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A significant amount of binge drinking among adults escapes public health scrutiny because it occurs among individuals who drink at a moderate average level. This observational study examined the role of a binge pattern of drinking in predicting alcohol problems among moderate drinkers in a U.S. national sample of adults.Participants were 1,229 current drinkers aged ≥30 years from 2 waves of the study of Midlife Development in the United States, with a 9-year time lag (2004-2015) (analyzed in 2021‒2022). Negative binomial regression analyses were used to examine the number of alcohol problems, and binary logistic regression analyses were used to examine multiple (≥2) alcohol problems.Independent of the average level of drinking, binge drinking was linked with an almost 3 times increase in the number of concurrent alcohol problems and a 40% increase in the number of alcohol problems prospectively 9 years later. Moderate average level drinkers accounted for most cases of binge drinking and multiple alcohol problems. Among moderate drinkers, binge drinking was linked with a close to 5 times increase in concurrent multiple alcohol problems and a2 times increase in multiple alcohol problems prospectively 9 years later.These results substantially broaden an increasing recognition that binge drinking is a public health concern among adults. Moderate average-level drinkers should be included in efforts to reduce alcohol problems in adults. These findings are applicable to primary and secondary prevention of alcohol problems with the potential to advance population health.

This article examines the interrelation between negative life events, ongoing life strains, and coping responses in a longitudinal study of clinically depressed and healthy adults. A two-wave, two-variable panel regression analysis revealed moderate stability of both life stressors and coping over a 1-year interval. The connections between life stressors and coping varied by group status and across specific types of stressors and modes of coping. For depressed persons, there was a relatively strong association between chronic strains and emotional discharge coping. Among the controls, negative events were associated with information and support seeking; however, an increase in chronic strains was associated with a decline in problem-solving coping. Overall, the results suggest that changes in stressful aspects of the psychosocial context are related to changes in the coping responses both clinically depressed and healthy adults use to manage specific stressful experiences.

Aims Opioid related deaths have more than tripled in recent years. Identifying and referring individuals with opioid use disorder (OUD) to treatment is one of the promising approaches to reduce opioid related deaths. However, using urine toxicology to identify opioid misuse is not reliable. This study validates the Screen of Drug Use (SoDU) to screen for OUD in the primary care setting, and establish its concurrent diagnostic validity among diverse subgroups of patients, including age, gender, race/ethnicity, marital status, educational level, and PTSD status. Methods We used data from 1283 primary care patients recruited in the VA in CA. This sample matched patient characteristics general VA population with mean age = 62, and 95% men. A total of 10.4% met DSM-5 criteria for any drug use disorder and 2.7% met criteria for OUD (with or without other drug use disorders). An opioid use abuse or dependence diagnosis based on the Mini International Diagnostic Interview was used as the criterion for having a DSM-5 opioid use disorder. Results The SoDU was 100% sensitive (95% confidence interval [CI], 89.9%–100%), and 86.3% specific (95% CI, 84.3%–88.1%). When tested in subgroups of patients, the SoDU maintained 100% sensitivity in all subgroups. Specificity ranged from 74.5% to 94.2% for diverse subgroups of patients. Conclusions The SoDU is an appropriate instrument to screen for opioid use disorder in primary care. It is brief, easy to use, and has good concurrent diagnostic validity for diverse groups of patients.

Alcohol-related problems affect increasing numbers of older adults. Recent studies have begun to investigate problem drinking among older adults based on a conceptual model proposing correlations between personal characteristics, life context (i.e., environmental factors), treatment, and drinking-related outcomes. In a community sample of older problem and nonproblem drinkers, alcohol consumption, life stressors, social resources, and coping responses differed between the two groups, although these factors did not directly and uniformly affect late-life drinking behavior. Furthermore, drinking behavior did not always have the expected effects on older drinkers' life contexts. Findings from a sample of treated alcohol and other drug-abusing older patients demonstrated the importance of providing mental health aftercare for this group.

