Lifetime drinking trajectories among veterans in treatment for HIV.

BACKGROUND: Previous work on the course of drinking across the life course identified 4 distinct patterns of problem drinking: severe chronic (SC), severe nonchronic (SNC), late onset (LO), and young adult (YA). The purpose of the current study was to determine the generalizability of these findings to a sample of midlife veterans with quite different characteristics from those previously assessed; specifically, veterans in treatment for HIV and veterans in treatment for non-HIV medical issues. METHODS: Participants were drawn from the Veterans Aging Cohort Study that included HIV-positive and matched non-HIV participants. As in our earlier studies, the lifetime drinking history was used to assess drinking phases, and latent growth mixture models were used for analyses. RESULTS: Similar to previous findings, both the HIV+ and non-HIV groups exhibited 4 patterns of drinking (SC, SNC, LO, and YA). SC drinkers had younger ages of onset for drinking and longer duration of smoking. SC drinkers also had the highest rates of cocaine use. Within the HIV+ subsample, SC and LO drinkers increased their drinking after their HIV diagnosis. CONCLUSIONS: This study is the first to examine lifetime drinking patterns among those treated for HIV and provides an excellent starting point for examining finer-grained relationships involving drinking, onset of HIV, and treatment outcomes. Absent from the current study and of particular importance to future work in this area is the need for precise information regarding the temporal relationship between date of HIV diagnosis, onset of treatment, and changes in drinking behavior over the life course.

Trajectories of Lifetime Comorbid Alcohol and Other Drug Use Disorders Through Midlife.

OBJECTIVE: Very few studies have examined the developmental nature of comorbid alcohol use disorders and drug use disorders (AUD-DUD). The current study sought to extend our understanding of the nature of AUD-DUD comorbidity by characterizing the developmental course of AUD-DUD comorbidity, determining the degree to which the two disorders occur during the same period, and eliciting differences in AUD-DUD trajectories over the life course. METHOD: Vietnam-era male veterans and matched civilians provided retrospective accounts of alcohol- and other drug-related experiences spanning 25 years. Concurrent growth mixture modeling was used to describe the course of AUD-DUD lifetime comorbidity. RESULTS: Five trajectories were identified based on the probabilities of diagnosing with AUD-DUD: substance switching (increasing AUD, decreasing DUD); young adult (both AUD and DUD decreasing rapidly after young adulthood); severe nonchronic (both AUD and DUD decreasing slowly in the third decade of life); severe chronic alcohol-severe nonchronic drug (AUD remains high and DUD decreases in the fourth decade); and young adult alcohol-severe chronic drug (decreasing AUD in the second decade and DUD remains high). CONCLUSIONS: For the majority of this sample, substance use disorders continued or worsened through adulthood, indicating a problem that extends far beyond young adulthood. Demographic characteristics differed among the trajectories; however, psychiatric diagnoses did not differ except for the number of years with diagnoses of antisocial personality disorder. Subthreshold symptoms in adulthood may be present for a significant period before diagnosis, making this period important for intervention and prevention. Integration of efforts into healthcare, employment, and public policy will help target those at highest risk.