Wine consumption and 20-year mortality among late-life moderate drinkers.

OBJECTIVE: This study examined level of wine consumption and total mortality among 802 older adults ages 55-65 at baseline, controlling for key sociodemographic, behavioral, and health status factors. Despite a growing consensus that moderate alcohol consumption is associated with reduced total mortality, whether wine consumption provides an additional, unique protective effect is unresolved. METHOD: Participants were categorized in three subsamples: abstainers, high-wine-consumption moderate drinkers, and low-wine-consumption moderate drinkers. Alcohol consumption, sociodemographic factors, health behavior, and health problems were assessed at baseline; total mortality was indexed across an ensuing 20-year period. RESULTS: After adjusting for all covariates, both high-wine-consumption and low-wine-consumption moderate drinkers showed reduced mortality risks compared with abstainers. Further, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine were older, were more likely to be male, reported more health problems, were more likely to be tobacco smokers, scored lower on socioeconomic status, and (statistical trend) reported engaging in less physical activity. Controlling only for overall ethanol consumption, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine showed a substantially increased 20-year mortality risk of 85%. However, after controlling for all covariates, the initial mortality difference associated with wine consumption was no longer significant. CONCLUSIONS: Among older adults who are moderate drinkers, the apparent unique effects of wine on longevity may be explained by confounding factors correlated with wine consumption.

Impulsivity is an independent predictor of 15-year mortality risk among individuals seeking help for alcohol-related problems.

BACKGROUND: Although past research has found impulsivity to be a significant predictor of mortality, no studies have tested this association in samples of individuals with alcohol-related problems or examined moderation of this effect via socio-contextual processes. The current study addressed these issues in a mixed-gender sample of individuals seeking help for alcohol-related problems. METHODS: Using Cox proportional hazard models, variables measured at baseline and Year 1 of a 16-year prospective study were used to predict the probability of death from Years 1 to 16 (i.e., 15-year mortality risk). There were 628 participants at baseline (47.1% women); 515 and 405 participated in the follow-up assessments at Years 1 and 16, respectively. Among Year 1 participants, 93 individuals were known to have died between Years 1 and 16. RESULTS: After controlling for age, gender, and marital status, higher impulsivity at baseline was associated with an increased risk of mortality from Years 1 to 16; however, this association was accounted for by the severity of alcohol use at baseline. In contrast, higher impulsivity at Year 1 was associated with an increased risk of mortality from Years 1 to 16, and remained significant when accounting for the severity of alcohol use, as well as physical health problems, emotional discharge coping, and interpersonal stress and support at Year 1. In addition, the association between Year 1 impulsivity and 15-year mortality risk was moderated by interpersonal support at Year 1, such that individuals high on impulsivity had a lower mortality risk when peer/friend support was high than when it was low. CONCLUSIONS: The findings highlight impulsivity as a robust and independent predictor of mortality and suggest the need to consider interactions between personality traits and socio-contextual processes in the prediction of health-related outcomes for individuals with alcohol use disorders.

Alcoholics Anonymous attendance, decreases in impulsivity and drinking and psychosocial outcomes over 16 years: moderated-mediation from a developmental perspective.

AIMS: To examine whether decreases in impulsivity account for links between Alcoholics Anonymous (AA) attendance and better drinking and psychosocial outcomes, and whether these mediational 'effects' are conditional on age. DESIGN: A naturalistic study in which individuals were assessed at baseline, and 1, 8 and 16 years later. SETTING: Participants initiated help-seeking through the alcohol intervention system (detoxification programs, information and referral centers). PARTICIPANTS: Individuals with alcohol use disorders and no prior history of substance abuse treatment at baseline [n=628; 47% women; mean age=34.7 years (standard deviation=9.4)]. MEASUREMENTS: Self-reports of impulsivity and drinking pattern at baseline and year 1, duration of AA (number of weeks) in year 1 and drinking (alcohol use problems, self-efficacy to resist drinking) and psychosocial outcomes (emotional discharge coping, social support) at baseline and follow-ups. FINDINGS: Controlling for changes in drinking pattern, decreases in impulsivity were associated with fewer alcohol use problems, better coping and greater social support and self-efficacy at year 1, and better coping and greater social support at year 8. Decreases in impulsivity statistically mediated associations between longer AA duration and improvements on all year 1 outcomes and indirect effects were moderated by participant age (significant only for individuals 25 years of age or younger). CONCLUSIONS: Decreased impulsivity appears to mediate reductions in alcohol-related problems over 8 years in people attending Alcoholics Anonymous.