Background There is a lack of research on the role of alcohol consumption in cigarette smoking among older adults, and the few studies on alcohol use and smoking with older adults have failed to distinguish between average level and pattern of drinking as predictors of smoking. The main purpose of this study was to examine the independent contributions of average level versus pattern of drinking as predictors of cigarette smoking among older adults. A subsidiary purpose was to examine the link between continued smoking and mortality among older smokers. Methods We investigated average level and pattern of drinking as predictors of current smoking among 1,151 older adults at baseline and of continued smoking and mortality among the subset of 276 baseline smokers tracked across 20 years. We used multiple linear and logistic regression analyses and, to test mediation, bias-corrected bootstrap confidence intervals. Results A high level of average drinking and a pattern of episodic heavy drinking were concurrently associated with smoking at baseline. However, only episodic heavy drinking was prospectively linked to continued smoking among baseline smokers. Continued smoking among baseline smokers increased the odds of 20-year mortality and provided an indirect pathway through which heavy episodic drinking related to mortality. Conclusions Smokers who misuse alcohol are a challenging population for smoking cessation efforts. Older adults who concurrently misuse alcohol and smoke cigarettes provide a unique target for public health interventions.

Aims PTSD, pain, and alcohol and drug use disorders (AUD and DUDs) are prevalent, debilitating, and costly. Clinicians benefit from understanding the co-occurrence among these conditions, especially cocaine and opioid use disorders. This is the first study to examine (1) the odds of having one condition in the presence of one of the other conditions, and (2) the extent to which having PTSD, pain, or an AUD raises the odds of having a DUD in VA primary care patients. Methods We used cross-sectional archival data from 1283 primary care patients recruited in VA primary care clinics. Pain was measured by the numeric rating scale. PTSD, AUD, and DUDs (i.e., cannabis, opioid, cocaine, and any drug use disorder) were measured by the Mini International Diagnostic Interview. We conducted logistic regression analyses to examine the odds of having one condition in the presence of other conditions. Results A total of 14.9 % of patients had PTSD, 52.8 % of patients had moderate or severe pain, 12.8 % had an AUD, and 10.4 % had any DUD. Patients who had one condition (PTSD, pain, AUD, or DUD) were highly likely to have one or more of the other conditions, with or without controlling for demographic variables. Conclusions VA Patients who had PTSD, moderate or severe pain, or an AUD were highly likely to have an opioid or cocaine use disorder, and therefore should be screened for DUDs in VA primary care.

Research on late-middle-aged and older adults has focused primarily on average level of alcohol consumption, overlooking variability in underlying drinking patterns. The purpose of the present study was to examine the independent contributions of an episodic heavy pattern of drinking versus a high average level of drinking as prospective predictors of drinking problems.The sample comprised 1,107 adults ages 55-65 years at baseline. Alcohol consumption was assessed at baseline, and drinking problems were indexed across 20 years. We used prospective negative binomial regression analyses controlling for baseline drinking problems, as well as for demographic and health factors, to predict the number of drinking problems at each of four follow-up waves (1, 4, 10, and 20 years).Across waves where the effects were significant, a high average level of drinking (coefficients of 1.56, 95% CI [1.24, 1.95]; 1.48, 95% CI [1.11, 1.98]; and 1.85, 95% CI [1.23, 2.79] at 1, 10, and 20 years) and an episodic heavy pattern of drinking (coefficients of 1.61, 95% CI [1.30, 1.99]; 1.61, 95% CI [1.28, 2.03]; and 1.43, 95% CI [1.08, 1.90] at 1, 4, and 10 years) each independently increased the number of drinking problems by more than 50%.Information based only on average consumption underestimates the risk of drinking problems among older adults. Both a high average level of drinking and an episodic heavy pattern of drinking pose prospective risks of later drinking problems among older adults.

Objective As cannabis has been legalized for medicinal and recreational use, rates of cannabis misuse and cannabis use disorder (CUD) have increased. However, only a small percentage of individuals with CUD seek treatment. A practical screening instrument is needed to detect CUD in primary care (PC) to address the needs of individuals with CUD. This study seeks to validate the 2-item Screen of Drug Use (SoDU) to help detect CUD in the PC setting. Method We used archival data from 1283 patients recruited in the Department of Veterans Affairs (VA) PC clinics. A total of 51 individuals (4%) met DSM-IV criteria for CUD (abuse or dependence; with or without other drug use disorders). A diagnosis of CUD based on the Mini International Diagnostic Interview (MINI) was used as the criterion. Concurrent diagnostic properties of the SoDU were examined against the MINI. Results The SoDU was 100% sensitive (95% confidence interval [CI], 93.00% - 100%), and 87.50% specific (95% CI, 85.53% - 89.23%). When tested in subgroups of patients varying in age, gender, race/ethnicity, marital status, educational level, and PTSD status, the SoDU maintained 100% sensitivity in all subgroups; specificity ranged from 76.26% to 94.34%. Conclusions The SoDU is an appropriate instrument to help identify CUD in primary care. It is brief, easy to use, and has good concurrent diagnostic validity for diverse groups of patients.

