Paul Sacco

Substance Abuse Among Older Adults

Although the myth that older adults do not use mood-altering substances persists, evidence suggests that substance use among older adults has been underidentified for decades. The baby boom generation is unique in its exposure to, attitudes toward, and prevalence of substance use-causing projected rates of substance use to increase over the next twenty years. Given their unique biological vulnerabilities and life stage, older adults who misuse substances require special attention. Prevalence rates of substance use and misuse among older adults, methods of screening and assessment unique to older adults, and treatment options for older adults are reviewed.

The impact of retirement on the drinking patterns of older adults: A review

OBJECTIVE Due to the aging of the population, there is renewed focus on the public health issues of middle-aged and older adults. One area of such focus is unhealthy drinking, and researchers seek to understand the unique developmental risk and protective factors among those entering older adulthood. Retirement has been hypothesized as a contributing factor in the onset and maintenance of unhealthy drinking in late life. This review describes the relevant theories and critically reviews empirical evidence that explores the relationship between alcohol and retirement drawn from both the industrial and organizational psychology and substance misuse literatures. METHOD Using four research databases, thirteen studies published in the last 25years that investigated the relationship of retirement and alcohol use and met specific selection criteria were reviewed. RESULTS The literature suggests that retirement may not have a strong direct impact on drinking behaviors or problems, but attributes of the process (e.g. retirement voluntariness) of transition to retirement and individual attributes, such as having a history of problem drinking, may facilitate or inhibit drinking. CONCLUSIONS Future research should delve into the social context of drinking in retirement with a goal of understanding the aspects and conditions of retirement that increase risk of alcohol problems. Investigation should also examine heterogeneity in retirement drinking patterns with a goal of identifying subpopulations that are at greater risk.

Substance Use and Mental Health Disorders Among Heterosexual Identified Men and Women Who Have Same-Sex Partners or Same-Sex Attraction: Results from the National Epidemiological Survey on Alcohol and Related Conditions

This study examined sexual orientation discordance, a mismatch between self-reported sexual identity and sexual behavior or sexual attraction, by describing the characteristics, substance use disorders, and mental health risks of heterosexual identified individuals who endorsed this pattern of sexual identification, behavior, and attraction. Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we created three groups based on participants’ reported sexual identity and either their sexual behavior or sexual attraction: heterosexual concordant, homosexual concordant, and heterosexual discordant. Bivariate models assessed the relationship of discordant status and demographic correlates, lifetime substance use disorders, and mental health diagnoses. Logistic regression models tested associations between both behavior discordance and attraction discordance and the likelihood of having lifetime disorders of substance use, major depression, and generalized anxiety. Results of this study provided evidence of varying levels of substance use and mental health disorder risk by gender, discordance status, and discordance type. Behavioral discordance was associated with increased risk of mental health and substance use disorder among women (compared to heterosexual concordance). Findings among men were less consistent with heightened risk of alcohol and inhalant use only. Attraction discordance was notably different from behavioral discordance. The odds of substance use and mental health disorders were the same or lower compared with both the heterosexual and homosexual concordance groups. Future research should begin to test theoretical explanations for these differences.

Gender Differences in Stressful Life Events, Social Support, Perceived Stress, and Alcohol Use Among Older Adults: Results From a National Survey

Stressful life events, perceived stress, and social support relationships with consumption, at-risk drinking, and alcohol use disorder (AUD) were studied in a population-based sample of current drinkers age 60+ in the National Epidemiologic Survey of Alcohol and Related Conditions (Wave 2; 2004–2005; n = 4,360). Stressful life events were associated with AUD among men and women, and crime victimization among men only. However, greater perceived stress was associated with lower consumption among women and greater odds of AUD in men, highlighting differences in the relationship between stress and alcohol use by gender that may be the result of the stress alcohol link.

Changes in Parental Assets and Children's Educational Outcomes

Several countries, including Canada, Singapore and the United Kingdom, have enacted asset-based policies for children in recent years. The premise underlying these policies is that increases in assets lead to improvement in various child outcomes over time. But little existing research examines this premise from a dynamic perspective. Using data from the NLSY79 mother and child datasets, two parallel process latent growth curve models are estimated to examine the effects of parental asset accumulation on changes in childrens achievements over six years during middle childhood. Results indicate that the initial level of assets is positively associated with math scores, but not reading scores, while faster asset accumulation is associated with changes in reading scores, but not in math scores. Overall, the results suggest that the relationship between assets and various child outcomes may not be straight-forward. Different dimensions of the asset experience may lead to different outcomes, and the same dimension may also have different effects. Implications for future research and for asset-based policies are discussed. There is increasing interest in asset-based policies and interventions as a social investment strategy, and a number of countries have implemented or are exploring this new policy approach. In recent years, the asset-building discussion has expanded to include children, with the implementation of national asset- based policies targeting children in Canada, Singapore, South Korea and the United Kingdom. Underlying these policies and interventions is the premise that the possession and accumulation of assets lead to a range of positive effects in children. With regard to childrens cognitive and educational outcomes such as math and reading achievements, it is postulated that higher levels of assets possessed and greater asset accumulation will be associated with improvement in childrens cognitive and educational development over time, which, in turn, leads to better attainment in these areas. Little existing research, however, examines this premise from a dynamic perspective.

