Course of Alcohol Dependence Among Vietnam Combat Veterans and Nonveteran Controls

Abstract

ABSTRACT. Objective: Identifying developmental trajectories of alcohol use is fundamental in building theories of alcoholism etiology and course. The purpose of this study was to replicate and generalize our previous fi nding that had been based on a twin sample drawn from the Vietnam Era Twin Registry. In this study, we made use of a nontwin sample of Vietnam veterans drawn from the Vietnam Era Study-a 25-year follow-up of the Vietnam Drug User Returns project that assessed the long-term medical and psychiatric consequences of substance abuse or dependence in Vietnam. Method: Alcohol-related behaviors and psychiatric status were assessed in a sample of 839 individuals that comprised 323 veterans who tested positive for drugs (i.e., opiates, barbiturates, or amphetamines) on discharge from Vietnam, 319 veterans who tested negative for drugs at that time, and a nonveteran control sample (n = 197). Individuals with a lifetime diagnosis of alcohol dependence (n = 293) were selected for further analysis. Using detailed life history charts, in-person structured interviews were conducted, which entailed retrospective reports covering the 25 years since the 1972 survey. Measures of alcohol and drug use as well as psychiatric symptoms were obtained by assessing each year of the follow-up interval, beginning with 1972. Results: Using latent growth mixture modeling, a four-class model was identifi ed with trajectories that were parallel to those identifi ed in our previous studies based on the Vietnam Era Twin Registry: severe chronic alcoholics, severe nonchronic alcoholics, late-onset alcoholics, and young-adult alcoholics. Conclusions: Present fi ndings provide additional support for the replicability and generalizability of meaningful differences in the course of alcoholism from early adulthood to midlife. (J. Stud. Alcohol Drugs, 71, 629-639, 2010)

Lifetime Drinking Trajectories Among Veterans in Treatment for HIV

“…Figure 1 (Panel A) depicts the probability of HD over time for each of the latent trajectories estimated from the four-group solution. The shapes of the HD trajectories in this sample were similar to the shapes of the AD and HD trajectories derived in our prior studies using participants from the VETR and VES (see Jacob et al, 2005, 2009, 2010, 2011). Per the class designations from our prior studies, we defined the first HD class as severe chronic (SC; n =293, 22.5% of total HD sample), which was characterized by a high probability of HD in early adulthood that remained relatively high until midlife, and then decreasing in the mid-40s.…”

“…Ninety-one cases were omitted from analyses due to a substantial amount of missing data on quantity and/or frequency of drinking. After converting QF scores into person-year format, individual years were collapsed into 11 age categories consistent with those used in our prior studies on the course of drinking: ages 12–20, 21–23, 24–26, 27–29, 30–32, 33–35, 36–38, 39–41, 42–44, 45–47, and 48–50 (see Jacob et al, 2005, 2009, 2010, 2011). The QF score within each category was dichotomized into a heavy-drinking/non-heavy-drinking variable, with heavy-drinking (HD) defined as 60 or more alcoholic drinks per month (Jacob et al, 2011; Stahre et al, 2006).…”

“…The LGMM approach identifies common patterns of growth (i.e., latent trajectories) based on a measurement of a variable over multiple time points (i.e., age categories) (Jacob et al, 2005; Jacob et al, 2009; Jacob et al, 2010; Jacob et al, 2011). LGMM allows the variability of latent classes (estimated in the form of intercepts and slopes) to be modeled as random (as opposed to fixed) effects.…”

“…Making use of data obtained from the Lifetime Drinking History (LDH) interview (Gladsjo et al, 1992; Jacob et al, 2009; Koenig et al, 2009; Lemmens et al, 1997; Skinner and Schuller, 1982; Skinner and Sheu, 1982), four drinking trajectories were identified (severe chronic, severe nonchronic, late onset and young adult alcoholism). Subsequently, these findings were replicated with a sample of nontwin veterans drawn from the Vietnam Era Study (VES), providing further support for the replicability of this set of AD trajectories over much of the life-course (Jacob et al, 2010). More recently, we reanalyzed data from the VETR using consumption-based indices in comparison to diagnostic indices (i.e., AD).…”

Psychiatric Morbidity is Linked to Problem Drinking in Midlife Among Alcohol-Dependent Men: A Co-Twin Control Study

“…To our knowledge, this represents the fi rst co-twin control study of factors that differentiate the course of problem drinking in midlife. Moreover, by identifying an unambiguous environmental explanation to a risk factor of AUD, this study builds on our program research, which has focused on the course of AUD from drinking onset to midlife (Jacob et al, 2005(Jacob et al, , 2010(Jacob et al, , 2012. Although these fi ndings alone are insuffi cient to demonstrate a clear genetic or environmental interpretation regarding correlates of problem drinking, they highlight the potential value of integrated interventions for comorbidity to address problem drinking among individuals in midlife (Drake et al, 2008;Torrens et al, 2012).…”