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© 2004 American Public Health Association
RESEARCH AND PRACTICE |
The authors are with the Center for Health Care Evaluation, Department of Veterans Affairs, Menlo Park, Calif. Rudolf H. Moos and Bernice S. Moos are also with the Department of Psychiatry and Behavioral Sciences at Stanford University, Palo Alto, Calif.
Correspondence: Requests for reprints should be sent to Rudolf H. Moos, PhD, Center for Health Care Evaluation (152-MPD), VA Health Care System, 795 Willow Rd, Menlo Park, CA 94025 (e-mail: rmoos{at}stanford.edu).
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONLATE-LIFE ALCOHOL CONSUMPTIONALCOHOL CONSUMPTION AND ALCOHOL...METHODSRESULTSDISCUSSIONReferences |
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Objectives. We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems.
Methods. A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later.
Results. Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals.
Conclusion. Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONLATE-LIFE ALCOHOL CONSUMPTIONALCOHOL CONSUMPTION AND ALCOHOL...METHODSRESULTSDISCUSSIONReferences |
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Excessive alcohol consumption is a significant public health problem and contributes to elevated mortality, morbidity, and related health care costs.1,2 Accordingly, there have been increasing efforts to identify patterns of high-risk alcohol consumption and examine the associations between these patterns and alcohol use–related symptoms and problems.3–10 Most of the studies have focused on mixed-age samples of individuals, have used cross-sectional designs, and have not considered older women and men separately. Thus, we know relatively little about patterns of high-risk alcohol consumption among older individuals, changes in these patterns with age, the association between these patterns and late-life alcohol use problems, or variations in these associations by gender.
To examine these issues, we focus on a community sample of older women and men and address 2 questions: (1) What proportion of older adults who consume alcohol engage in high-risk patterns of consumption, as defined by current standards? Are there gender differences in patterns of high-risk alcohol consumption and in changes in these patterns over time? (2) How well do alternative definitions of high-risk patterns of alcohol consumption predict late-life alcohol use problems, and do these predictions vary by gender or by age?
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LATE-LIFE ALCOHOL CONSUMPTION |
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TOPABSTRACTINTRODUCTIONLATE-LIFE ALCOHOL CONSUMPTIONALCOHOL CONSUMPTION AND ALCOHOL...METHODSRESULTSDISCUSSIONReferences |
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Several guidelines have been proposed to identify high-risk alcohol use patterns in mixed-age populations.11 In general nutritional guidelines, the Department of Agriculture recommended limits of no more than 2 drinks per day for men and 1 drink per day for women.12 The National Institute on Alcohol Abuse and Alcoholism advised weekly limits of no more than 14 drinks per week for men and no more than 7 drinks per week for women.13 Among adults aged 65 years or older, at-risk alcohol use has been defined as, on average, more than 1 drink per day, more than 7 drinks per week, or more than 3 drinks on heavier alcohol use occasions.14
Although these and other comparable guidelines have been examined in mixed-age populations, only a few studies have focused on older adults. In a study of primary care patients aged 60 years or older, 15% of men regularly had more than 14 drinks per week and 12% of women regularly had more than 7 drinks per week.15 With respect to daily limits, among current drinkers, up to 27% of men and 12% of women aged 60 years or older sometimes consume 3 or more drinks on 1 occasion.16–19 Graham et al.20 surveyed adults aged 65 years or older and found that among current drinkers, 29% of men and 6% of women had consumed 5 or more drinks on 1 occasion in the past 12 months.
These studies indicate that among nonabstinent adults aged 60 years or older, between 15% and 30% of men and between 5% and 15% of women consume alcohol in excess of current weekly/daily guidelines.21 We estimated the proportion of older women and men who drink in excess of specific weekly and daily guidelines and, by following individuals over 10 years, investigated how high-risk alcohol use patterns change with age.