Aims Stimulant misuse, overdose, and related deaths have increased dramatically. Identifying and referring individuals with stimulant use disorder to treatment may reduce misuse and overdose. This study validated the 2-item Screen of Drug Use (SoDU; Tiet et al., 2015) to screen for stimulant use disorder (and for cocaine and amphetamine use disorders) in a VA primary care setting, and to establish its concurrent diagnostic validity among diverse subgroups of patients, including age, gender, race/ethnicity, marital status, educational level, and PTSD status. Methods Archival data from 1283 VA primary care patients recruited in California were examined. This predominantly male sample matched general VA primary care patient population characteristics. A total of 79 individuals (6.2%) met criteria for a stimulant use disorder. The criterion for having a stimulant use disorder was a DSM-IV cocaine use disorder and/or amphetamine use disorder diagnosis based on the Mini International Diagnostic Interview. Results For stimulant use disorder, the 2-item SoDU was 93.67% sensitive (95% confidence interval [CI], 85.84%–97.91%), and 89.12% specific (95% CI, 87.22%–90.82%). When tested in diverse subgroups of patients, the sensitivity ranged from 66.67% to 100% and specificity ranged from 76.81% to 94.17%. When a follow-up question was added, the sensitivity was unchanged and the specificity was 99%, with lower false positive rate. Conclusions The SoDU, especially with a follow-up question, is an appropriate instrument for routine screening of stimulant use disorder in VA primary care settings. It has good concurrent diagnostic validity for diverse groups of patients.

Aims The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a screening instrument to detect substance use in primary care (PC). To screen for illicit substances (excluding tobacco and alcohol), the ASSIST consists of 8–57 questions and requires complicated scoring. To improve the efficiency of screening of drug misuse in PC, this study constructed and validated a two-item screen for drug use from the ASSIST. Methods Guided by previous reviews, the ASSIST was revised. Patients were recruited in VA primary care clinics (N = 1283). Half of the sample was used to develop the ASSIST-Drug; the other half was used to validate it. The Mini International Neuropsychiatric Interview (MINI) and the Inventory of Drug Use Consequences were the criterion measures. Results A brief, two-item ASSIST-Drug was constructed. Based on the development sample, the ASSIST-Drug was 94.1% sensitive and 89.6% specific for drug use disorders. Based on the validation sample, it was 95.4% sensitive and 87.8% specific. The ASSIST-Drug also had comparable sensitivity and specificity to identify drug use negative consequences, as well as for diverse subgroups of patients in terms of gender, age, race/ethnicity, marital status, educational levels, and post traumatic stress disorder status. Conclusions The ASSIST-Drug may be a useful screening tool for PC settings. It is reliable, brief, and easy to remember, administer and score. It is sensitive and specific for drug use disorders and drug use negative consequences, and the predictive properties are consistent across subgroup of patients.

Objective Drug use is prevalent and costly to society, but individuals with drug use disorders (DUDs) are under-diagnosed and under-treated, particularly in primary care (PC) settings. Drug screening instruments have been developed to identify patients with DUDs and facilitate treatment. The Drug Abuse Screening Test (DAST) is one of the most well-known drug screening instruments. However, similar to many such instruments, it is too long for routine use in busy PC settings. This study developed and validated a briefer and more practical DAST for busy PC settings. Method We recruited 1300 PC patients in two Department of Veterans Affairs (VA) clinics. Participants responded to a structured diagnostic interview. We randomly selected half of the sample to develop and the other half to validate the new instrument. We employed signal detection techniques to select the best DAST items to identify DUDs (based on the MINI) and negative consequences of drug use (measured by the Inventory of Drug Use Consequences). Performance indicators were calculated. Results The two-item DAST (DAST-2) was 97% sensitive and 91% specific for DUDs in the development sample and 95% sensitive and 89% specific in the validation sample. It was highly sensitive and specific for DUD and negative consequences of drug use in subgroups of patients, including gender, age, race/ethnicity, marital status, educational level, and posttraumatic stress disorder status. Conclusions The DAST-2 is an appropriate drug screening instrument for routine use in PC settings in the VA and may be applicable in broader range of PC clinics.

