis of a substance use disorder. Subjects were compared on demographic, medical, psychiatric, and social factors. Alcohol was the most commonly used drug for both groups and poly-drug addicts were the norm for both groups. Significant social and psychiatric pathology were also common in both groups. Elderly addicts were more likely to abuse benzodiazepines, be married, have ADL dysfunctions and neurologic and cognitive signs and symptoms, and to have psychotic symptoms. They were also more likely to threaten violence, lie about their drug use, and to be non-compliant with medical care. Younger addicts were more likely to have job, housing, and legal problems, use street drugs, and to have their addiction as their chief complaint.

Brain gray and white matter volume loss accelerates with aging in chronic alcoholics: a quantitative MRI study.

Magnetic resonance imaging (MRI) was used to study in vivo the brains of 49 patients with chronic alcoholism, 3 to 4 weeks post-withdrawal, and 43 normal healthy controls, all right-handed male veterans between the ages of 23 and 70 years. MRI scans were analyzed using a semi-automated procedure, which allowed the subcortical regions to be segmented into cerebrospinal fluid (CSF) and brain tissue and the cortical regions to be segmented into CSF, gray matter, and white matter. An age regression model was used to examine the effects of alcohol on brain structure, over and above that expected from the normal aging process. The alcoholics exhibited decreased tissue and increased CSF after correcting for aging. In the cortex, there was significant loss of both gray matter and white matter volume. In this sample of alcoholics, no particular cortical region was preferentially affected or spared. Furthermore, brain tissue volume loss increased with advanced age in the alcoholics. In this group of alcoholics there was no relationship between length of illness and age, i.e., the younger alcoholics had as heavy alcohol use histories as did the older alcoholics. Thus, the increased brain tissue loss with advanced age is interpreted as evidence for age-related increase in brain vulnerability to chronic alcohol abuse.

Age-related psychiatric comorbidities and level of functioning in alcoholic veterans seeking outpatient treatment.

The relationship of age and of level of adaptive functioning to comorbidity of mental disorders among alcoholics was studied in a survey of all alcoholics seeking outpatient mental health treatment in the Veterans Affairs mental health care system during a one-month period in 1986 (N = 22,463). More than half of the alcoholic outpatients had one or more comorbid psychiatric diagnoses. Rates for comorbid substance abuse disorders, posttraumatic stress disorder, schizophrenia, and personality disorders peaked in younger alcoholics and then decreased with age. Age-related increases were observed for major depression, anxiety disorders, and organic brain syndrome or dementia. DSM-III axis V ratings of poor to grossly impaired functioning were consistent across age groups. More than half of alcoholics with a comorbid psychiatric disorder were rated as severely impaired, compared with less than a third of those with no comorbid mental disorder.

The premature aging hypothesis: old before its time?

This study tested the hypothesis that alcoholism results in premature aging of memory functioning. It was proposed that support for the premature aging hypothesis must come from qualitative as well as quantitative similarities between younger alcoholics and older controls. The California Verbal Learning Test (CVLT) was administered to young and old alcoholics and to young and old controls. The CVLT provides measures of recall, recognition, learning strategies, and error types. Alcoholism and aging produced similar levels of immediate and delayed free recall. However, poor recognition memory and more frequent intrusion and false positive errors were associated with alcoholism but not with aging. Qualitative differences in error types between alcoholism and aging were also found. Results indicated that alcoholism and aging produce independent verbal learning decrements.

Alcoholism in Elderly Persons: Medical Aspects and Prognosis of 216 Inpatients

We describe 216 elderly patients (65 years of age or older) who were treated for alcoholism in an inpatient treatment program. Emphasis is placed on the demographics, medical characteristics, results of laboratory tests, outcome of treatment, and various comparisons of early- and late-onset alcoholism. The frequency of serious medical disorders among these patients was higher than would be expected for the overall population of a similar age. Elderly alcoholics have more abnormal results of commonly used laboratory tests than do younger alcoholics. Our data show that the elderly alcoholic can be successfully treated in a medically oriented inpatient treatment program. The concept of less-intensive treatment for the elderly alcoholic is generally not supported. More-intensive treatment may be necessary for some of these patients because of the high frequency of accompanying major medical and psychiatric problems. Early-onset alcoholism predominated, but we found no major differences between the two groups.

Age and sex differences in the responses of alcoholics to the Self‐Administered Alcoholism Screening Test

The Self-Administered Alcoholism Screening Test (SAAST) was completed by 583 inpatients (437 men; 146 women) who were undergoing evaluation and treatment for alcoholism. Endorsement frequencies were computed separately for men and women, and a principal components analysis was performed on the item intercorrelation matrix. Six components (or factors) were retained for interpretation. Men were significantly more likely to engage in occupationally and socially disruptive behaviors (component II) and to elicit concern on the part of others (component V). Women were significantly more likely to admit to loss of control (component I), to experience emotional consequences and request help (component IV), and to report alcohol problems in their families (component VI). Younger alcoholics were more likely to admit to a loss of control, to have occupational and social disruption, to experience emotional consequences and request help, and to obtain higher total scores on the SAAST. Older alcoholics were more likely to report physical consequences of drinking (component III). Twenty-two alcoholics who scored in the nonalcoholic range (6 or below) were likely to be initially resistant and unaccepting of treatment.

Young and old alcoholics: some personality differences.

Ninety-one alcoholic males aged 20-65 completed the MMPI. Their T scores on 10 clinical scales and 3 other indices were correlated with age. Seven of 13 correlations were statistically significant. There was a significant negative correlation between age and psychopathic deviance, paranoia, schizophrenia, and mania, and there was a significant positive correlation between age and hypochondriasis. Goldberg's indices showed that younger alcoholics' profiles resembled those of a sociopathic population as opposed to a psychiatric population and tended toward psychoticism rather than neuroticism. Results can assist practitioners in understanding and planning for a young clientele.

Alcoholism in the elderly

Alcoholism is a more common problem in the elderly than has been recognized. Manifestations are more subtle than in younger alcoholics, and problems are primarily social rather than medical. Treatment approaches directed at the psychosocial stresses associated with aging are the most successful. The principles of the therapeutic community have also been effective in eliminating alcoholism and other behavioral disorders in elderly alcoholics.

Neuropsychological function in young alcoholics and polydrug abusers

Abstract The neuropsychological abilities of younger (mean age, 30) alcoholics and polydrug abusers were compared. On the basis of a clinician's rating of Halstead-Reitan results, 10 of 20 polydrug users (50%) and 4 of 20 alcoholics (20%) were found to show impairment. The polydrug users also scored significantly worse on Halstead's Impairment Index, Category Test, and Trail-Making Test, part B. Because the two groups were closely matched in age, education, Verbal IQ, and the medical history, the possibility is raised that, whereas 10 years of heavy drinking is not sufficient to yield neuropsychological impairment in younger persons, heavy multiple drug abuse might have more serious implications for cerebral functioning.