History of drinking problems diminishes the protective effects of within-guideline drinking on 18-year risk of dementia and CIND.

OBJECTIVE: To examine the moderating effect of older adults' history of drinking problems on the relationship between their baseline alcohol consumption and risk of dementia and cognitive impairment, no dementia (CIND) 18 years later. METHOD: A longitudinal Health and Retirement Study cohort (n = 4421) was analyzed to demonstrate how older adults' baseline membership in one of six drinking categories (non-drinker, within-guideline drinker, and outside-guideline drinker groups, divided to reflect absence or presence of a history of drinking problems) predicts dementia and CIND 18 years later. RESULTS: Among participants with no history of drinking problems, 13% of non-drinkers, 5% of within-guideline drinkers, and 9% of outside-guideline drinkers were classified as having dementia 18-years later. Among those with a history of drinking problems, 14% of non-drinkers, 9% of within-guideline drinkers, and 7% of outside-guideline drinkers were classified with dementia. With Non-Drinker, No HDP as reference category, being a baseline within-guideline drinker with no history of drinking problems reduced the likelihood of dementia 18 years later by 45%, independent of baseline demographic and health characteristics; being a baseline within-guideline drinker with a history of drinking problems reduced the likelihood by only 13% (n.s.). Similar patterns obtained for the prediction of CIND. CONCLUSIONS: For older adults, consuming alcohol at levels within validated guidelines for low-risk drinking may offer moderate long-term protection from dementia and CIND, but this effect is diminished by having a history of drinking problems. Efforts to predict and prevent dementia and CIND should focus on older adults' history of drinking problems in addition to how much alcohol they consume.

Drinking Level Versus Drinking Pattern and Cigarette Smoking Among Older Adults.

BACKGROUND: There is a lack of research on the role of alcohol consumption in cigarette smoking among older adults, and the few studies on alcohol use and smoking with older adults have failed to distinguish between average level and pattern of drinking as predictors of smoking. The main purpose of this study was to examine the independent contributions of average level versus pattern of drinking as predictors of cigarette smoking among older adults. A subsidiary purpose was to examine the link between continued smoking and mortality among older smokers. METHODS: We investigated average level and pattern of drinking as predictors of current smoking among 1,151 older adults at baseline and of continued smoking and mortality among the subset of 276 baseline smokers tracked across 20 years. We used multiple linear and logistic regression analyses and, to test mediation, bias-corrected bootstrap confidence intervals. RESULTS: A high level of average drinking and a pattern of episodic heavy drinking were concurrently associated with smoking at baseline. However, only episodic heavy drinking was prospectively linked to continued smoking among baseline smokers. Continued smoking among baseline smokers increased the odds of 20-year mortality and provided an indirect pathway through which heavy episodic drinking related to mortality. CONCLUSIONS: Smokers who misuse alcohol are a challenging population for smoking cessation efforts. Older adults who concurrently misuse alcohol and smoke cigarettes provide a unique target for public health interventions.

Al-Anon newcomers: benefits of continuing attendance for six months.

BACKGROUND: Al-Anon Family Groups, a 12-step mutual-help program for people concerned about another person's drinking, is the most widely used form of help by Concerned Others. OBJECTIVES: This longitudinal study examined newcomers' outcomes of attending Al-Anon. Aims were to better understand early gains from Al-Anon to inform efforts in the professional community to facilitate concerned others' attendance of and engagement in Al-Anon. METHODS: We compared two groups of Al-Anon newcomers who completed surveys at baseline and 6 months later: those who discontinued attendance by the 6-month follow-up (N = 133), and those who were still attending Al-Anon meetings (N = 97); baseline characteristics were controlled in these comparisons. RESULTS: Newcomers who sustained participation in Al-Anon over the first 6 months of attendance were more likely than those who discontinued participation during the same period to report gains in a variety of domains, such as learning how to handle problems due to the drinker, and increased well-being and functioning, including reduced verbal or physical abuse victimization. Newcomers to Al-Anon reported more personal gains than drinker-related gains. The most frequent drinker gain was a better relationship with the Concerned Other; attendees were more likely to report this, as well as daily, in-person contact with the drinker. CONCLUSION: Al-Anon participation may facilitate ongoing interaction between Concerned Others and drinkers, and help Concerned Others function and feel better. Thus, short-term participation may be beneficial. Health-care professionals should consider providing referrals to Al-Anon and monitoring early attendance.