Although Al-Anon Family Groups (Al-Anon) is the most common source of help for people concerned about someone else's drinking, only 16% of members are men. To identify gender differences, we compared demographics, reasons for attendance, health status, and personal functioning, and drinker characteristics of 174 men and women attending Al-Anon. Men and women were similar in most areas; however, some key differences emerged. Men reported better overall mental health than women, and described some differing concerns and drinker characteristics. With this information, healthcare providers may facilitate men's participation in Al-Anon by addressing their unique concerns and possible barriers to attendance.

Background Although higher rates of depression and lower rates of social behaviors (i.e., social support and activities) and physical activities are associated with mortality, the independent contribution of each of these factors needs examination. Methods A prospective sample of 848 individuals (55% female) was used; half were clinically depressed at baseline; the other half comprised a comparison sample matched on census tract, gender, and marital status. Depressive symptoms, social behaviors, and physical activities were examined as time-varying predictors of mortality over a 30-year period using multiple imputation for missing data and Cox proportional hazards regression, controlling for demographic factors and health risk factors. Results By the end of the study, 137 individuals from the depressed sample and 99 individuals from the comparison sample had died. Although the mortality rate is higher in the depressed sample, after controlling for demographic, health risk factors, social behaviors, and physical activity, there was no significant difference in mortality between the depressed and control samples. Among participants in the depressed sample, reduced participation in social activities was significantly associated with a higher risk of mortality. Limitations Frequency and intensity of activities were not assessed and all data except for mortality were self-report. Conclusions Promoting social engagement through activities may hold promise for delaying mortality among individuals who are depressed. Potential methods to promote social engagement and factors such as positive emotions that should be considered in future studies are discussed.

Al-Anon Family Groups (Al-Anon), a 12-step mutual-help program for people concerned about another's drinking, is the most widely used form of help for concerned others (COs) in the US. This study assessed the prevalence of dropout, and predictors of dropout, in the six months following newcomers' initial attendance at Al-Anon meetings. Al-Anon's World Service Office mailed a random sample of groups, which subsequently yielded a sample of 251 newcomers who completed surveys at baseline and 6 months later. At the 6-month follow-up, 57% of newcomers at baseline had dropped out (had not attended any Al-Anon meetings during the past month). At baseline, individuals who later dropped out of Al-Anon were less likely to have been referred to Al-Anon by their drinker's health care provider, and reported less severe problems than individuals who continued to attend, but dropouts were more often concerned about their drinker's psychological health; newcomers with these concerns may have found them incompatible with Al-Anon's philosophy. Dropouts reported high rates of problems, suggesting that COs who drop out of Al-Anon would benefit from ongoing help and support.

Background and Objectives Despite Al-Anon's widespread availability and use, knowledge is lacking about the drinkers in attendees' lives. We filled this gap by describing and comparing Al-Anon newcomers' and members' reports about their “main drinker” (main person prompting initial attendance). Methods Al-Anon's World Service Office mailed a random sample of groups, yielding completed surveys from newcomers (N = 362) and stable members (N = 265). Results Newcomers' and members' drinkers generally were comparable. They had known their drinker for an average of 22 years and been concerned about his or her's drinking for 9 years; about 50% had daily contact with the drinker. Most reported negative relationship aspects (drinker gets on your nerves; you disagree about important things). Newcomers had more concern about the drinker's alcohol use than members did, and were more likely to report their drinkers' driving under the influence. Drinkers' most frequent problem due to drinking was family arguments, and most common source of help was 12-step groups, with lower rates among drinkers of newcomers. Concerns spurring initial Al-Anon attendance were the drinker's poor quality of life, relationships, and psychological status; goals for initial attendance reflected these concerns. Discussion and Conclusions The drinker's alcohol use was of less concern in prompting initial Al-Anon attendance, and, accordingly, the drinker's reduced drinking was a less frequently endorsed goal of attendance. Scientific Significance Family treatments for substance use problems might expand interventions and outcome domains beyond abstinence and relationship satisfaction to include the drinker's quality of life and psychological symptoms and in turn relieve concerns of family members. (Am J Addict 2014;23:329–336)