Why Do Older Unhealthy Drinkers Decide to Make Changes or Not in Their Alcohol Consumption? Data from the Healthy Living as You Age Study

To understand characteristics of older at‐risk drinkers and reasons why they decide to change or maintain their alcohol consumption.

Drinking behavior among older adults at a continuing care retirement community: affective and motivational influences

Objectives: The purpose of this pilot study was to describe patterns of alcohol consumption among continuing care retirement community(CCRC) residents and to explore the role of drinking motives and affective states on drinking context and consumption. Method: We utilized a phone-based daily diary approach to survey older adults about their daily alcohol consumption, context of drinking (e.g. drinking alone), positive and negative affect, and their motives for drinking. Data were analyzed descriptively, and regression models were developed to examine associations between sociodemographic factors, affect, drinking context and motives, and alcohol consumption. Results: CCRC residents drank most frequently at home and were alone almost half of drinking days on average, although the context of drinking varied considerably by participant. Problem alcohol use was rare, but hazardous use due to specific comorbidities, symptoms and medications, and the amount of alcohol consumption was common. Respondents endorsed higher social motives for drinking and lower coping motives. Social motives were associated with decreased likelihood of drinking alone, but negative affect was associated with decreased likelihood of drinking outside ones home. Coping and social motives were associated with greater consumption, and higher positive affect was associated with lower consumption. Conclusion: Among CCRC residents, alcohol use may be socially motivated rather than motivated by coping with negative affect. Future research should examine other motives for drinking in older adulthood. Evaluation of older adults living in CCRCs should include attention to health factors beyond problem use as other forms of hazardous use may be common in CCRCs.

Functioning of Alcohol Use Disorders Criteria Among Middle-Aged and Older Adults: Implications for DSM-5

This study explored dimensionality and rank-order severity of the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) alcohol use disorder (AUD) criteria among adults 50+ years old. Secondary analysis was performed on data from individuals 50+ (N = 3,412) from the 2009 National Survey of Drug Use and Health. Confirmatory factor analyses (CFA) and item response theory (IRT) analyses were performed on the 11 AUD criteria. DSM-IV and DSM fifth edition (DSM-5) classifications were compared. CFA revealed a one-factor model. IRT analyses revealed that AUD criteria identify only severe cases of AUD. Overall, 5.8% met criteria for a DSM-IV AUD; 7.5% met criteria for DSM-5 AUD.

Help seeking for drug and alcohol problems among adults age 50 and older: A comparison of the NLAES and NESARC surveys

BACKGROUND Due to population aging and generational changes in alcohol and drug use, substance use disorders and treatment need are projected to increase among adults over 50. We analyzed data from two national surveys conducted 10 years apart [(NLAES (1991-1992) and NESARC (2001-2002)] to explore changes in help-seeking for alcohol and drug problems among adults over age 50. METHODS Data were pooled on help seeking for substance related problems, sociodemographic and clinical variables, and services type (i.e., formal and informal). Differences between the surveys were assessed, and help seeking among those under age 50 was compared to younger individuals; changes in the sociodemographic and clinical correlates of help seeking among those over age 50 were examined. RESULTS Among those 50 and older, rates of lifetime help seeking for any substance problem were higher in NESARC than NLAES, and percentages of those considering but not getting help were also higher in NESARC. Among those 50+, rates of past-year help seeking for drug use were higher in NESARC, but among those with lifetime substance use disorders, help seeking rates for alcohol and any substance were lower in the NESARC. Older help seekers in the NESARC were less likely to be White, more likely to be low income, and more likely to be current or former drug users than NLAES help seekers. CONCLUSIONS This study documents increased rates of help seeking for substance related problems among those 50 and older and identifies cohort differences in profile of past-year help seekers.

Employee Assistance Program Services for Alcohol and Other Drug Problems: Implications for Increased Identification and Engagement in Treatment

BACKGROUND Fourteen million U.S. workers meet the diagnostic criteria for substance dependence, costing millions in lost productivity. Prior research suggests that employees who follow through with their Employee Assistance Programs (EAP) recommendations are more likely to participate and remain engaged in alcohol and other drug (AOD) treatment programs. This study identified rates of lifetime EAP service use for AOD problems and compared adults who reported using EAP services for AOD problems with those who used services other than EAP. METHODS Researchers analyzed a subset of participants from the National Epidemiologic Survey of Alcohol and Related Conditions who reported having received help for an AOD problem (NESARC, 2001-2002). Statistical analyses tested for differences in sociodemographic variables, lifetime mental health and substance abuse disorders, and health disability between EAP services users and users of other types of services. RESULTS Among adults who sought services for AOD problems (n= 2,272), 7.58% (n= 166) reported using EAP services for these problems at some point during their lives. Major depressive disorder (lifetime), a drug use disorder (lifetime), and Black race/ethnicity were associated with a greater likelihood that someone would seek EAP services for help with their AOD problem. CONCLUSIONS Results provide a foundation for researchers to understand who uses EAP services for AOD problems. Health and mental health professionals should increase their knowledge of EAP services to improve continuity of care for employees with AOD problems. EAPs are in a unique position to reach out to vulnerable employees in the workplace and engage them in treatment.