The objective of the study was to estimate the effect of a brief alcohol-reduction intervention on health care use. Male veterans aged 55 years and older drinking more than guideline limits participated in an effective primary care-based randomized clinical trial to reduce drinking. Repeated measures ANCOVA assessed short-term and long-term changes in both inpatient and outpatient utilization. Stage of change (SOC) was assessed in a subsample to test for interaction between SOC and the intervention. Veterans exposed to the intervention used more outpatient medical services in the short term. Long-term effects on inpatient/outpatient use were not observed. SOC did not moderate the effect of the intervention but was associated with differential use of health care services. A cost-effective brief intervention to reduce drinking may spur increased efforts to seek health care. Early detection and management of alcohol-related or other illnesses might be expected to accrue savings in later years.
2. Adams WL, Barry KL, Fleming MF: Screening for problem drinking in older primary care patients. JAMA276(24):1964-1967, 1996.
3.
3. Lusky RA: Anticipating the needs of the U.S. aged in the 21st century: Dilemmas in epidemiology, gerontology, and public policy. Soc Sci Med23(12):1217-1227, 1986.
4.
4. Hoffman C, Rice D, Sung H-Y: Persons with chronic conditions. Their prevalence and costs. JAMA276(18):1473-1479, 1996.
5.
5. Krause N, Liang J, Jain A, Sugisawa H: Gender differences in health among the Japanese elderly. Arch Geront Geriatr26:141-159, 1998.
6.
6. Waldo DR, Sonnefeld ST, McKusick DR, Arnett RH III: Health expenditures by age group, 1977 and 1987. Health Care Fin Rev10(4):111-120, 1989.
7.
7. Adams WL, Cox NS: Epidemiology of problem drinking among elderly people. Int J Addict30(13-14):1693-1716, 1995.
8.
8. Adams WL, Yuan Z, Barboriak JJ, Rimm AA: Alcohol-related hospitalizations of elderly people: Prevalence and geographic variation in the United States. JAMA270(10): 1222-1225, 1993.
9.
9. Dupree LW, Broskowski H, Schonfeld L: The gerontology alcohol project: A behavioral treatment program for elderly alcohol abusers. Gerontologist24(5):510-516, 1984.
10.
10. Paganini-Hill A, Ross RK, Henderson BE: Prevalence of chronic disease and health practices in a retirement community. J Chronic Dis39(9):699-707, 1986.
11.
11. Blow FC, Barry KL, BootsMiller BJ, Copeland LA, McCormick R, Visnic SG: Longitudinal assessment of inpatient use and functioning of seriously mentally ill veterans with and without co-occurring substance use disorders. J Psychiatr Res32:311-319, 1998.
12.
12. Beresford TP: Alcoholic elderly: Prevalence, screening, diagnosis, and prognosis, in Beresford T, Gomberg E (eds.): Alcohol and Aging. New York, Oxford University Press, 1995, pp.3-18.
13.
13. Finlayson RE: Comorbidity in elderly alcoholics, in Beresford T, Gomberg ESL (eds.): Alcohol and Aging. New York, Oxford University Press, 1995, pp. 56-69.
14.
14. Stinson FS, Dufour MC, Bertolucci D: Alcohol-related morbidity in the aging population. Alcohol Health Res World13(1):80-87, 1989.
15.
15. Helzer JE, Burnam A, McEvoy LT: Alcohol abuse and dependence, in Robins LN, Regier DA (eds.): Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York, Free Press, 1991, pp. 81-115.
16.
16. Beresford TP, Gomberg E: Alcohol and Aging. New York, Oxford University Press, 1995.
17.
17. Gomberg ESL: Prevalence of alcoholism among ward patients in a Veterans Administration hospital. J Studies Alcohol36(11):1458-1467, 1975.
18.
18. Carmody AP:Alcoholism and Problem Drinking, 1970-1975: A Statistical Analysis of VA Hospital Patients. Washington, DC, Reports & Statistics Service, Office of Controller, Veterans Administration, 1977.
19.
19. Booth BM, Blow FC, Loveland Cook CA, Bunn JY, Fortney JC: Relationship between inpatient alcoholism treatment and longitudinal changes in health care utilization. J Stud Alcohol58(6):625-637, 1997.
20.
20. Richards MS, Goldberg J, Rodin MB, Anderson RJ: Alcohol consumption and problem drinking in white male veterans and nonveterans. Am J Public Health79(8):1011-1015, 1989.
22. Kizer KW: Vision for Change: A Plan to Restructure the Veterans Health Administration. Washington, DC, Department of Veterans Affairs, 1995.
23.
23. Adams WL: Interactions between alcohol and other drugs, in Gurnack AM (ed.): Older Adults' Misuse of Alcohol, Medicines, and Other Drugs. New York, Springer, 1997, pp. 185-205.
24.
24. Blow FC: The spectrum of alcohol interventions for older adults, in Gomberg ESL, Hegedus AM, Zucker RA (eds.): Alcohol Problems and Aging. Bethesda, MD, U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1998, pp. 373-396.
25.
25. Babor TF, Korner P, Wilber C, Good SP: Screening and early intervention strategies for harmful drinkers: Initial lessons from the Amethyst Project. Aust Drug Alcohol Rev6:325-339, 1987.
26.
26. Miller WR, Rollnick S: Motivational Interviewing: Preparing People to Change Addictive Behavior. New York, Guilford, 1991.
27.
27. Harris KB, Miller WR: Behavioral self-control training for problem drinkers: Components of efficacy. Psychol Addict Behav4(2):82-90, 1990.
28.
28. Wallace P, Cutler S, Haines A: Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. BMJ297(6649):663-668, 1988.
29.
29. Fleming MF, Barry KL, Manwell LB, Johnson K, London R: Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care practices. JAMA277(13):1039-1045, 1997.