Background Analyses of moderate drinking have focused overwhelmingly on average consumption, which masks diverse underlying drinking patterns. This study examined the association between episodic heavy drinking and total mortality among moderate-drinking older adults. Methods At baseline, the sample was comprised of 446 adults aged 55 to 65; 74 moderate drinkers who engaged in episodic heavy drinking and 372 regular moderate drinkers. The database at baseline also included a broad set of sociodemographic, behavioral, and health status covariates. Death across a 20-year follow-up period was confirmed primarily by death certificate. Results In multiple logistic regression analyses, after adjusting for all covariates, as well as overall alcohol consumption, moderate drinkers who engaged in episodic heavy drinking had more than 2 times higher odds of 20-year mortality in comparison with regular moderate drinkers. Conclusions Among older moderate drinkers, those who engage in episodic heavy drinking show significantly increased total mortality risk compared to regular moderate drinkers. Episodic heavy drinking—even when average consumption remains moderate—is a significant public health concern.

Empirical knowledge is lacking about Al-Anon Family Groups (Al-Anon), the most widely used form of help by people concerned about another's drinking, partly because conducting research on 12-step groups is challenging. Our purpose was to describe a new method of obtaining survey data from 12-step group attendees and to examine influences on initial Al-Anon attendance and attendees' recent life contexts and functioning.Al-Anon's World Service Office sent a mailing to a random sample of groups, which subsequently yielded surveys from newcomers (n = 359) and stable members (n = 264).Reasons for groups' nonparticipation included having infrequent newcomers and the study being seen as either contrary to the 12 Traditions or too uncomfortable for newcomers. Main concerns prompting initial Al-Anon attendance were problems with overall quality of life and with the Al-Anon trigger (a significant drinking individual), and being stressed and angry. Goals for Al-Anon attendance were related to the following concerns: better quality of life, fewer trigger-related problems, and less stress. Members reported better functioning in some of these domains (quality of life, relationship with the trigger) but did not differ from newcomers on physical and psychological health. Newcomers were more likely to have recently drunk alcohol and to have obtained treatment for their own substance misuse problems.This method of collecting data from 12-step group attendees yielded valid data and also was seen by many in Al-Anon as consistent with the Traditions. Both newcomers and members had aimed to improve their overall quality of life and well-being through Al-Anon, and, indeed, members were more satisfied with their quality of life than were newcomers.

Although integrated approaches are recommended and effective for treating patients with co-occurring substance use and psychotic disorders (SUD-PSY), many patients receive standard, nonintegrated substance use disorder (SUD) treatment. Research has yet to investigate how patients with co-occurring substance use and psychotic disorders respond to standard SUD treatment, an issue we address here. In a naturalistic follow-up of 236 male SUD-PSY patients receiving 12-step facilitation or cognitive–behavioral-oriented SUD treatment, we found that patients (1) demonstrated significant improvements in proximal outcomes (e.g., approach coping) from treatment intake to discharge, and in distal outcomes (e.g., psychiatric symptoms, substance use frequency) from treatment intake to 1- and 5-year follow-ups, and (2) tended to have similar outcomes whether they received 12-step facilitation or cognitive–behavioral SUD treatment. Patients who (3) were more involved in treatment, as reflected by more positive perceptions of and more satisfaction, tended to experience better proximal outcomes and engage in more continuing care, and those who (4) experienced better proximal outcomes tended to have better psychiatric and substance use outcomes in the years following treatment. Our results suggest that SUD-PSY patients can benefit from standard SUD treatments, even though it may not directly address their psychiatric disorders.