Longitudinal changes in somatic symptoms and family disagreements among depression and community groups: a 23-year study.

BACKGROUND: Few longitudinal studies describe the relationship between somatic symptoms and family disagreements. We examined changes over time in somatic symptoms, family disagreements, their interrelationships, and whether these patterns differed between individuals treated for depression (depression group) and individuals from the same community (community group). METHODS: We followed participants in the depression (N = 423) and community (N = 424) groups for 23 years (the community group was matched to the depression group on socioeconomic status, gender, and marital status). All participants were age 18+ and completed surveys at baseline, 1, 4, 10, and 23 year follow-ups. We assessed somatic symptoms and family disagreements at each time point and used latent growth curve modeling to examine change in these constructs over time. RESULTS: Somatic symptoms and family disagreements changed differently over time. Somatic symptoms decreased between baseline and the 10 year follow-up, but increased between the 10 and 23 year follow-ups, whereas family disagreements decreased linearly over time. Somatic symptoms and family disagreements were higher at baseline and declined at a faster rate in the depression compared to the community group. The relationship between changes in somatic symptoms and changes in family disagreements was also stronger in the depression group: a larger decrease in somatic symptoms was associated with a larger decrease in family disagreements. CONCLUSIONS: Longitudinal changes in somatic symptoms and family disagreements differ between depression and community groups. Individuals treated for depression had more somatic symptoms and family disagreements at baseline and improved at a faster rate compared to individuals in the community. Somatic symptoms and family disagreements may be important targets when treating depression, given the strong interrelationship among these factors in individuals with depression.

The impact of posttraumatic stress disorder on cannabis quit success.

BACKGROUND: Though a growing number of US Veterans are being diagnosed with cannabis use disorders, with posttraumatic stress disorder (PTSD) observed as the most frequently co-occurring psychiatric disorder among this population, no research has investigated the impact of PTSD diagnosis on cannabis quit success. OBJECTIVES: The present study sought to determine the impact of PTSD on cannabis use following a self-guided quit attempt. METHODS: Participants included 104, primarily male, cannabis-dependent US Veterans (Mage = 50.90 years, SDage = 9.90). The study design was prospective and included an assessment immediately prior to the quit attempt, and assessments weekly for the first 4 weeks post-quit, and then monthly through 6 months post-quit. RESULTS: Results indicated that PTSD diagnosis was not associated with time to first lapse or relapse. However, individuals with PTSD used more cannabis at baseline and evidenced a slower initial decline in cannabis use immediately following the quit attempt. All findings were significant after accounting for alcohol and tobacco use across the cessation period, as well as co-occurring mood and anxiety disorder diagnoses. CONCLUSION: Findings highlight the potential utility of interventions for individuals with cannabis use disorder and co-occurring PTSD, particularly early in a cessation attempt.

Episodic heavy drinking and 20-year total mortality among late-life moderate drinkers.

