1. Course of Alcohol Use Disorders: Data from a 35 Year Follow Up
Priscila Dib Gonçalves, Ph.D.
Marc A. Schuckit, M.D.
Tom L. Smith, Ph.D.
University of São Paulo; University of California San Diego

2. This Lecture Covers Background on this study - Definitions
- AUD clinical course
San Diego Prospective Study results

3. This Lecture Covers Background on this study - Definitions
- AUD clinical course
San Diego Prospective Study results

4. Middle Age Heavy Drinking
Prevalent
25%: men drink daily or have 5+ drinks/day
↑ BAC/drink with age
↑ age → ↓ alcohol oxidation
Higher body fat vs. muscle as ↑ age:
↑ BAC/drink
Most alcohol-related deaths occur ages 45-60

5. Alcohol Use Disorders (AUDs)
Chronic
Persistent pattern of problems
Onset early to mid 20s
Middle age AUD prevalence
10% past year
28% lifetime
AUDs ↓ lifespan ~10 years

6. This Lecture Covers Background on this study - Definitions
- AUD clinical course
San Diego Prospective Study results

7. Standard drink = 10-12 grams of ethanol
High Risk Drinking
Men
Women
Drinks/week ≥ 14 7
Drinks/occasion ≥ 4 3
Standard drink = grams of ethanol
12oz beer
8oz malt
5oz wine
1.5oz
liquor
National Institute on Alcohol Abuse and Alcoholism (NIAAA) (2010)

8. DSM-IV AUD Criteria Remission: abstinence of all symptoms
Dependence (3+ criteria)
Abuse (1+ criterion)
- Tolerance
- Unable to stop/cut down
- Taken ↑ amounts/periods
- Given up activities
- A lot of time spent
- Use despite health probl.
- Withdrawal
- Failure major roles
- Hazardous use
- Legal problems
- Use despite social probl.
Remission: abstinence of all symptoms

9. Level of Response (LR) Instrument
LR rationale
- Youth drinks for effects
- If need more for effect→ will drink more
Instrument
Self-Report of the Effects of Alcohol
- Number of drinks required up to 4 effects
- ↑ Scores → more drinks for effects = ↓ LR
Low LR: predicts heavy drinking and AUDs

10. This Lecture Covers Background on this study - Definitions
- AUD clinical course
San Diego Prospective Study results

11. AUD Course Onset early to mid 20’s Fluctuates - Heavy drinking
- Remission
Remission types
- Non-abstinence (2 types)
- Abstinence

12. Remission Types and Predictors
Drinking Abstain Lo risk Hi risk
Predictors
Drinking intensity Low ? High
Drinking frequency Low ? High
Alcohol problems Low ? High
AUD onset Late ? Early
Dependence No ? Yes
Treatment/ AA No ? Yes

13. This Lecture Covers Background on this study - Definitions
- AUD clinical course
San Diego Prospective Study results

14. Longitudinal Studies Important to: But few studies are
- Evaluate AUD course
- Observe remission predictors
But few studies are
- > 10 years
- Begin early and continue to age 50+
- Distinguish between drinking outcome types

15. San Diego Prospective Study
University of California, San Diego (UCSD)
453 participants at study entry
year-old white males
- Students/non-academic staff UCSD
- No baseline alcohol dependence
- 50% had a parent with AUD

16. Assessments Baseline: Age 20 Interview and alcohol challenge
Followed at 10 years; then every 5 years
Alcohol, drug, psychiatric problems
Additional measures at some follow ups
Self-Report of the Effects of Alcohol (SRE)
Personality
“Significant other” report

17. Probands at Age 50 156 of AUDs followed at age 55 (94.5%)
Original sample: 453 men
11 died
442 followed
397 in all follow ups through age 50 (90%)
165 developed AUD by age 50
156 of AUDs followed at age 55 (94.5%)

18. Hypotheses 1. Most will have low risk/abstinence at 55
2. Remission outcome characteristics
Lo risk Hi risk Abstain
AUD onset Late Early Early
LR High Low Low
Prior drinking Low High High
Alcohol problems Low High High
Other drug use Low High High
LR= level of response

19. Age 50-55 Outcomes Group (%) Abstinent Risky Drinking 1+ DSM
Low (14) No No No
High (20) No Yes No
AUD (56) No N/A Yes
Abstain (10) Yes N/A N/A

20. Groups = at Baseline (Age 20)
Demography 23 years old
14% were married
80% had a religion
Drinking patterns 3 drinks/usual
10 days/month
+ Family History AUD 65%

21. Groups From 50 to 55 = Demography 17 years of education
92% ever married
34% ever divorced
60% high job status
≠ Drinking patterns
Low risk High risk AUD
- Frequency
- Usual quantity
- Max quantity

22. Overall Substance Use 30-50
Drinking patterns 3 drinks/usual
15 drinks/max
AUD onset years old
Drug use 63% tobacco
85% cannabis
50% stimulants

23. Groups Differed Ages 30-50 Lo risk Hi risk AUD Abstain
Level of response
Usual frequency
Dependence, %
Treatment/AA, %
CUD, %
CUD = cannabis use disorders

24. Group Membership Predictors
Analyses: logistic regression
Results showed in odds ratios
Lo risk Hi risk Abstain
Drinks for effect
Usual frequency
Treatment
CUD
CUD = cannabis use disorders

25. Take Home Message AUDs: persistent in white collar men (56%)
Remission types and predictors
- Low risk drinking: ↑ LR, ↓ alcohol frequency
- High risk drinking: similar to active AUD
- Abstinence: ↓ LR, ↑ treatment, ↑ CUD
Physicians: screen for alcohol use & problems
- 50’s & 60’s
- All socioeconomic status