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ALCOHOL CONSUMPTION AND ALCOHOL USE PROBLEMS |
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TOPABSTRACTINTRODUCTIONLATE-LIFE ALCOHOL CONSUMPTIONALCOHOL CONSUMPTION AND ALCOHOL...METHODSRESULTSDISCUSSIONReferences |
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We identified 3 studies that examined the connections between patterns of alcohol consumption and alcohol-related symptoms or problems among older adults. In a study of adults older than 55 years, Chermack et al.22 noted that individuals who consumed an average of more than 1 drink per day, and those who consumed 5 or more drinks on any 1 day, were more likely to experience alcohol-related symptoms than were individuals who consumed less alcohol.
Hilton23 found that among individuals who consumed 5 or more drinks on 1 occasion as often as once a week, 13% to 18% of those aged 50 to 59 years and 19% to 24% of those aged 60 years or older had alcohol use–related problems. Frequent heavy drinkers were much more likely to report alcohol use–related symptoms and consequences.24 Finally, in their study of older problem drinkers, Walton et al.25 found that both average and maximal consumption levels at baseline were associated with subsequent alcohol-related problems. We focus here on a community sample of older adults and identify relations between different levels of alcohol consumption and the presence of alcohol use problems among women and men.
One issue that arises with respect to current guidelines is whether they should be different for women and for men.26 As far as we know, no existing studies have compared the prevalence of alcohol use problems among older women and men who consume comparable numbers of drinks per week or day; we address that issue here.
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METHODS |
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TOPABSTRACTINTRODUCTIONLATE-LIFE ALCOHOL CONSUMPTIONALCOHOL CONSUMPTION AND ALCOHOL...METHODSRESULTSDISCUSSIONReferences |
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Participants
A sample of 1884 late-middle-aged community residents (aged 55 to 65 years at baseline) was recruited between 1986 and 1988 in northern California to participate in a study of late-life alcohol consumption and alcohol use problems. A screening procedure excluded individuals who had never consumed alcohol. The sample was composed of individuals who had had outpatient contact with a health care facility within the last 3 years and was comparable to similarly aged community samples with regard to such health characteristics as prevalence of chronic illness and hospitalization.27 Informed consent was obtained from all participants; additional details about recruitment are available elsewhere.28,29
We contacted these individuals again 1 and 4 years later and obtained 95% response rates at both follow-up points.29,30 By the 10-year follow-up, 489 individuals had died; of the 1395 participants who were still living, 1291 (93%) completed the follow-up surveys. We focus here on the baseline and 10-year follow-up data, which were collected by a combination of mail and telephone surveys.
The follow-up sample was composed of 529 women and 761 men. On average, at baseline, these women and men were slightly older than 61 years; about three quarters had completed high school. The men were less likely than the women to be White (90% of men vs 94% of women), were more likely to be married (78% of men vs 62% of women), were more likely to be employed (54% of men vs 47% of women), and had more personal annual income ($32 200 for men vs $22 200 for women). Overall, 92% of the participants had consumed alcohol in the 2 years before baseline; the other 8% had consumed alcohol earlier in their lives.
Measures
Alcohol consumption was assessed with items adapted from the Health and Daily Living Form.31 The frequency of alcohol consumption was assessed by responses to 3 questions asking how often per week (never, less than once, once or twice, 3 to 4 times, or nearly every day) participants consumed typical amounts of wine, beer, and hard liquor in the last month. When a respondent reported consuming 2 or 3 beverages, we could not ascertain whether these beverages were consumed on the same day or on different days. Thus, we estimated the frequency of alcohol consumption based on each of these 2 possibilities and averaged them.
The usual number of drinks consumed per week and per day was assessed by the frequency of consumption of each beverage and additional items that tapped the usual number of drinks of wine (in glasses), beer (in glasses or cans), and hard liquor (in shots) consumed on days in the last month when the individual drank that beverage.
We also estimated the largest amount of alcohol consumption, as assessed by questions that asked about the largest amount of wine, beer, and hard liquor participants consumed on any 1 day in the last month. We converted the responses to reflect the ethanol content of these beverages and then summed them.32 Evidence supporting the validity of these types of self-report measures of alcohol consumption has been reported for mixed-age and older adults.33–36
An index of alcohol use problems in the last 12 months was composed of 12 items drawn from the Drinking Problems Index.37 The items were dichotomized (yes/no) and assessed interpersonal problems, such as whether family members or friends had expressed worries about the participant’s alcohol use or a friendship had ended because of the participant’s alcohol use, and functioning problems, such as whether alcohol use had caused the respondent to have a fall or accident, skip meals, or neglect daily activities. Individuals who gave positive responses to 2 or more of these items were considered to have an alcohol use problem.