Driving while intoxicated among individuals initially untreated for alcohol use disorders: one- and sixteen-year follow-ups.

OBJECTIVE: This study examined associations between frequency of driving while intoxicated (DWI) at baseline and obtaining alcohol-related help at follow-up, and between obtaining help and subsequent reductions in DWI. It also examined improvements on personal functioning and life context indices as mediators between obtaining help and reduced occurrences of DWI. METHOD: A total of 628 individuals who were initially untreated for alcohol use problems completed a baseline inventory; follow-ups were 1, 3, and 16 years later. RESULTS: More extended participation in outpatient treatment and Alcoholics Anonymous (AA) during Year 1 was associated with a lower likelihood of DWI at the 1-year follow-up. More extended participation in AA through Year 3 was associated with a lower likelihood of DWI at the 16-year follow-up. Improvement on personal functioning and life context indices was associated with reduced risk of subsequent occurrences of DWI. Decreases in drinking-related problems, impulsivity, and drinking to reduce tension mediated associations between more AA participation and reductions in DWI at 1 year. CONCLUSIONS: Among initially untreated individuals, sustained mutual help may be associated with a reduced number of occurrences of DWI via fewer drinking consequences and improved psychological functioning and coping. Treatment providers should attend to these concomitants of DWI and consider actively referring individuals to AA to ensure ongoing AA affiliation.

Twenty-year alcohol-consumption and drinking-problem trajectories of older men and women.

OBJECTIVE: The aim of this study was to describe older adults' 20-year alcohol-consumption and drinking-problem trajectories, identify baseline predictors of them, and determine whether older men and women differ on late-life drinking trajectory characteristics and predictors. METHOD: Two-group simultaneous latent growth modeling was used to describe the characteristics and baseline predictors of older community-residing men's (n = 399) and women's (n = 320) 20-year drinking trajectories. Chi-square difference tests of increment in fit of latent growth models with and without gender invariance constraints were used to determine gender differences in drinking trajectory characteristics and predictors. RESULTS: Unconditional quadratic growth models best described older individuals' within-individual, 20-year drinking trajectories, with alcohol consumption following an average pattern of delayed decline, and drinking problems an average pattern of decline followed by leveling off. On average, older men declined in alcohol consumption somewhat later than did older women. The best baseline predictors of more rapid decline in alcohol consumption and drinking problems were drinking variables indicative of heavier, more problematic alcohol use at late middle age. CONCLUSIONS: The course of alcohol consumption and drinking problems from late middle age onward is one of net decline, but this decline is neither swift nor invariable. Gender differences in the timing of decline in drinking suggest that ongoing monitoring of alcohol consumption may be especially important for older men. Further research is needed to identify factors known at late middle age that prospectively explain long-term change in late-life use of alcohol.

Personal, family and social functioning among older couples concordant and discordant for high-risk alcohol consumption.

AIMS: This study compares the personal, family and social functioning of older husbands and wives concordant or discordant for high-risk alcohol consumption and identifies predictors of changes in concordance and high-risk consumption. DESIGN, PARTICIPANTS, MEASUREMENTS: Three groups of couples were identified at baseline and followed 10 years later: (i) concordant couples in which husbands and wives engaged in low-risk alcohol consumption (n = 54); (ii) concordant couples in which husbands and wives engaged in high-risk alcohol consumption (n = 38); and (iii) discordant couples in which one partner engaged in high-risk alcohol consumption and the other partner did not (n = 75). At each follow-up, husbands and wives completed an inventory that assessed their personal, family and social functioning. FINDINGS: Compared to the low-risk concordant group, husbands and wives in the high-risk concordant group were more likely to rely on tension-reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high-risk drinking included tension-reduction coping, friend approval of drinking and, for husbands, their wives' level of drinking. CONCLUSIONS: High-risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long-term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high-risk drinking.

