Rudolf H. Moos's research while affiliated with Stanford University and other places
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Publications (568)
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:...
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’...
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 condition...
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 disorde...
Aims:
Opioid related deaths have more than tripled in recent years. Identifying and referring individuals with opioid use disorder (OUD) to treatment is one of the promising approaches to reduce opioid related deaths. However, using urine toxicology to identify opioid misuse is not reliable. This study validates the Screen of Drug Use (SoDU) to sc...
Objective:
As cannabis has been legalized for medicinal and recreational use, rates of cannabis misuse and cannabis use disorder (CUD) have increased. However, only a small percentage of individuals with CUD seek treatment. A practical screening instrument is needed to detect CUD in primary care (PC) to address the needs of individuals with CUD. T...
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 contribu...
Objective:
Drug use is prevalent and costly to society, but individuals with drug use disorders (DUDs) are under-diagnosed and under-treated, particularly in primary care (PC) settings. Drug screening instruments have been developed to identify patients with DUDs and facilitate treatment. The Drug Abuse Screening Test (DAST) is one of the most wel...
Objective:
Research on late-middle-aged and older adults has focused primarily on average level of alcohol consumption, overlooking variability in underlying drinking patterns. The purpose of the present study was to examine the independent contributions of an episodic heavy pattern of drinking versus a high average level of drinking as prospectiv...
Aims:
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a screening instrument to detect substance use in primary care (PC). To screen for illicit substances (excluding tobacco and alcohol), the ASSIST consists of 8-57 questions and requires complicated scoring. To improve the efficiency of screening of drug misuse in PC, t...
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 pr...
Objectives:
To characterize warfarin eligibility and receipt among Veterans Health Administration (VHA) patients with and without mental health conditions (MHCs).
Study design:
Retrospective cohort study.
Methods:
This observational study identified VHA atrial fibrillation (AF) patients with and without MHCs in 2004. We examined unadjusted MHC...
This study examined social processes of support, goal direction, provision of role models, and involvement in rewarding activities to explain benefits of participating in Al-Anon, a 12-step mutual-help program for people concerned about another person's substance use. Newcomers to Al-Anon were studied at baseline and 6 months later, at which time t...
In Reply We thank McNeely and Saitz for their thoughtful letter. The Screen of Drug Use (SoDU)1 is able to identify negative consequences of drug use and drug use disorders in primary care (PC) patients. The criterion of negative consequences of drug use includes domains of impulse control (eg, driving under the influence, risky sexual behaviors),...
Because worldwide 76.3 million people have alcohol use disorders (AUDs), and 15.3 million have other drug use disorders, understanding the course of substance use problems is critical to promoting early intervention and treatment and reducing the devastating impact of substance use disorders (SUDs). The research reviewed here provides a perspective...
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...
Background: Though a growing number of U.S. 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 so...
Research on moderate drinking has focused on the average level of drinking. Recently, however, investigators have begun to consider the role of the pattern of drinking, particularly heavy episodic drinking, in mortality. The present study examined the combined roles of average drinking level (moderate vs. high) and drinking pattern (regular vs. hea...
Illicit drug use is prevalent, and primary care provides an ideal setting in which to screen for drug use disorders (DUDs) and negative consequences of drug use (NCDU). Comprehensive reviews have concluded that existing drug use screening instruments are not appropriate for routine use in primary care.
To develop and validate a screening instrument...
Patient-centered models of assessment have shown considerable promise for increasing patients' readiness for mental health treatment in general, but have not been used to facilitate patients' engagement in substance use disorder (SUD) treatment. We developed a brief patient-centered intervention using assessment and feedback of personality data and...
The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and programme factors as predictors of health outcomes. Therefore, we examined associations...
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...
No single empirically-support psychosocial treatment approach has been identified as superior for addressing late-life substance abuse. Regardless of approach, treatment should be age-sensitive. Age-sensitive interventions are supportive and non-confrontational; flexible and responsive to functional, sensory, and cognitive limitations as well as ge...
Mental health condition (MHC) comorbidity is associated with lower intensity care in multiple clinical scenarios. However, little is known about the effect of MHC upon clinicians’ decisions about intensifying antiglycemic medications in diabetic patients with poor glycemic control. We examined whether delay in intensification of antiglycemic medica...
Although Al-Anon Family Groups (Al-Anon) is the most common source of help for people concerned about someone else's drinking, only 16% of members are men. To identify gender differences, we compared demographics, reasons for attendance, health status, and personal functioning, and drinker characteristics of 174 men and women attending Al-Anon. Men...
Background
Although higher rates of depression and lower rates of social behaviors (i.e., social support and activities) and physical activities are associated with mortality, the independent contribution of each of these factors needs examination.
Methods
A prospective sample of 848 individuals (55% female) was used; half were clinically depresse...
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.
At baseline, the sample was comprised of 446 adults aged 55 to 65; 74 moderate drinkers who...
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...
Our review of the literature indicates that among the most effective treatments for alcohol and illicit drug use disorders are cognitive-behavioral treatments, community reinforcement and contingency management approaches, 12-step facilitation and 12-step treatment, behavioral couples and family treatment, and motivational enhancement interventions...