Analytic Plan
We conducted repeated measures analyses of variance to examine the change from baseline to the 10-year follow-up, gender differences, and gender by time interactions on alternative indexes of high-risk levels of alcohol consumption. Then, for each of the alternative indexes, we conducted 2-way analyses of variance, separately at baseline and at the 10-year follow-up, to examine whether the number of individuals with alcohol use problems varied by guideline adherence and gender.
We also estimated the sensitivity, specificity, and overall accuracy of the alternative guidelines. Sensitivity was defined as the percentage of individuals who had an alcohol use problem whose alcohol consumption exceeded the guideline; that is, the percentage of correctly identified positive cases. Specificity was defined as the percentage of individuals who did not have an alcohol use problem whose alcohol consumption was within the guideline; that is, the percentage of correctly identified negative cases. Accuracy was defined as the percentage of individuals who either had an alcohol use problem and exceeded the guidelines or did not have a problem and drank within guideline limits.
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RESULTS |
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TOPABSTRACTINTRODUCTIONLATE-LIFE ALCOHOL CONSUMPTIONALCOHOL CONSUMPTION AND ALCOHOL...METHODSRESULTSDISCUSSIONReferences |
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Alcohol Consumption
At baseline, more than 70% of women and men consumed alcohol on 1 or more days per week in the last month, about 50% consumed alcohol on 3 or more days, and about 35% consumed alcohol on 5 or more days (Table 1
). A significant time x gender interaction indicated a steeper decline among women than among men in the frequency of alcohol use 1 or more days per week.
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With respect to weekly consumption, at baseline, 38% of women and 48% of men had more than 7 drinks per week; 16% of women and 29% of men had more than 14 drinks per week. With regard to daily consumption, at baseline, 51% of women and 62% of men had more than 1 drink on the days they drank; 8% of women and 19% of men had more than 3 drinks on 1 occasion. Almost 39% of women and 52% of men consumed more than 7 drinks per week or more than 3 drinks per day; 17% of women and 31% of men drank more than 14 drinks per week or more than 4 drinks per day. There was a significant decline on all the quantity indexes over the 10-year interval; there were no significant interactions reflecting differential declines by gender.
Correspondence Between Alcohol Consumption and Alcohol Use Problems
At baseline, for each of the guidelines, individuals who exceeded the recommended amounts of alcohol consumption were more likely to have alcohol use problems (Table 2). On all guidelines, men were more likely to have alcohol use problems. There were significant interactions between adherence to the guidelines (1 = yes; 0 = no) and gender (1 = female; 0 = male) such that men who exceeded guidelines were more likely to have alcohol use problems than women who exceeded guidelines. Individuals who exceeded higher weekly and daily alcohol use guideline levels were more likely to have alcohol use problems.
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Comparable results were obtained when the same analyses were conducted on the 10-year data (Table 3
). In all alcohol use guideline groups, the proportion of individuals who reported alcohol use problems declined in comparison with baseline levels. As at baseline, individuals who exceeded recommended amounts were more likely to have alcohol use problems than were individuals whose alcohol consumption was within limits.
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We used baseline data to estimate the sensitivity, specificity, and overall accuracy of the alternative guidelines. The guideline of no more than 1 drink per day had the highest sensitivity but also the lowest specificity and accuracy (Table 4
). The guideline of no more than 14 drinks per week (with or without a limit of no more than 4 drinks per day) had high specificity and overall accuracy, but low sensitivity. The guideline of no more than 7 drinks per week (with or without a limit of 3 drinks per day) had moderate to high sensitivity, specificity, and accuracy.
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Subsidiary Analyses
We first considered why men who used alcohol in excess of suggested guidelines were more likely to have alcohol use problems than were women at comparable numbers of drinks per week and per day. We thought that the most likely explanation was that men consumed a larger maximal volume of alcohol. To examine this idea, we selected individuals who at baseline exceeded the combined guidelines of 7 drinks per week/3 drinks per day. Using this sample, we conducted logistic regression analyses in which the step 1 predictors were gender, marital status, and the number of drinks per week and per day, the step 2 predictor was the largest amount of alcohol consumed per day, and the criterion was the presence of alcohol use problems.
