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Analyzing
Lifetime Drinking Trajectories
Principal
Investigator: Marcia Russell, Ph.D.
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.
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