Late-life alcohol consumption and 20-year mortality.

BACKGROUND: Growing epidemiological evidence indicates that moderate alcohol consumption is associated with reduced total mortality among middle-aged and older adults. However, the salutary effect of moderate drinking may be overestimated owing to confounding factors. Abstainers may include former problem drinkers with existing health problems and may be atypical compared to drinkers in terms of sociodemographic and social-behavioral factors. The purpose of this study was to examine the association between alcohol consumption and all-cause mortality over 20 years among 1,824 older adults, controlling for a wide range of potential confounding factors associated with abstention. METHODS: The sample at baseline included 1,824 individuals between the ages of 55 and 65. The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social-behavioral factors. Abstention was defined as abstaining from alcohol at baseline. Death across a 20-year follow-up period was confirmed primarily by death certificate. RESULTS: Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social-behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers. CONCLUSIONS: Findings are consistent with an interpretation that the survival effect for moderate drinking compared to abstention among older adults reflects 2 processes. First, the effect of confounding factors associated with alcohol abstention is considerable. However, even after taking account of traditional and nontraditional covariates, moderate alcohol consumption continued to show a beneficial effect in predicting mortality risk.

Spouses of older adults with late-life drinking problems: health, family, and social functioning.

OBJECTIVE: This study focuses on the health, family, and social functioning of spouses of late-life remitted and continuing problem drinkers, and on predictors of spouses' alcohol-related functioning and depressive symptoms. METHOD: Three groups of spouses were compared at baseline and a 10-year follow-up: (a) spouses (n = 73) of older adults who had no drinking problems at baseline or follow-up, (b) spouses (n = 25) of older adults who had drinking problems at baseline but not follow-up, and (c) spouses (n = 69) of older adults who had drinking problems at both baseline and follow-up. At each contact point, spouses completed an inventory that assessed their alcohol-related, health, family, and social functioning. RESULTS: At baseline, compared with spouses of problem-free individuals, spouses of older adults whose drinking problems later remitted reported more alcohol consumption, poorer health, more depressive symptoms, and less involvement in domestic tasks and social and religious activities. At the 10-year follow-up, spouses of remitted problem drinkers were comparable to spouses of problem-free individuals, but spouses of continuing problem drinkers consumed more alcohol, incurred more alcohol-related consequences, and had friends who approved more of drinking. Overall, spouses whose friends approved more of drinking and whose partners consumed more alcohol and had drinking problems were likely to consume more alcohol and to have drinking problems themselves. CONCLUSIONS: Spouses of older adults whose late-life drinking problems remit can attain normal functioning; however, spouses of older adults with continuing late-life drinking problems experience some ongoing deficits.

Patients with substance use and personality disorders: a comparison of patient characteristics, treatment process, and outcomes in Swiss and U.S. substance use disorder programs.

BACKGROUND: Cross-cultural comparisons may increase our understanding of different models of substance use treatment and help identify consistent associations between patients' characteristics, treatment conditions, and outcomes. OBJECTIVES: The aim of the study was to compare matched samples of substance use disorder (SUD) patients with personality disorders (PD) in Swiss and the United States (U.S.) residential SUD treatment programs and examine the relationship of program characteristics to 1-year outcomes. METHODS: A prospective, naturalistic design was used to compare 132 demographically matched Swiss and U.S. male patients drawn from a sample of 10 Swiss and 15 U.S. public treatment programs. Patients completed comparable inventories at admission, discharge, and 1-year follow-up. RESULTS: Compared to Swiss SUD-PD patients, U.S. SUD-PD patients had more severe substance use and psychosocial problems at admission and follow-up. More intensive treatment and a stronger emphasis on patients' involvement were related to better outcomes for both Swiss and U.S. SUD-PD patients. CONCLUSION: There may be some cross-cultural consistency in the associations between treatment characteristics and SUD-PD patients' outcomes. SCIENTIFIC SIGNIFICANCE: Treatment evaluation findings from representative programs in one country may apply elsewhere and contribute to our overall knowledge about how to improve SUD-PD patients' outcomes.