After entering the number of drinks per week and per day, men were more likely to have alcohol use problems than were women (ß=–.52; P < .05). However, after the largest amount of alcohol consumption was entered, the gender difference in alcohol use problems was no longer significant (ß=–.38; P > .05). The findings were comparable when we repeated the analyses on participants who exceeded the guideline of 14 drinks per week/4 drinks per day. Men consumed higher absolute amounts of alcohol than women at each level of weekly and daily alcohol use.
The likelihood of alcohol use problems decreased over the 10-year interval, even among participants who exceeded alcohol use guidelines. Again, we suspected that this was because these drinkers decreased their alcohol consumption. To consider this issue, we conducted repeated measures analyses of variances on individuals who consumed more than 7 drinks per week or more than 2 drinks per day at both baseline and follow-up, and who had an alcohol use problem at baseline but not at follow-up. The findings showed that these individuals consumed fewer drinks per week and per day and consumed less alcohol on maximal alcohol use occasions at 10 years than at baseline.
At baseline, participants lost to mortality or attrition consumed alcohol somewhat less frequently than surviving participants but were somewhat more likely to have alcohol use problems. Therefore, we focused on whether the associations at baseline between alcohol consumption and alcohol use problems of these participants were comparable to those of the surviving participants. Analyses of variance like those in Table 2
showed similar associations between the number of drinks per week and per day and alcohol use problems at baseline among individuals who dropped out of the study or died as among surviving participants.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONLATE-LIFE ALCOHOL CONSUMPTIONALCOHOL CONSUMPTION AND ALCOHOL...METHODSRESULTSDISCUSSIONReferences |
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We have shown that a substantial proportion of older adults engage in patterns of alcohol consumption that exceed suggested guidelines, that the prevalence of excessive consumption declines with age, and that there is correspondence between the number of drinks consumed per week/per day and late-life alcohol use problems among both women and men. In addition, at comparable numbers of drinks, older men were more likely to have alcohol use problems than were older women.
Alcohol Use Guidelines and Patterns of Alcohol Consumption
Current guidelines for alcohol consumption recommend limits varying from 1 drink per day for women and 2 drinks per day for men to a weekly limit of 7 drinks for women and 14 drinks for men with no more than 3 drinks on heavier-use occasions.12–14 At baseline, 8% of women and 19% of men exceeded the limit of 3 drinks per day. These percentages are close to prior estimates of nonabstinent older women and men who consume 3 or more drinks per day.16–19
Consistent with previous reports,15–17,19,20 older men were more likely than older women to drink in excess of current guidelines. Both women and men showed declines in alcohol consumption and in the percentage of individuals who exceeded 1 or more low-risk alcohol use guidelines. These longitudinal findings extend those of prior cross-sectional studies by confirming an age-related decline in alcohol consumption and by showing that this decline is comparable among women and men.15–17,20,23 However, part of the decline may owe to a period effect of lowered alcohol consumption.38,39
Patterns of Alcohol Consumption and Alcohol Use Problems
Older adults whose alcohol consumption exceeded acceptable guidelines were more likely to have alcohol use problems.3–11 The finding that alcohol consumption in excess of either weekly or daily guidelines was associated with an elevated risk of alcohol use problems suggests that consumption guidelines for older adults should include both limits. The combined limits provide a clearer idea about recommended alcohol consumption and apply to individuals who drink on most or all days and to those who drink more heavily only on weekends or special occasions.