30.
30. Bandura A: Social Learning Theory. New York, General Learning Press, 1971.
31.
31. Prochaska JO, DiClemente CC: Toward a comprehensive model of change, in Miller WR, Heather N (eds.): Treating Addictive Behaviors: Processes of Change. New York, Plenum, 1986, pp. 3-27.
32.
32. DiClemente CC: Motivational interviewing and the stages of change, in Miller WR, Rollnick S: Motivational Interviewing: Preparing People to Change Addictive Behavior. New York, Guilford, 1991, pp. 191-202.
33.
33. Werch CE: Behavioral self-control strategies for deliberately limiting drinking among college students. Addict Behav15(2):119-128, 1990.
34.
34. Institute of Medicine: Our vision, in Committee of the Institute of Medicine, Division of Mental Health and Behavioral Medicine: Broadening the Base of Treatment for Alcohol Problems. Washington, DC, National Academy Press, 1990, pp. 13-22.
35.
35. Miller WR, Taylor CA, West JC: Focused versus broad-spectrum behavior therapy for problem drinkers. J Consult Clin Psychol48(5):590-601, 1980.
36.
36. Chermack ST, Blow FC, Hill EM, Mudd SA: The relationship between alcohol symptoms and consumption among older drinkers. Alcohol Clin Exp Res20(7):1153-1158, 1996.
37.
37. Blow FC, Walton MA, Barry KL, Coyne JC, Mudd SA, Copeland LA: The relationship between alcohol problems and health functioning of older adults screened in primary care settings. J Am Geriatr Soc48(7):769-774, 2000.
38.
38. Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL: Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings. Med Care38(1):7-18, 2000.
39.
39. National Institute on Alcohol Abuse and Alcoholism: The Physicians Guide to Helping Patients With Alcohol Problems. Washington, DC: National Institute of Health, 1995. (Report No. 95-3769.)
40.
40. Piette JD, Barnett PG, Moos RH: First-time admissions with alcohol-related medical problems: A 10-year follow-up of a national sample of alcoholic patients. J Stud Alcohol59(1):89-96, 1998.
41.
41. Fleming MF, Manwell LB, Barry KL, Adams W, Stauffacher EA: Brief physician advice for alcohol problems in older adults: A randomized community-based trial. J Fam Pract48(5): 378-384, 1999.
42.
42. Sanchez-Craig M, Wilkinson DA, Davila R: Empirically based guidelines for moderate drinking: 1-year results from three studies with problem drinkers. Am J Public Health85:823-828, 1995.
43.
43. Ewing JA, Rouse BA: Identifying the hidden alcoholic. Paper presented at the Twenty-Ninth International Congress on Alcohol and Drug Dependence, Sydney, Australia, February 3, 1970.
44.
44. Mayfield D, McLeod G, Hall P: The CAGE questionnaire: Validation of a new alcoholism screening instrument. Am J Psychiatry131(10):1121-1123, 1974.
45.
45. Blow FC, Brower KJ, Schulenberg JE, Demo-Dananberg LM, Young JP, Beresford TP: The Michigan Alcoholism Screening Test-Geriatric Version (MAST-G): A new elderly-specific screening instrument. Alcohol Clin Exp Res16(2):372, 1992.
46.
46. Barry KL, Fleming MF: The Alcohol Use Disorders Identification Test (AUDIT) and the SMAST-13: Predictive validity in a rural primary care sample. Alcohol Alcohol28(1):33-42, 1993.
47.
47. Kales HC, Blow FC, Copeland LA, Bingham CR, Kammerer EE, Mellow AM: Health care utilization by older patients with coexisting dementia and depression. Am J Psychiatry156(4): 550-556, 1999.
49. Blow FC, Ullman E, Barry KL, Copeland LA, McCormick R, Van Stone W: Effectiveness of specialized treatment programs for veterans with serious and persistent mental illness: A three-year follow-up study. Am J Orthopsychiatry70(3):389-400, 2000.
50.
50. Sobal J, Revicki D, DeForge BR: Patterns of interrelations among health-promotion behaviors. Am J Prev Med8:351-359, 1992.
51.
51. Unger J: Stages of change of smoking cessation: Relationships with other health behaviors. Am J Prev Med12(2):134-138, 1996.
52.
52. Smith JW: Medical manifestations of alcoholism in the elderly, in Gurnack AM (ed.): Older Adults' Misuse of Alcohol, Medicines, and Other Drugs. New York, Springer, 1997, pp. 54-93.
53.
53. Eckhardt MJ, Martin PR: Clinical assessment of cognition in alcoholism. Alcohol Clin Exp Res10:123-127, 1986.
54.
54. Kales HC, Blow FC, Bingham RC, Roberts JS, Copeland LA, Mellow AM: Race, psychiatric diagnosis, and mental health care utilization in older patients. Am J Geriatr Psychiatry8(4):301-309, 2000.
55.
55. Perz CA, DiClemente CC, Carbonari JP: Doing the right thing at the right time? The interaction of stages and processes of change in successful smoking cessation. Health Psychol15(6):462-468.
56.
56. Goldberg DN, Hoffman AM, Farinha MF, Marder DC, Tinson-Mitchem L, Burton D, Smith EG: Physician delivery of smoking-cessation advice based on the stages-of-change model. Am J Prev Med10(5):267-274, 1994.
57.
57. Farkas AJ, Pierce JP, Zhu S-H, Rosbrook B, Gilpin EA, Berry C, Kaplan RM: Addiction versus stages of change models in predicting smoking cessation. Addiction91(9):1271-1280.
58.
58. Prochaska JO, Norcross JC, DiClemente CC: Changing for Good. New York, William Morrow, 1994.