BACKGROUND: Analyses of moderate drinking have focused overwhelmingly on average consumption, which masks diverse underlying drinking patterns. This study examined the association between episodic heavy drinking and total mortality among moderate-drinking older adults. METHODS: At baseline, the sample was comprised of 446 adults aged 55 to 65; 74 moderate drinkers who engaged in episodic heavy drinking and 372 regular moderate drinkers. The database at baseline also included a broad set of sociodemographic, behavioral, and health status covariates. Death across a 20-year follow-up period was confirmed primarily by death certificate. RESULTS: In multiple logistic regression analyses, after adjusting for all covariates, as well as overall alcohol consumption, moderate drinkers who engaged in episodic heavy drinking had more than 2 times higher odds of 20-year mortality in comparison with regular moderate drinkers. CONCLUSIONS: Among older moderate drinkers, those who engage in episodic heavy drinking show significantly increased total mortality risk compared to regular moderate drinkers. Episodic heavy drinking-even when average consumption remains moderate-is a significant public health concern.

Al-Anon family groups' newcomers and members: Concerns about the drinkers in their lives.

BACKGROUND AND OBJECTIVES: Despite Al-Anon's widespread availability and use, knowledge is lacking about the drinkers in attendees' lives. We filled this gap by describing and comparing Al-Anon newcomers' and members' reports about their "main drinker" (main person prompting initial attendance). METHODS: Al-Anon's World Service Office mailed a random sample of groups, yielding completed surveys from newcomers (N = 362) and stable members (N = 265). RESULTS: Newcomers' and members' drinkers generally were comparable. They had known their drinker for an average of 22 years and been concerned about his or her's drinking for 9 years; about 50% had daily contact with the drinker. Most reported negative relationship aspects (drinker gets on your nerves; you disagree about important things). Newcomers had more concern about the drinker's alcohol use than members did, and were more likely to report their drinkers' driving under the influence. Drinkers' most frequent problem due to drinking was family arguments, and most common source of help was 12-step groups, with lower rates among drinkers of newcomers. Concerns spurring initial Al-Anon attendance were the drinker's poor quality of life, relationships, and psychological status; goals for initial attendance reflected these concerns. DISCUSSION AND CONCLUSIONS: The drinker's alcohol use was of less concern in prompting initial Al-Anon attendance, and, accordingly, the drinker's reduced drinking was a less frequently endorsed goal of attendance. SCIENTIFIC SIGNIFICANCE: Family treatments for substance use problems might expand interventions and outcome domains beyond abstinence and relationship satisfaction to include the drinker's quality of life and psychological symptoms and in turn relieve concerns of family members.

Coping strategies predictive of adverse outcomes among community adults.

OBJECTIVES: To examine associations between coping strategies at baseline and adverse outcomes 13 years later, and whether gender and age moderated these associations. METHOD: Participants (N = 651) completed a survey on demographic characteristics, coping strategies, and psychosocial outcomes (negative life events, alcohol consumption, drinking problems, and suicidal ideation). RESULTS: At the follow-up (N = 521), more use of avoidance coping was associated with more drinking problems and suicidal ideation at follow-up. Men high in avoidance coping reported more alcohol consumption and suicidal ideation at follow-up than did men low on avoidance coping. Younger adults high in avoidance coping reported more negative life events at follow-up than did younger adults low on avoidance coping. CONCLUSIONS: Reliance on avoidance coping may be especially problematic among men and younger adults.

Alcoholics Anonymous and reduced impulsivity: a novel mechanism of change.

ABSTRACT   Reduced impulsivity is a novel, yet plausible, mechanism of change associated with the salutary effects of Alcoholics Anonymous (AA). Here, the authors review their work on links between AA attendance and reduced impulsivity using a 16-year prospective study of men and women with alcohol use disorders (AUDs) who were initially untreated for their drinking problems. Across the study period, there were significant mean-level decreases in impulsivity, and longer AA duration was associated with reductions in impulsivity. In turn, decreases in impulsivity from baseline to Year 1 were associated with fewer legal problems and better drinking and psychosocial outcomes at Year 1, and better psychosocial functioning at Year 8. Decreases in impulsivity mediated associations between longer AA duration and improvements on several Year 1 outcomes, with the indirect effects conditional on participants' age. Findings are discussed in terms of their potential implications for research on AA and, more broadly, interventions for individuals with AUDs.

