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Problem Drinking Early in Life Linked to Health Problems Decades Later

by U.S. Medicine

December 5, 2016

Problems Persist Even When Alcohol Dependence Ends Early On

By Brenda L. Mooney

MENLO PARK, CA—Is problem drinking among young military servicemembers a life sentence for ill health?

A new study suggested it could be in some cases. It reported that veterans who had a problem with alcohol dependence for at least five years when they were young still face adverse health effects later in life, even if they overcame problem drinking years before.

The article in the Journal of Studies on Alcohol and Drugs detailed generally reduced physical and mental health in 664 male veterans, now in their 60s, who had been dependent on alcohol as young adults.1

What was most surprising, according to the VA authors, was that problems persisted even in those veterans who had overcome their drinking problems by age 30.

Lead researcher Randy Haber, PhD, of the Palo Alto, CA, VA Health Care System, noted that heavy drinking at any point in life might have hidden consequences. He pointed out that previous studies have shown how the brain and other bodily functions can be affected by excessive drinking over the long term.

This study, he suggested, makes the case that years of alcohol dependence during young adulthood can result in silent but “permanent” injuries which can lead to serious health problems later in life.

That could have long-term implications for the VA. The most recent DoD survey of excessive alcohol use among active-duty personnel revealed widespread prevalence of “binge” drinking, defined as consuming five or more drinks for males or four or more drinks for females on a single occasion, according to a study earlier this year in the journal Alcohol Research: Current Reviews.2

Across the U.S. armed services, 33% of personnel reported binge drinking during the 30 days preceding the survey, ranging from 24% in the Air Force to 49% in the Marines. In fact, 20% of male and female active-duty personnel were found to be engaged in heavy drinking, which was defined as binge drinking at least once a week during the past 30 days.

With colleagues from the Palo Alto VAMC and the Hunter Holmes McGuire VAMC in Richmond, VA, Haber used a larger study of Vietnam-era veterans, focusing on 368 men who did not report any symptoms of alcohol dependence at any point in adulthood, 221 who had at least three symptoms of dependence in young adulthood and middle-age and 75 who had symptoms in early adulthood but not after the age of 30.

The subsample of Vietnam Era Twin Registry members, all of whom had a lifetime diagnosis of alcohol dependence, was grouped according to lifespan drinking patterns as assessed by the Lifetime Drinking History interview in 2001.

Results indicated that men who had alcohol dependence symptoms for at least five years in early adulthood scored lower on standard measures of both physical and mental health once they’d reached their 60s. Those who drank at diagnostic levels in young adulthood and in midlife exhibited significant health liabilities on every late-life health measure, according to study authors, while those who drank at diagnostic levels for five or more years in young adulthood but drank only at minimal levels or not at all in midlife still exhibited similar liabilities on most late-life health measures.

In fact, according to the study, only those individuals who drank diagnostically for less than five years in young adulthood displayed normal levels of late-life health.

Results showed:

  • Veterans with alcohol dependence in young adulthood had, on average, three medical conditions in later life, whereas those without that history reported two.
  • Scores on a depression scale were about twice as high in those veterans.
  • The effects were seen even among men who’d been free of dependence symptoms for several decades.

“These findings point to a distal, but surprisingly strong, link between diagnostic-level young-adult alcohol use and subsequent morbidity and mortality in late life,” the study authors wrote. “Future studies should examine the possibility that a permanent alcohol-related injury (probably to the developing brain) results from persistent diagnostic drinking during adolescence and young adulthood that, in turn, results in negative late-life health consequences. Because late life is associated with declining physical strength and resilience, it may be that this injury in young adulthood is most consequential at this later stage of life. These findings shed light on an important personal, familial and public health concern that warrants additional study.”

Researchers pointed out that the findings make sense in the context of the greater addiction literature. “For example,” they wrote, “smoking often begins in adolescence/young adulthood and, if extended, can result in a permanent increase in risk due to injury. This is not a felt injury, but tar does not dissipate—rather, it accumulates in the lungs over time. Cumulative tar exposure has been found to be a reliable measure of the relative risk of Kreyberg type 1 and 2 lung which more commonly emerges in late life. In a similar way, persistent alcohol exposure may injure key body systems, of note the prefrontal cortex and anterior cingulate cortex of the brain and thus create a permanent increase in risk.”

The report described how repeated diagnostic-level exposures to alcohol before age 30 could have a “cumulative, negative impact that results in increasing, unseen injury that, over time, results in the currently observed negative late-life health outcomes.”

Study authors called for replication of their study in other samples as well as a focus on additional biomedical and neuropsychological inquiries before the “relationship between young-adult drinking risk and late-life health outcomes is well understood.”

In a press release, Haber urged patients with past  alcohol dependence to “keep going,” and not obsess about possible health effects.

“Live your life to its fullest,” he said.

 

Table 3. Post hoc univariate tests (with covariates) differentiating short and longer duration of young-adult diagnostic drinking; cases with duration of ≤4 years are compared with those with duration of ≥5 years of diagnostic drinking under age 30

Chronic drinkers, p values Group 1a: Chronic Young adult 1–4 years of diagnostic drinking Low persistence (n = 55) M (SD) Group 1b: Chronic Young adult 5–17 years of diagnostic drinking High persistence (n = 267) M (SD) Group 3: Minimal (reference) No diagnostic drinking (no AD symptoms) (n = 368) M (SD)
Current number of health conditions 2.6 (3.7) 3.2*** (3.4) 2.0 (2.4)
Current physical health score: VR-36 75.5 (14.8) 65.5*** (22.5) 77.3 (19.6)
Current mental health score: VR-36 71.8 (16.2) 66.7*** (20.9) 78.8 (16.2)
Current overall health score: VR-36 74.3 (14.0) 66.2*** (20.3) 78.0 (16.8)
Depression (current) by PHQ-9 3.9 (4.8) 5.7*** (5.7) 2.5 (4.0)
Social support (current) by MOS 57.4 (19.4) 49.1*** (19.7) 61.0 (17.6)
Resilience (current) by CDRS 73.4* (16.4) 68.0*** (19.7) 80.7 (17.6)
Disability by WHO-DAS 13.6 (13.9) 20.2*** (17.4) 9.2 (13.1)
Mortality by state death certificates 0.09 (0.29) 0.12* (0.33) 0.06 (0.23)

Notes: Linear (or logistic) regression models adjusted for covariates (age, education, employment, marital status, and income) were used to test for group differences as indicated. AD = alcohol dependence; VR-36 = Veteran RAND 36-item health assessment; PHQ-9 = Patient Health Questionnaire; MOS = Medical Outcomes Study; CDRS = Conner-Davidson Resilience Scale; WHO-DAS = World Health Organization Disability Assessment Schedule II.

*p ≤ .05;
***p ≤ .001.

 

1 Haber JR, Harris-Olenak B, Burroughs T, Jacob T. Residual Effects: Young Adult Diagnostic Drinking Predicts Late-Life Health Outcomes. J Stud Alcohol Drugs. 2016 Nov;77(6):859-867. PubMed PMID: 27797686.

2 Allen JP, Crawford EF, Kudler H. Nature and Treatment of Comorbid Alcohol Problems and Post-Traumatic Stress Disorder Among American Military Personnel and Veterans. Alcohol Res. 2016;38(1):133-40. Review. PubMed PMID: 27159820; PubMed Central PMCID: PMC4872608.


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