Associations with Age of Onset for Alcohol Use Disorder Among Older Adults

Background and Purpose: Compared to early age of onset patterns associated with alcohol use disorders (AUD), later age of onset for AUD is associated with improved physical and mental health outcomes among young and middle-aged adults. Additional research suggests that young and middle aged adults with late onset AUD experience better treatment outcomes, including a higher likelihood of both relapse and abstinence. However, health outcomes and treatment efficacy among older adults (those aged 55 and older) with a later age of AUD onset are less clear. As the number of older adults with AUDs are increasing, identification of factors associated with age of onset may be helpful in determining specific higher and lower risk groups among older adults with AUDs. Therefore, the purpose of this study is to better understand the demographic and clinical characteristics associated with age of onset among older adults with an AUD.  

Methods: Data are from the 2012-2013 National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III), a population-representative survey of United States adults aged 18 or older living in non-institutionalized settings. Our sample included respondents who were age 55 and over and met DSM-5 diagnostic criteria for an alcohol use disorder (AUD) at any point in their life (N = 1,096). Through a structured clinical interview process, participants reported the age at which their AUD symptoms first appeared, as well as past-year alcohol consumption (number of drinks per drinking day), sociodemographic and clinical factors (age, gender, race/ethnicity, annual household income, lifetime DSM-5 mental health/substance use diagnoses, presence of chronic health conditions, etc.).

Results: Among older adults, the average age at which their AUD symptoms first appeared was about 32 years. When examining associations with age of onset, a negative binomial regression model showed that higher past year alcohol consumption was associated with an older age of onset (IRR = 1.02, p < .01). Women reported an older age of onset compared to men (IRR = 1.12, p < .01). Black/African American (IRR = 1.36, p < .01) and Hispanic individuals (IRR = 1.12, p < .05) reported an older age of onset compared to White non-Hispanic individuals.

Conclusions and Implications: Older adults with later age of onset for AUD were characterized as more likely to be female, racial/ethnic minority and heavier alcohol users. Social work practitioners working with older adult clients who have a history of AUD may benefit from these findings, as they suggest older adults with late onset AUD may represent a unique group, in need of specialized substance use services. Additional research on the efficacy of current social work interventions for treating AUDs (including screening, brief intervention and referral to treatment services (SBIRT) & motivational interviewing-based treatment approaches) may be needed to establish whether these interventions are as effective for older adults with late onset AUD, given their unique characteristics.