Older adults' health and late-life drinking patterns: a 20-year perspective.

OBJECTIVES: This study focused on the associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. METHODS: A sample of 719 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption and this survey was followed 10 years and 20 years later. RESULTS: Health-related problems increased and alcohol consumption and drinking problems declined over the 20-year interval. Medical conditions, depressive symptoms, medication use, and acute health events were associated with a higher likelihood of abstinence; acute health events were also associated with less alcohol consumption. In contrast, reliance on alcohol to reduce pain was linked to more alcohol consumption. Moreover, an individual's overall health burden and reliance on alcohol to reduce pain were associated with more drinking problems. Reliance on alcohol to reduce pain potentiated the association between health burden, alcohol consumption and drinking problems. CONCLUSION: Older adults who have more health problems and rely on alcohol to manage pain are at elevated risk for drinking problems. Health care providers should target high-risk older adults, such as those who drink to reduce pain, for screening and brief interventions to help them identify new ways to cope with pain and curtail their drinking.

Social and financial resources and high-risk alcohol consumption among older adults.

BACKGROUND: This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life. METHOD: A sample of 55- to 65-year-old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption. RESULTS: Over the 20-year interval, there was evidence of both social causation and social selection processes in relation to high-risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends' approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high-risk alcohol consumption. Conversely, indicating the presence of social selection, high-risk alcohol consumption was associated with subsequent higher levels of friends' approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members. CONCLUSIONS: These findings reflect mutual influence processes in which older adults' social resources and high-risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late-life social factors may amplify their excessive alcohol consumption.

Late-life and life history predictors of older adults' high-risk alcohol consumption and drinking problems.

AIMS: This prospective, longitudinal study focused on late-life and life history predictors of high-risk alcohol consumption and drinking problems during a 20-year interval as adults matured from age 55-65 to 75-85. DESIGN, SETTING, PARTICIPANTS: A sample of older community residents (N=719) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 10 and 20 years later. MEASUREMENTS: At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems, and personal and life context factors. Participants also provided information about their life history of drinking and help-seeking. RESULTS: Older adults who, at baseline, had more friends who approved of drinking, relied on substances for tension reduction, and had more financial resources were more likely to engage in high-risk alcohol consumption and to incur drinking problems at 10- and 20-year follow-ups. With respect to life history factors, drinking problems by age 50 were associated with a higher likelihood of late-life high-risk alcohol consumption and drinking problems; having tried to cut down on drinking and participation in Alcoholics Anonymous were associated with a lower likelihood of high-risk consumption and problems. CONCLUSION: Specific late-life and life history factors can identify older adults likely to engage in excessive alcohol consumption 10 and 20 years later. Targeted screening that considers current alcohol consumption and life context, and history of drinking problems and help-seeking, could help identify older adults at higher risk for excessive or problematic drinking.

Changes in ambivalence mediate the relation between entering treatment and change in alcohol use and problems.

The present study examined the role of ambivalence about change as (1) a predictor of subsequent heavy alcohol use and drinking problems and (2) a mediator of change between entering treatment and heavy alcohol use and drinking problems among individuals self-referring for treatment with an alcohol use disorder. A sample of 439 individuals (49.9% female) who initiated help-seeking was surveyed at baseline, and at 1 year and 3 year follow-ups on domains of alcohol-related and personal functioning. A series of regression analyses indicated that a measure reflecting ambivalence significantly predicted subsequent heavy alcohol use and related problems and mediated changes between entering treatment and heavy alcohol use and related problems. The findings highlight one mechanism associated with treatment seeking, initiation of and engagement in treatment, and reduction in heavy alcohol use and related problems.

Treatment, alcoholics anonymous, and 16-year changes in impulsivity and legal problems among men and women with alcohol use disorders.