Objectives To examine associations between coping strategies at baseline and adverse outcomes 13 years later, and whether gender and age moderated these associations. Method Participants (N = 651) completed a survey on demographic characteristics, coping strategies, and psychosocial outcomes (negative life events, alcohol consumption, drinking problems, and suicidal ideation). Results At the follow-up (N = 521), more use of avoidance coping was associated with more drinking problems and suicidal ideation at follow-up. Men high in avoidance coping reported more alcohol consumption and suicidal ideation at follow-up than did men low on avoidance coping. Younger adults high in avoidance coping reported more negative life events at follow-up than did younger adults low on avoidance coping. Conclusions Reliance on avoidance coping may be especially problematic among men and younger adults.

To examine the associations between predisposing and need factors and receipt of mental health care and to examine age as a moderator of these associations.Participants (N=521) were surveyed as part of a larger study on health and adaptation.Obtaining mental health care was predicted by more reliance on approach coping, and more depressive and medical symptoms. Interactions of age x depressive symptoms and age x gender revealed that middle-aged adults with more depressive symptoms and middle-aged men were less likely to obtain care.Middle-aged men and middle-aged adults with depression may not be obtaining needed mental health care.

There is debate about whether dually diagnosed patients benefit from mutual-help groups (MHGs), partly because social anxiety may make participation problematic. We examined dually diagnosed patients' participation in MHGs and outcomes at 6, 12, and 24 months post-treatment, and the extent to which social anxiety was associated with participation. We also examined whether MHG participation and social anxiety were related to outcomes, and whether social anxiety moderated associations between participation and outcomes. We found high rates of MHG participation. Among patients who attended at least one meeting, outcomes were positive. Social anxiety was not associated with levels of MHG participation, but more participation was associated with better outcomes. When social anxiety moderated associations between MHG participation and outcomes, patients with more social anxiety benefited more from participation. Treated dually diagnosed patients participate in, and benefit from, MHGs, and participation and benefits are comparable, or even strengthened, among more socially-anxious patients.

Reduced impulsivity is a novel, yet plausible, mechanism of change associated with the salutary effects of Alcoholics Anonymous (AA). Here, the authors review their work on links between AA attendance and reduced impulsivity using a 16-year prospective study of men and women with alcohol use disorders (AUDs) who were initially untreated for their drinking problems. Across the study period, there were significant mean-level decreases in impulsivity, and longer AA duration was associated with reductions in impulsivity. In turn, decreases in impulsivity from baseline to Year 1 were associated with fewer legal problems and better drinking and psychosocial outcomes at Year 1, and better psychosocial functioning at Year 8. Decreases in impulsivity mediated associations between longer AA duration and improvements on several Year 1 outcomes, with the indirect effects conditional on participants’ age. Findings are discussed in terms of their potential implications for research on AA and, more broadly, interventions for individuals with AUDs.

Between 7% and 15% of individuals who participate in psychosocial interventions for substance use disorders may be worse off after treatment than before. Intervention-related predictors of iatrogenic effects include lack of bonding; lack of goal direction and monitoring; confrontation, criticism, and high emotional arousal; models and norms for substance use; and stigma and inaccurate expectations. Life context and personal predictors include lack of support, criticism, and more severe substance use and psychological problems. Ongoing monitoring and safety standards are needed to identify and counteract adverse consequences of intervention programs.

Al-Anon Family Groups, a 12-step mutual-help program for people concerned about another person's drinking, is the most widely used form of help by Concerned Others.This longitudinal study examined newcomers' outcomes of attending Al-Anon. Aims were to better understand early gains from Al-Anon to inform efforts in the professional community to facilitate concerned others' attendance of and engagement in Al-Anon.We compared two groups of Al-Anon newcomers who completed surveys at baseline and 6 months later: those who discontinued attendance by the 6-month follow-up (N = 133), and those who were still attending Al-Anon meetings (N = 97); baseline characteristics were controlled in these comparisons.Newcomers who sustained participation in Al-Anon over the first 6 months of attendance were more likely than those who discontinued participation during the same period to report gains in a variety of domains, such as learning how to handle problems due to the drinker, and increased well-being and functioning, including reduced verbal or physical abuse victimization. Newcomers to Al-Anon reported more personal gains than drinker-related gains. The most frequent drinker gain was a better relationship with the Concerned Other; attendees were more likely to report this, as well as daily, in-person contact with the drinker.Al-Anon participation may facilitate ongoing interaction between Concerned Others and drinkers, and help Concerned Others function and feel better. Thus, short-term participation may be beneficial. Health-care professionals should consider providing referrals to Al-Anon and monitoring early attendance.

