Adults’ may report their symptoms of alcohol use disorders (AUDs) differently as they age, potentially impeding clinicians’ ability to recognize problematic drinking among older people, a new study suggests. Diagnostic criteria for alcohol and other substance use disorders (SUDs) are intentionally broad, applying across diverse patient populations and experiences. Risky alcohol use fluctuates, however, and some alcohol problems tend to present at different ages. The shifting manifestations of alcohol dependence and abuse, as reported by patients, may make it harder for clinicians to identify the disorder or its persistence in older people. This elevates the risks associated with AUDs in older adults, who in addition face a greater likelihood of alcohol-related consequences and reach higher blood alcohol levels with fewer drinks compared to younger adults. For the study in Alcoholism: Clinical & Experimental Research, researchers examined how two generations of people with persistent AUDs reported their diagnostic symptoms and how these self-assessments changed over time.

At around age 20, male college students who had consumed alcohol and did not meet the criteria for AUD or SUD were interviewed about their alcohol and drug use. From around age 30 to 55, these first-generation participants were re-interviewed every five years about their alcohol and drug use, psychiatric diagnoses, impulsivity and sensation seeking (traits related to substance use). They were also screened according to DSM-IV AUD and SUD criteria in the Diagnostic and Statistical Manual, which guides clinicians. These participants’ adult children also became part of the study; they were interviewed at an average of age 18 and followed similarly to their fathers until around age 30. The researchers worked with the data of first-generation participants who met the diagnostic criteria for AUD during the five years before each of three follow-ups (106 people yielding 318 interviews) and second-generation participants who met the criteria before each of two follow-ups (68 people and 136 interviews). Leaning more heavily on first-generation experiences, the investigators used statistical analysis to explore participants’ evolving endorsement of AUD diagnostic criteria.

The salience of specific diagnostic criteria changed for both generations as they grew older. Regarding the first-generation participants, changes in the prior 5-years in the pattern of the endorsement of the 11 DSM-IV AUD criteria included that they became less likely to report tolerance (needing more alcohol to become intoxicated), perhaps because tolerance had been established earlier in life. They were also less likely to report alcohol withdrawal symptoms, failing to meet obligations, and drinking in hazardous situations. Over the same timespan they became more likely to say they’d been consuming more alcohol than intended, spent more time drinking, and continued to drink despite alcohol-related problems. With increasing age, the second-generation participants were more likely to report giving up important activities because of drinking. Both generations increasingly said they spent a great time of time involved with alcohol.

The authors advise that clinicians and researchers consider which AUD criteria are most salient at varying ages. This could help identify older versus younger drinkers who might benefit from treatment and inform effective diagnostic tools. They also recommend additional research on how changes in AUD criteria endorsement manifest over the entire lifetime.