OBJECTIVE: The link between impulsive personality traits and alcohol use disorders (AUDs) is well established. No studies, however, have investigated whether receipt of help for AUDs predicts change in impulsivity or whether such change is associated with relevant outcomes such as legal problems. The present study examined predictive associations between the duration of help for AUDs (Alcoholics Anonymous [AA], professional treatment) and impulsivity and legal problems over 16 years in men and women with AUDs. METHOD: Participants who were initially untreated for their AUDs (n(men) = 332, n(women) = 296) completed follow-up telephone interviews at 1 and 16 years after their baseline assessment. RESULTS: Impulsivity and legal problems declined between baseline and the 1-year and 16-year follow-ups among both women and men. A longer duration of participation in AA predicted a decline in impulsivity at both follow-up assessments, and, in turn, a decline in impulsivity predicted a decline in legal problems at Years 1 and 16. In addition, a longer duration of participation in AA predicted fewer legal problems at Year 1, and this association was moderated by gender (significant in men) and impulsivity (significant for individuals with higher baseline scores). CONCLUSIONS: The results highlight the potential for AA and professional treatment to reduce the expression of impulsivity and related disinhibitory traits and legal problems in individuals with AUDs.

Gender differences in 16-year trends in assault- and police-related problems due to drinking.

This study examined the frequency and predictors of physical assault and having trouble with the police due to drinking over 16 years among women and men who, at baseline, were untreated for their alcohol use disorder. Predictors examined were the personal characteristics of impulsivity, self-efficacy, and problem-solving and emotional-discharge coping, as well as outpatient treatment and Alcoholics Anonymous (AA) participation. Women and men were similar on rates of perpetrating assault due to drinking, but men were more likely to have had trouble with the police due to drinking. Respondents who, at baseline, were more impulsive and relied more on emotional discharge coping, and less on problem-solving coping, assaulted others more frequently during the first year of follow-up. Similarly, less problem-solving coping at baseline was related to having had trouble with the police more often at one and 16 years due to drinking. The association between impulsivity and more frequent assault was stronger for women, whereas associations of self-efficacy and problem-solving coping with less frequent assault and police trouble were stronger for men. Participation in AA was also associated with a lower likelihood of having trouble with the police at one year, especially for men. Interventions aimed at decreasing impulsivity and emotional discharge coping, and bolstering self-efficacy and problem-solving coping, during substance abuse treatment, and encouragement to become involved in AA, may be helpful in reducing assaultive and other illegal behaviors.

Older adults' alcohol consumption and late-life drinking problems: a 20-year perspective.

AIMS: The aim of this study was to identify changes in patterns of alcohol consumption over a 20-year interval among older women and men, and to examine the associations between guideline-defined excessive drinking and late-life drinking problems. DESIGN, PARTICIPANTS AND MEASURES: A community sample of 719 adults between 55 and 65 years of age who consumed alcohol at or prior to baseline participated in a survey of alcohol consumption and drinking problems and was followed 10 years and 20 years later. FINDINGS: The likelihood of excessive drinking declined over the 20-year interval as adults matured into their 70s and 80s. However, at ages 75-85, 27.1% of women and 48.6% of men consumed more than two drinks per day or seven drinks per week. At comparable guideline levels of alcohol consumption, older men were more likely to have drinking problems than were older women. Consumption of more than two drinks per day or seven drinks per week was identified as a potential conservative guideline for identifying excessive drinking associated with an elevated likelihood of drinking problems. CONCLUSIONS: A substantial percentage of older adults who consume alcohol engage in guideline-defined excessive drinking and incur drinking problems. The finding that older men may be more likely than older women to experience problems when they drink beyond guideline levels suggests that alcohol guidelines for men should not be set higher than those for women.

Problem-free drinking over 16 years among individuals with alcohol use disorders.