To characterize warfarin eligibility and receipt among Veterans Health Administration (VHA) patients with and without mental health conditions (MHCs).Retrospective cohort study.This observational study identified VHA atrial fibrillation (AF) patients with and without MHCs in 2004. We examined unadjusted MHC-related differences in warfarin eligibility and warfarin receipt among warfarin-eligible patients, using logistic regression for any MHC and for specific MHCs (adjusting for sociodemographic and clinical characteristics).Of 125,670 patients with AF, most (96.8%) were warfarin-eligible based on a CHADS2 stroke risk score. High stroke risk and contraindications to anticoagulation were both more common in patients with MHC. Warfarin-eligible patients with MHC were less likely to receive warfarin than those without MHC (adjusted odds ratio [AOR], 0.90; 95% CI, 0.87-0.94). The association between MHC and warfarin receipt among warfarin-eligible patients varied by specific MHC. Patients with anxiety disorders (AOR, 0.86; 95% CI, 0.80-0.93), psychotic disorders (AOR, 0.77; 95% CI, 0.65-0.90), and alcohol use disorders (AOR 0.62, 95% CI 0.54-0.72) were less likely to receive warfarin than patients without these conditions, whereas patients with depressive disorders and posttraumatic stress disorder were no less likely to receive warfarin than patients without these conditions.Compared with patients with AF without MHCs, those with MHCs are less likely to be eligible for warfarin receipt and, among those eligible, are less likely to receive such treatment. Although patients with AF with MHC need careful assessment of bleeding risk, this finding suggests potential missed opportunities for more intensive therapy among some individuals with MHCs.

PurposeThe purpose of this paper is to review some research on the environmental characteristics of residential care settings.Design/methodology/approachThe paper's approach is an integrative overview and formulation of a conceptual framework to understand and measure the key environmental domains of residential care programs.FindingsThe five major domains that comprise the characteristics of residential program are the institutional context, physical and architectural features, policies and services, aggregate resident and staff characteristics, and the social climate. The multiphasic environmental assessment procedure (MEAP), which systematically assesses these domains, shows that, for example, programs with better physical features tend to have better policy and program characteristics, more functionally able residents, more varied and experienced staff, and a more cohesive social climate.Practical implicationsThe conceptual framework and assessment procedures can be used to provide useful information to help prospective residents and staff select appropriate residential care settings, to identify characteristics of settings most amenable to change, decide what changes would benefit residents and staff, and, by providing systematic feedback, help guide program improvement; and identify environmental features most closely associated with residents' quality of life and functional maintenance or improvement.Originality/valueThe paper presents a unique and innovative conceptualization of the environmental domains of residential care settings, along with a validated procedure to measure these domains.

When military service members separate from the military, many return to their families of origin, living with their parents for a period of several weeks to years. While research with veterans and their spouses has documented the particular strain of this reintegration period on veterans and their partners, little research to date has examined veterans’ experiences living with their parents. The present study sought to fill this research gap by investigating veterans’ experiences living with their parents using qualitative, in-depth interviews with Iraq and Afghanistan veterans in California. Overall, veterans appreciated the instrumental and emotional support their parents provided when they separated. However, in some cases, living with parents also produced conflict and strain. In situations where adult veteran children had difficulty with the transition to civilian life or returned with mental health problems, parents were often the first to identify these problems and to support their children in accessing appropriate care. We analyze these findings in light of family systems theory, identifying ways in which adult veteran children continue a process of differentiation while living with their parents and maintaining emotional connectedness. We suggest ways that clinicians can better support veterans and their parents through the reintegration period and recommend that programming for military families explicitly include parents of service members in addition to conjugal families.