At baseline, almost 40% of women and more than 50% of men exceeded the limits of 7 drinks per week/3 drinks per day. Moreover, 25% of women and 44% of men who exceeded these limits had 1 or more alcohol use problems. Thus, these guidelines apply to a substantial proportion of older adults and identify a large number who have alcohol use problems. Taken together with their relatively high sensitivity for both women and men, these considerations indicate that combined limits of 7 drinks per week/3 drinks per day may be the preferred guideline for defining heavy/high-risk alcohol use for older adults. Nevertheless, low-risk levels for older adults may be as little as 1 drink per day and a maximum of 2 drinks per occasion, especially among individuals who have coexisting health problems, such as hypertension and diabetes, or who are using medications that interact with alcohol.13,40
Among older adults who exceeded alcohol use guidelines, older men were more likely than older women to have alcohol use problems. This gender difference occurred in part because men who exceeded alcohol use guidelines consumed more alcohol than women did. In addition, compared with women, men may drink more rapidly, consume more of the drinks served to them, be less likely to drink with meals, and concentrate their alcohol use over a shorter interval.26 Thus, even though they consume a comparable number of drinks, men may engage in alcohol use behaviors associated with higher levels of alcohol consumption, resulting in more harmful alcohol use consequences. These considerations support the idea that the recommended number of drinks suggested for older men should not necessarily exceed those recommended for older women.
Among older adults who exceeded alcohol consumption guidelines, those aged between 65 and 75 years (at the 10-year follow-up) were less likely to have alcohol use problems than were those between the ages of 55 and 65 years (at baseline). Reductions in the amount of alcohol consumed tended to explain this finding. As they grow older, many adults may make subtle shifts within relatively stable patterns of alcohol consumption that enable them to continue to drink in ways that reduce the likelihood of experiencing alcohol use problems. In addition, fewer problems may arise because there are relaxed norms and less "surveillance" of older adults, who may be more likely to drink alone and less likely to have family members or friends recognize their excessive alcohol use.
Between 5% and 10% of individuals whose alcohol consumption was below guidelines for at-risk alcohol use nevertheless had had alcohol use problems. These individuals may have previously exceeded high-risk alcohol consumption guidelines and developed alcohol use problems that subsequently motivated them to cut down or stop their alcohol use. More information is needed about the time lag between the reduction of alcohol consumption and the decline of alcohol use problems and about factors, such as health-related stressors and friends’ disapproval of alcohol use, associated with the decision to curtail or stop their alcohol use.41
Limitations and Conclusions
We recruited a community sample of non-abstinent individuals who may have consumed more alcohol than individuals in a representative population sample. Thus, the proportions of older women and men who exceeded low-risk alcohol consumption thresholds may be somewhat high and cannot be taken as population estimates. Nevertheless, the findings show that many older adults drink in excess of low-risk guideline limits and continue to do so well into their late 60s and early 70s.
On a related point, we assessed alcohol use problems specifically relevant to older adults; some of the problems might be considered to be relatively minor, such as neglecting one’s appearance because of alcohol use. To the extent that this is the case, our findings may overestimate the extent to which low levels of alcohol consumption are associated with alcohol use problems that are of more serious concern, such as drunk driving.
In conclusion, our findings support the idea that appropriate alcohol consumption guidelines for older adults are no more than 7 drinks per week/3 drinks per heavy-use occasion and that these guidelines should be no more liberal for older men than for older women. Future research should focus on the type and severity of specific problems associated with high-risk patterns of late-life alcohol consumption and whether these vary for women and men, the social contexts that influence late-life alcohol use, and identification of health status indexes that may influence changes in late-life alcohol use patterns and problems. Most important, to provide more detailed and useful consumption guidelines for older adults, we need to specify how older individuals can maintain relatively stable patterns of moderate alcohol consumption without incurring alcohol use problems.
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Acknowledgments |
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Preparation of this manuscript was supported in part by the National Institute on Alcohol Abuse and Alcoholism (grants AA06699 and AA12718) and by the Department of Veterans Affairs Health Services Research and Development Service.
We thank Kristin Nichols for her help in setting up the data files.
Human Participant Protection
This study was approved by the Stanford University panel on medical human subjects.
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Footnotes |
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Peer Reviewed
Note. The views expressed here are the authors’ own and do not necessarily represent the views of the Department of Veterans Affairs.
Contributors
All authors have participated in this 10-year longitudinal study since its inception. R.H. Moos, P.L. Brennan, and K.K. Schutte conceptualized ideas, interpreted findings, and reviewed drafts of the article. B.S. Moos organized the data files and conducted the statistical analyses.