Iatrogenic effects of psychosocial interventions: treatment, life context, and personal risk factors.

Between 7% and 15% of individuals who participate in psychosocial interventions for substance use disorders may be worse off after treatment than before. Intervention-related predictors of iatrogenic effects include lack of bonding; lack of goal direction and monitoring; confrontation, criticism, and high emotional arousal; models and norms for substance use; and stigma and inaccurate expectations. Life context and personal predictors include lack of support, criticism, and more severe substance use and psychological problems. Ongoing monitoring and safety standards are needed to identify and counteract adverse consequences of intervention programs.

Suicidal ideation in adult offspring of depressed and matched control parents: childhood and concurrent predictors.

BACKGROUND: Suicidal ideation predicts suicide behaviors; however, research is needed on risk factors for suicidal ideation in adults, a common developmental period for first suicide attempts. AIMS: To examine childhood and concurrent predictors of suicidal ideation among 340 adult offspring of depressed and matched control parents. METHOD: Parents were assessed at baseline, and adult offspring were assessed 23 years later. RESULTS: Offspring who reported past-month suicidal ideation (7%) had parents who, 23 years earlier, reported suicidal ideation, psychological inflexibility and use of avoidance coping. Offspring experiencing suicidal ideation were more likely to be unemployed and more depressed, consumed more alcohol and had more drinking problems. They were more anxious and inflexible, had weaker social ties and less cohesive families and had more negative life events and used more avoidance coping. A childhood risk index predicted offspring's suicidal ideation above and beyond concurrent factors. CONCLUSIONS: Along with concurrent risk factors, poor parental functioning may confer long-term risk for adult suicidal ideation. Interventions to prevent the transmission of suicidal ideation to offspring should focus on ameliorating parental risk factors.

Binge Drinking and Alcohol Problems Among Moderate Average-Level Drinkers.

INTRODUCTION: A significant amount of binge drinking among adults escapes public health scrutiny because it occurs among individuals who drink at a moderate average level. This observational study examined the role of a binge pattern of drinking in predicting alcohol problems among moderate drinkers in a U.S. national sample of adults. METHODS: Participants were 1,229 current drinkers aged ≥30 years from 2 waves of the study of Midlife Development in the United States, with a 9-year time lag (2004-2015) (analyzed in 2021‒2022). Negative binomial regression analyses were used to examine the number of alcohol problems, and binary logistic regression analyses were used to examine multiple (≥2) alcohol problems. RESULTS: Independent of the average level of drinking, binge drinking was linked with an almost 3 times increase in the number of concurrent alcohol problems and a 40% increase in the number of alcohol problems prospectively 9 years later. Moderate average level drinkers accounted for most cases of binge drinking and multiple alcohol problems. Among moderate drinkers, binge drinking was linked with a close to 5 times increase in concurrent multiple alcohol problems and a >2 times increase in multiple alcohol problems prospectively 9 years later. CONCLUSIONS: These results substantially broaden an increasing recognition that binge drinking is a public health concern among adults. Moderate average-level drinkers should be included in efforts to reduce alcohol problems in adults. These findings are applicable to primary and secondary prevention of alcohol problems with the potential to advance population health.

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.

Painful medical conditions and alcohol use: a prospective study among older adults.

