Analyzing Lifetime Drinking Trajectories

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DESCRIPTION (provided by applicant): Despite the critical impact that lifetime drinking patterns have on the development of alcohol disorders and chronic diseases, the challenges involved in their assessment and analysis have largely precluded their systematic study. To address this need, we developed a computer-assisted personal interview to assess lifetime drinking patterns, the Cognitive Lifetime Drinking History (CLDH), for use in the Center for Clinical and Medical Epidemiology of Alcohol from 1994 to 1999. However, only recently were statistical procedures and software developed for trajectory analysis that would allow us to fully examine data provided by the CLDH, taking changes in drinking patterns over time into consideration. This software provides procedures that can: (1) identify common patterns of change in alcohol consumption over a lifetime; (2) provide statistical tests of the adequacy of the reduced trajectories; and (3) provide statistical tests of the relations between the trajectories themselves and problem outcomes (Nagin, 1999). We propose to apply trajectory analysis to data from Center case-control studies of chronic disease and alcoholism to investigate lifetime drinking trajectories (LDTs), as follows: (1) normative LDTs (N=3637 controls); (2) LDTs and risk factors for chronic disease, i.e., blood pressure, oxidative stress, and blood lipids (controls only); (3) LDTs and myocardial infarction (N=3402, 707 cases, plus controls frequency matched for age, gender, county of residence); (4) LDTs among untreated and treated alcoholic populations (N=335); and (5) LDTs and recovery from alcoholism without treatment or entry into treatment. Currently, medical advice and guidelines for moderate drinking are based on epidemiological studies in which alcohol intake was measured at only one point in time, and few have considered drinking patterns. These studies will provide data for the first time on the relation of lifetime drinking patterns to long-term health outcomes. The majority of alcoholics never seek treatment. Although many eventually recover, the processes and consequences involved are poorly understood. The proposed studies have the potential to aid in assessing unmet needs for treatment, which problem drinkers are likely to benefit from brief interventions, and factors influencing treatment entry.