BACKGROUND: Limited data exist on the rates and long-term stability of non-problem drinking in individuals who sought help for an alcohol use disorder. METHODS: A sample of initially untreated individuals with alcohol use disorders (n=420) was surveyed at baseline and 1 year and was re-assessed at 8 and 16 years. RESULTS: In the 6 months prior to the 1-year assessment, 36% (n=152) of participants reported abstinence from alcohol, 48% (n=200) reported drinking with problems, and 16% (n=68) reported non-problem drinking. At each follow up, 16-21% of the sample reported non-problem drinking. Compared to individuals in the abstinent and problem-drinking groups, individuals who were drinking in a problem-free manner at 1 year had reported, at baseline, fewer days of intoxication, drinks per drinking day, alcohol dependence symptoms, and alcohol-related problems, less depression, and more adaptive coping mechanisms. Over time, 48% of participants who engaged in non-problem drinking at 1 year continued to report positive outcomes (either non-problem drinking or abstinence) throughout the long-term follow-up, whereas 77% of those abstaining at 1 year reported positive outcomes throughout the same time period. Additionally, 43% of individuals with problematic alcohol consumption at 1 year reported positive outcomes over the remaining follow-up interval, a rate that was not significantly different from the rate of positive outcomes of 48% observed in those with initial problem-free drinking. CONCLUSIONS: Although some individuals report non-problem drinking a year after initially seeking help, this pattern of alcohol use is relatively infrequent and is less stable over time than is abstinence. An accurate understanding of the long-term course of alcohol use and problems could help shape expectations about the realistic probability of positive outcomes for individuals considering moderate drinking as a treatment goal.

Predictors of changes in alcohol-related self-efficacy over 16 years.

Self-efficacy is a robust predictor of short- and long-term remission after treatment. This study examined the predictors of self-efficacy in the year after treatment and 15 years later. A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years. Predictors of self-efficacy at 1 year included improvement from baseline to 1 year in heavy drinking, alcohol-related problems, depression, impulsivity, avoidance coping, social support from friends, and longer duration of participation in Alcoholics Anonymous (AA). Female gender, more education, less change in substance use problems, and impulsivity during the first year predicted improvement in self-efficacy over 16 years. Clinicians should focus on keeping patients engaged in AA, addressing depressive symptoms, improving patient's coping, and enhancing social support during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.

Treated and untreated alcohol-use disorders: course and predictors of remission and relapse.

The research described here focused on personal, life context, and help-related factors to trace the long-term course of treated and untreated alcohol-use disorders. A group of 461 individuals who sought help for alcohol problems was surveyed at baseline and 1, 3, 8, and 16 years later. Compared with individuals who remained untreated, individuals who entered treatment and/or Alcoholics Anonymous (AA), and participated in these modalities for a longer interval, were more likely to attain remission. Personal resources associated with social learning, stress and coping, behavior economic, and social control theories predicted the maintenance of remission.

Substance use disorder treatment programs in Switzerland and the USA: Program characteristics and 1-year outcomes.

AIM: This study compared matched samples of substance use disorder (SUD) patients in Swiss and United States (US) residential treatment programs and examined the relationship of program characteristics to patients' substance use and psychosocial functioning at a 1-year follow-up. DESIGN AND SETTING: The study used a prospective, naturalistic design and a sample of 10 public programs in the German-speaking part of Switzerland and 15 US public treatment programs. PARTICIPANTS: A total of 358 male patients in Swiss programs were matched on age, marital status and education with 358 male patients in US programs. A total of 160 Swiss and 329 US patient care staff members also participated. MEASUREMENT: Patients completed comparable inventories at admission, discharge and 1-year follow-up to assess their substance use and psychological functioning and receipt of continuing care. Staff members reported on program characteristics and their beliefs about substance use. FINDINGS: Compared to Swiss patients, US patients had more severe substance use and psychological problems at intake and although they did not differ on abstinence and remission at follow-up, had somewhat poorer outcomes in other areas of functioning. Swiss programs were longer and included more individual treatment sessions; US programs included more group sessions and were more oriented toward a disease model of treatment. Overall, length of program, treatment intensity and 12-step orientation were associated with better 1-year outcomes for patients in both Swiss and US programs. CONCLUSIONS: The sample of Swiss and US programs studied here differed in patient and treatment characteristics; however, in general, there were comparable associations between program characteristics and patients' 1-year outcomes. These findings suggest that associations between treatment processes and patients' outcomes may generalize from one cultural context to another.