OBJECTIVE: To determine associations between older adults' baseline painful medical conditions and their 10-year drinking behavior, and whether personal and life context characteristics moderate these associations. METHODS: At baseline, then, 1, 4, and 10 years later, late-middle-aged community residents (M = 61 years; N = 1,291) were surveyed regarding their painful medical conditions, use of alcohol, and personal and life context characteristics. Latent growth modeling was used to determine concurrent and prospective relationships between painful medical conditions and 10-year drinking behavior, and moderating effects of personal and life context characteristics on these relationships. RESULTS: At baseline, individuals reporting more numerous painful medical conditions consumed alcohol less frequently, but had more frequent drinking problems, than did individuals with fewer such conditions. Being female and having more interpersonal social resources strengthened the association between painful medical conditions and less ethanol consumed. For men more so than women, more numerous painful medical conditions were associated with more frequent drinking problems. Baseline painful medical conditions alone had no prospective effect on 10-year change in drinking behavior, but being older and having more interpersonal social resources made it more likely that baseline painful medical conditions would predict decline over time in frequency of alcohol consumption and drinking problems. CONCLUSIONS: Late-middle-aged individuals who have more numerous painful medical conditions reduce alcohol consumption but nonetheless remain at risk for more frequent drinking problems. Gender, age, and interpersonal social resources moderate the influence of painful medical conditions on late-life alcohol use. These results imply that older individuals with pain are at little immediate or long-term risk for increased alcohol consumption, but clinicians should remain alert to drinking problems among their older pain patients, especially men.

Strong associations among PTSD, pain, and alcohol and drug use disorders in VA primary care patients.

AIMS: PTSD, pain, and alcohol and drug use disorders (AUD and DUDs) are prevalent, debilitating, and costly. Clinicians benefit from understanding the co-occurrence among these conditions, especially cocaine and opioid use disorders. This is the first study to examine (1) the odds of having one condition in the presence of one of the other conditions, and (2) the extent to which having PTSD, pain, or an AUD raises the odds of having a DUD in VA primary care patients. METHODS: We used cross-sectional archival data from 1283 primary care patients recruited in VA primary care clinics. Pain was measured by the numeric rating scale. PTSD, AUD, and DUDs (i.e., cannabis, opioid, cocaine, and any drug use disorder) were measured by the Mini International Diagnostic Interview. We conducted logistic regression analyses to examine the odds of having one condition in the presence of other conditions. RESULTS: A total of 14.9 % of patients had PTSD, 52.8 % of patients had moderate or severe pain, 12.8 % had an AUD, and 10.4 % had any DUD. Patients who had one condition (PTSD, pain, AUD, or DUD) were highly likely to have one or more of the other conditions, with or without controlling for demographic variables. CONCLUSIONS: VA Patients who had PTSD, moderate or severe pain, or an AUD were highly likely to have an opioid or cocaine use disorder, and therefore should be screened for DUDs in VA primary care.

Screen of drug use: Diagnostic accuracy for stimulant use disorder.

AIMS: Stimulant misuse, overdose, and related deaths have increased dramatically. Identifying and referring individuals with stimulant use disorder to treatment may reduce misuse and overdose. This study validated the 2-item Screen of Drug Use (SoDU; Tiet et al., 2015) to screen for stimulant use disorder (and for cocaine and amphetamine use disorders) in a VA primary care setting, and to establish its concurrent diagnostic validity among diverse subgroups of patients, including age, gender, race/ethnicity, marital status, educational level, and PTSD status. METHODS: Archival data from 1283 VA primary care patients recruited in California were examined. This predominantly male sample matched general VA primary care patient population characteristics. A total of 79 individuals (6.2%) met criteria for a stimulant use disorder. The criterion for having a stimulant use disorder was a DSM-IV cocaine use disorder and/or amphetamine use disorder diagnosis based on the Mini International Diagnostic Interview. RESULTS: For stimulant use disorder, the 2-item SoDU was 93.67% sensitive (95% confidence interval [CI], 85.84%-97.91%), and 89.12% specific (95% CI, 87.22%-90.82%). When tested in diverse subgroups of patients, the sensitivity ranged from 66.67% to 100% and specificity ranged from 76.81% to 94.17%. When a follow-up question was added, the sensitivity was unchanged and the specificity was 99%, with lower false positive rate. CONCLUSIONS: The SoDU, especially with a follow-up question, is an appropriate instrument for routine screening of stimulant use disorder in VA primary care settings. It has good concurrent diagnostic validity for diverse groups of patients.

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 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.

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.

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.