Objective:
Empirical knowledge is lacking about Al-Anon Family Groups (Al-Anon), the most widely used form of help by people concerned about another's drinking, partly because conducting research on 12-step groups is challenging. Our purpose was to describe a new method of obtaining survey data from 12-step group attendees and to examine influence...
Background:
Life stressors and personal and social resources are associated with depression in the short-term, but little is known about their associations with the long-term course of depression. The current paper presents results of a 23-year study of community adults who were receiving treatment for depression at baseline (N=382).
Methods:
Se...
Background. Warfarin anticoagulation for atrial fibrillation (AF) requires routine INR blood testing, usually performed by a single anticoagulation clinic or provider. Regular INR testing improves INR control, and monthly INR testing and adequate time in INR therapeutic range are endorsed quality and performance measures. However, many Veterans wit...
We evaluated receipt of cervical cancer screening in a national sample of 34,213 women veterans using Veteran Health Administration facilities between 2003 and 2007 and diagnosed with 1) posttraumatic stress disorder (PTSD), or 2) depression, or 3) no psychiatric illness.
Our study featured a cross-sectional design in which logistic regression anal...
To examine the associations between predisposing and need factors and receipt of mental health care and to examine age as a moderator of these associations.
Participants (N=521) were surveyed as part of a larger study on health and adaptation.
Obtaining mental health care was predicted by more reliance on approach coping, and more depressive and me...
Although integrated approaches are recommended and effective for treating patients with co-occurring substance use and psychotic disorders (SUD-PSY), many patients receive standard, nonintegrated substance use disorder (SUD) treatment. Research has yet to investigate how patients with co-occurring substance use and psychotic disorders respond to st...
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 fo...
Within the last 30 years, a substantial number of interventions for alcohol use disorders (AUDs) have received empirical support. Nevertheless, fewer than 25% of individuals with alcohol-related problems access these interventions. If several intensive psychosocial treatments are relatively effective, but most individuals in need do not access them...
This study evaluated the prevalence and types of criminal arrest among 99,512 male veterans in substance use disorder (SUD) treatment across 150 VA facilities from 1998 to 2001. Participants were assessed with the Addiction Severity Index (ASI), which includes detailed information about lifetime criminal activity. A majority of the patients (58.2%)...
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 sub...
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:
Pa...
Purpose
The purpose of this paper is to review some research on the environmental characteristics of residential care settings.
Design/methodology/approach
The paper's approach is an integrative overview and formulation of a conceptual framework to understand and measure the key environmental domains of residential care programs.
Findings
The fiv...
Background
Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems.
Methods
We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241) and batterer intervention programs (BIPs; N=235) in California (70% response rate) to examine the extent to whic...
Severe alcohol misuse as measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is associated with increased risk of future fractures and trauma-related hospitalizations. This study examined the association between AUDIT-C scores and two-year risk of any type of trauma among US Veterans Health Administration (VHA) patients...
Al-Anon Family Groups, commonly known as Al-Anon, is a mutual-help organization for relatives and friends of people misusing alcohol and other substances. We first summarize Al-Anon's history and current membership and then describe its theoretical basis and helping approach. We review evidence for Al-Anon's active ingredients and outcomes and pres...
Many patients treated for substance use disorder (SUD) do not achieve lasting recovery from a single episode of treatment and require continuing care. The current randomized clinical trial investigated whether in-person continuing care as usual (CCAU) following intensive outpatient SUD treatment leads to better SUD outcomes when compared with telep...
Information about aging-related change in coping is limited mainly to results of cross-sectional studies of age differences in coping, and no research has focused on predictors of aging-related change in coping behavior. To extend research in this area, we used longitudinal multilevel modeling to describe older adults' (n = 719; baseline M = 61 yea...
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, uniqu...
The current study examined the relationship between co-occurring substance use and Axis I psychiatric disorders and treatment utilization and outcome among homeless individuals (N=365) who participated in an episode of intensive outpatient substance use treatment. Compared to patients without a co-occurring diagnosis, homeless patients with a diagn...
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.
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...
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.
A naturalistic study in which individuals were assessed at baseline, and 1, 8 and 16 years later.
Participants initiated help-seekin...
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 f...
Excessive alcohol use is associated with a variety of negative health outcomes, including liver disease, upper gastrointestinal bleeding, and pancreatitis.
To determine the 2-year risk of gastrointestinal-related hospitalization and new-onset gastrointestinal illness based on alcohol screening scores.
Retrospective cohort study.
Male (N = 215, 924)...
We examined change in family support and depressive symptoms over the course of 23 years and included the potential moderators of gender and participation in treatment. A sample of 373 depressed individuals provided data in five waves, with baseline, 1-year, 4-year, 10-year, and 23-year follow-ups. Multilevel modeling was used to evaluate longitudi...
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...
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.
Two-group simultaneous latent growth modeling was used to describe the characterist...