Al-Anon Family Groups, commonly known as Al-Anon, is a mutual-help organization for relatives and friends of people misusing alcohol and other substances. We first summarize Al-Anon's history and current membership and then describe its theoretical basis and helping approach. We review evidence for Al-Anon's active ingredients and outcomes and present a conceptual model to guide future research. Research opportunities include understanding Al-Anon newcomers, specifying Al-Anon's active ingredients, and examining potential synergistic influences between Al-Anon participation and identified substance misusers’ participation in mutual-help groups such as Alcoholics Anonymous. We suggest that mutual-help and professional communities work together to facilitate early participation in Al-Anon by shortening the time between problem recognition and seeking help from the fellowship.

Information about aging-related change in coping is limited mainly to results of cross-sectional studies of age differences in coping, and no research has focused on predictors of aging-related change in coping behavior. To extend research in this area, we used longitudinal multilevel modeling to describe older adults' (n = 719; baseline M = 61 years) 20-year, intraindividual approach and avoidance coping trajectories, and to determine the influence of two sets of predictors (threat appraisal and stressor characteristics; gender and baseline personal and social resources) on level and rate of change in these trajectories.Over the 20-year study interval, participants declined in the use of approach coping and most avoidance coping strategies, but there was significant variation in this trend. In simultaneous predictive models, female gender, more threat appraisal, stressor severity, social resources, and depressive symptoms, and fewer financial resources were independently associated with higher initial levels of coping responses. Having more social resources, and fewer financial resources, at baseline in late-middle-age predicted faster decline over time in approach coping. Having more baseline depressive symptoms, and fewer baseline financial resources, hastened decline in use of avoidance coping. Independent of other variables in these models, decline over time in approach coping and avoidance coping remained statistically significant.Overall decline in coping may be a normative pattern of coping change in later life. However, it also is modifiable by older adults' stressor appraisals, their stressors, and the personal and social resources they possess at entry to later life, in late-middle-age.

This study examined level of wine consumption and total mortality among 802 older adults ages 55-65 at baseline, controlling for key sociodemographic, behavioral, and health status factors. Despite a growing consensus that moderate alcohol consumption is associated with reduced total mortality, whether wine consumption provides an additional, unique protective effect is unresolved.Participants were categorized in three subsamples: abstainers, high-wine-consumption moderate drinkers, and low-wine-consumption moderate drinkers. Alcohol consumption, sociodemographic factors, health behavior, and health problems were assessed at baseline; total mortality was indexed across an ensuing 20-year period.After adjusting for all covariates, both high-wine-consumption and low-wine-consumption moderate drinkers showed reduced mortality risks compared with abstainers. Further, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine were older, were more likely to be male, reported more health problems, were more likely to be tobacco smokers, scored lower on socioeconomic status, and (statistical trend) reported engaging in less physical activity. Controlling only for overall ethanol consumption, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine showed a substantially increased 20-year mortality risk of 85%. However, after controlling for all covariates, the initial mortality difference associated with wine consumption was no longer significant.Among older adults who are moderate drinkers, the apparent unique effects of wine on longevity may be explained by confounding factors correlated with wine consumption.

This study examined social processes of support, goal direction, provision of role models, and involvement in rewarding activities to explain benefits of participating in Al-Anon, a 12-step mutual-help program for people concerned about another person's substance use. Newcomers to Al-Anon were studied at baseline and 6 months later, at which time they were identified as having either sustained attendance or dropped out. Among both newcomers and established Al-Anon members ("old-timers"), we also used number of Al-Anon meetings attended during follow-up to indicate extent of participation. Social processes significantly mediated newcomers' sustained attendance status versus dropped out and outcomes of Al-Anon in the areas of life context (e.g., better quality of life, better able to handle problems due to the drinker), improved positive symptoms (e.g., higher self-esteem, more hopeful), and decreased negative symptoms (e.g., less abuse, less depressed). Social processes also significantly mediated newcomers' number of meetings attended and outcomes. However, among old-timers, Al-Anon attendance was not associated with outcomes, so the potential mediating role of social processes could not be examined, but social processes were associated with outcomes. Findings add to the growing body of work identifying mechanisms by which 12-step groups are effective, by showing that bonding, goal direction, and access to peers in recovery and rewarding pursuits help to explain associations between sustained Al-Anon participation among newcomers and improvements on key concerns of Al-Anon attendees. Al-Anon is free of charge and widely available, making it a potentially cost-effective public health resource for help alleviating negative consequences of concern about another's addiction.