Accepted for publication October 26, 2003.
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References |
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TOPABSTRACTINTRODUCTIONLATE-LIFE ALCOHOL CONSUMPTIONALCOHOL CONSUMPTION AND ALCOHOL...METHODSRESULTSDISCUSSIONReferences |
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1. Institute for Health Policy. Substance Abuse: The Nation’s Number One Health Problem: Key Indicators for Policy. Princeton, NJ: Robert Wood Johnson Foundation; 2001.
2. Substance Abuse and Mental Health Services Administration. Summary of Findings from the 1999 National Household Survey on Drug Abuse. Rockville, Md: Office of Applied Studies; 2000.
3. Dawson D. Alternative measures and models of hazardous consumption. J Subst Abuse. 2000;12:79–91.[Medline]
4. Dawson DA, Archer L. Relative frequency of heavy drinking and the risk of alcohol dependence. Addiction. 1993;88:1509–1518.[Web of Science][Medline]
5. Dawson DA, Grant BF, Harford TC. Variation in the association of alcohol consumption with five DSM-IV alcohol problem domains. Alcohol Clin Exp Res. 1995;19:66–74.[Web of Science][Medline]
6. Grant BF, Harford TC. The relationship between ethanol intake and DSM-III alcohol use disorders: a cross-perspective analysis. J Subst Abuse. 1989;1:231–252.
7. Midanik L. Drunkenness, feeling the effects, and 5+ measures. Addiction. 1999;94:887–897.[Web of Science][Medline]
8. Midanik LT, Tam TW, Greenfield TK, Caetano R. Risk functions for alcohol-related problems in a 1988 US national sample. Addiction. 1996;91:1427–1437.[Web of Science][Medline]
9. Room R, Bondy SJ, Ferris J. The risk of harm to oneself from drinking, Canada 1989. Addiction. 1995;90:499–513.[Web of Science][Medline]
10. Wilsnack RW, Wilsnack SC, Klassen AD. Women’s drinking and drinking problems: patterns from a 1981 national survey. Am J Public Health. 1984;74:1231–1238.
11. Dawson D. United States low-risk drinking guidelines: an examination of four alternatives. Alcohol Clin Exp Res. 2002;24:1820–1829.
12. Nutrition and Your Health: Dietary Guidelines for Americans. Washington, DC: US Department of Agriculture; 2000.
13. National Institute on Alcohol Abuse and Alcoholism. The Physicians Guide to Helping Patients with Alcohol Problems. Bethesda, Md: US Department of Health and Human Services, National Institutes of Health; 1995. NIH Publication 95–3769.
14. The American Geriatrics Society. Clinical Guidelines for Alcohol Use Disorders in Older Adults. November 2003. Available at: http://www.americangeriatrics.org/products/positionpapers/alcohol.shtml. Accessed July 28, 2004.
15. Adams WL, Barry KL, Fleming MF. Screening for problem drinking in older primary care patients. JAMA. 1996;276:1964–1967.
16. Fillmore KM. Prevalence, incidence, and chronicity of drinking patterns and problems among men as a function of age: a longitudinal and cohort analysis. Br J Addict. 1987;82:77–83.[Web of Science][Medline]
17. Fillmore KM. Women’s drinking across the adult life course as compared to men’s. Br J Addict. 1987;82:801–811.[Web of Science][Medline]
18. Adlaf EM, Smart RG. Alcohol use, drug use, and well-being in older adults in Toronto. Int J Addict. 1995;30:1985–2016.[Medline]
19. Moore AA, Hays RD, Greendale GA, Damesyn M, Reuben DB. Drinking habits among older persons: findings from the NHANES I epidemiologic follow-up study (1982–84). J Am Geriatr Soc. 1989;47:412–416.