We examined the associations of recent victimization with subsequent participation in alcohol-related treatment and mutual help, and with short- and long-term drinking and health outcomes. Treatment-naïve men and women having an alcohol use disorder with (n = 73) or without (n = 491) recent violence victimization were assessed at baseline and 1 and...
This study examined the associations between 12-step self-help group participation following substance abuse treatment and abstinence from marijuana use at 1-, 2-, and 5-years post-treatment. These associations were examined among 1288 male patients of the Department of Veterans Affairs who used marijuana within the 3 months prior to admission to t...
This chapter describes four related theories about the social processes that shield individuals from developing substance
use disorders and foster the long-term process of stable remission and recovery. These theories are (1) social control theory,
which focuses on the provision of support, goal direction, and monitoring; (2) social learning theory...
In many evaluations of care for patients with substance use disorders (SUD), a substantial proportion of patients are abstinent from substances prior to their baseline assessment. For researchers evaluating the effect of treatments or patterns of care on follow-up abstinence, especially with non-randomized designs, this raises important conceptual...
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...
Methodological challenges arise when one uses various Veterans Health Administration (VHA) data sources, each created for distinct purposes, to characterize length of stay (LOS). To illustrate this issue, we examined how algorithm choice affects conclusions about mental health condition (MHC)-related differences in LOS for VHA patients with diabete...
We sought to determine the sex- and age-specific risk of mortality associated with scores on the 3-item Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questionnaire using data from a national sample of Veterans Health Administration (VHA) patients. Men (N = 215,924) and women (N = 9168) who completed the AUDIT-C in a patient survey...
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,
Three groups of couples were identified at baseline and followed 10 years later: (i) concordant co...
This chapter provides an overview of the processes and outcomes of self-help or mutual support groups that focus primarily on substance use and associated disorders. The overview covers the role of attendance and involvement in self-help groups, primarily Alcoholics Anonymous and Narcotics Anonymous, in improving substance use and psychosocial func...
IntroductionThe Course of Addictive DisordersScreening and Initial Referral of PatientsDescriptions of Psychosocial Treatments for SudSelf-Help for Substance Use DisorderRole of Referring Physician During Self-Help and/or Professional Sud TreatmentContinuing CareManaging Treatment-Resistant PatientsConclusions
AcknowledgmentReferences
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.
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 prob...
Sexual violence and posttraumatic stress disorder (PTSD) have been linked to increased reports of distress and pain during the pelvic examination. Efforts to more fully characterize these reactions and identify core factors (i.e., beliefs about the examination) that may influence these reactions are warranted.
This descriptive, cross-sectional stud...
This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age. Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories. Community residents (n = 1,291; age 55 to 65 years at baseline) were...
We examined whether parents' stressors and avoidance coping when offspring were children helped to explain associations between parent depression at baseline and offspring's avoidance coping and depression in adulthood. Self-report data were collected at baseline and 1 year from parents (N = 326) and at 23 years from adult offspring (N = 326). Asso...
Some demographic and social factors that indicate the need to place high priority on the development of specialized living environments and of community settings that are responsive to the needs of older people are described. The article then focuses on one central aspect of this issue: the formulation of a conceptual framework to guide evaluations...
This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life.
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 finan...
We compared outpatients (regional facility) with substance use and psychiatric (N = 199) or only substance use (N = 146) disorders on baseline and one-year symptoms (93% follow-up), and treatment and 12-step group participation over the year (2005). We examined whether diagnostic status moderated associations between participation and outcomes (Add...
Individuals who have both substance use disorders and mental health problems have poorer treatment outcomes. This study examines the relationship of service utilization and 12-step participation to outcomes at 1 and 5 years for patients treated in one of two integrated service delivery systems: the Department of Veterans Affairs (VA) system and a h...
Past studies of the underlying structure of depressive symptoms have yielded mixed results, with some studies supporting a continuous conceptualization and others supporting a categorical one. However, no study has examined this research question with an exclusively older adult sample, despite the potential uniqueness of late-life depressive sympto...
Little research has examined the role of retirement in shaping late-life drinking careers, and it has generally been limited to cross-sectional designs or short-term follow-ups that emphasize group-level comparisons of retirees and nonretirees. The purpose of this study was to determine the following: (a) the effect of retired status on older adult...
This study focused on the associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems.
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.
He...
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.
The aim of the study was to compare matched samples of substance use disorder (SUD) patients with personality disorders (PD) in Swis...
This study employed a prospective design to examine the role of friend and partner relationship quality 1 year following substance use disorder treatment in the association between depressive symptoms at discharge from treatment and abstinence from substance use 2 years after treatment.
The sample consisted of 1,453 male veterans who used alcohol a...
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.
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 an...
While considerable research exists on the role of physical illness in initiating depressive reactions, the role of depression in the onset of physical illness is much less studied. Moreover, whereas almost all previous research on depression and incident physical illness has involved specific physical illnesses, the present study examines the link...
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...
The present investigation examined the role of anxiety symptoms immediately following substance abuse treatment in the relation between frequency of pre-treatment marijuana use and relapse to marijuana use at 12-months post-treatment among 1288 male patients who used marijuana within the 3 months prior to admission to treatment. Consistent with exp...
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% f...