20. Graham K, Clarke D, Bois C, et al. Addictive behavior of older adults. Addict Behav. 1996;21:331–348.[Medline]
21. Blow F. Treatment of older women with alcohol problems: meeting the challenge for a special population. Alcohol Clin Exp Res. 2000;24:1257–1266.[Web of Science][Medline]
22. Chermack ST, Blow FC, Hill EM, Mudd SA. The relationship between alcohol symptoms and consumption among older drinkers. Alcohol Clin Exp Res. 1996;20:1153–1158.[Web of Science][Medline]
23. Hilton ME. Demographic characteristics and the frequency of heavy drinking as predictors of self-reported drinking problems. Br J Addict. 1987;82:913–925.[Web of Science][Medline]
24. Hilton ME. Drinking patterns and drinking problems in 1984: results from a general population survey. Alcohol Clin Exp Res. 1987;11:167–175.[Web of Science][Medline]
25. Walton MA, Mudd SA, Blow FC, Chermack ST, Gomberg E. Stability in the drinking habits of older problem drinkers recruited from non-treatment settings. J Subst Abuse Treat. 2000;18:169–177.[Web of Science][Medline]
26. Graham K, Wilsnack R, Dawson D, Vogeltanz N. Should alcohol consumption measures be adjusted for gender differences? Addiction. 1998;93:1137–1147.[Web of Science][Medline]
27. Brennan P, Moos R. Life stressors, social resources, and late-life problem drinking. Psychol Aging. 1990;5:491–501.[Web of Science][Medline]
28. Moos R, Brennan P, Fondacaro M, Moos B. Approach and avoidance coping responses among older problem and nonproblem drinkers. Psychol Aging. 1990;5;31–40.[Web of Science][Medline]
29. Moos R, Brennan P, Moos B. Short-term processes of remission and nonremission among late-life problem drinkers. Alcohol Clin Exp Res. 1991;15:948–955.[Medline]
30. Schutte K, Brennan P, Moos R. Remission of late-life drinking problems: a four-year follow-up. Alcohol Clin Exp Res. 1994;18:835–844.[Medline]
31. Moos R, Cronkite R, Finney J. Health and Daily Living Form Manual. 2nd ed. Palo Alto, Calif: Mind Garden; 1992.
32. Zernig G, Saria A, Kurz M, O’Malley SS. Definitions of a "standard drink." In: Zernig G, Saria A, Kurz M, O’Malley SS, eds. Handbook of Alcoholism. Boca Raton, Fla: CRC Press; 2000.
33. Babor TF, Stephens RS, Marlatt A. Verbal report methods in clinical research on alcoholism: response bias and its minimization. J Stud Alcohol. 1987;48:410–424.[Web of Science][Medline]
34. Stacy AW, Widaman KF, Hays R, DiMatteo MR. Validity of self-reports of alcohol and other drug use: a multitrait multimethod assessment. J Pers Social Psychol. 1985;49:219–232.[Web of Science][Medline]
35. Tucker JA, Vuchinich RE, Harris CV, Gavornik MG, Rudd EJ. Agreement between subject and collateral verbal reports of alcohol consumption in older adults. J Stud Alcohol. 1991;52:148–155.[Web of Science][Medline]
36. Werch CE. Quantity-frequency and diary measures of alcohol consumption for elderly drinkers. Int J Addict. 1989;24:859–865.[Web of Science][Medline]
37. Finney J, Moos R, Brennan P. The Drinking Problems Index: a measure to assess alcohol-related problems among older adults. J Subst Abuse. 1991;3:431–440.
38. Levenson MR, Aldwin CN, Spiro A. Age, cohort, and period effects on alcohol consumption and problem drinking: findings from the Normative Aging Study. J Stud Alcohol. 1998;59:712–722.[Web of Science][Medline]
39. Nephew TM, Williams GD, Yi H, Hoy AK, Stinson FS, Dufour MC. Alcohol Epidemiologic Data System. Report 59: Apparent Per Capita Alcohol Consumption: National, State and Regional Trends, 1970–1999. Rockville, Md: National Institute on Alcohol Abuse and Alcoholism; 2002.
40. Center for Substance Abuse Treatment. Substance Abuse Among Older Adults. Rockville, Md: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 1998. Treatment Improvement Protocol (TIP) Series 26. DHHS Publication SMA 98–3179.
41. Schutte KK, Byrne FE, Brennan PL, Moos R. Successful remission of late-life drinking problems: a 10-year follow-up. J Stud Alcohol. 2001;62:322–334.[Web of Science][Medline]
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