title: Effects of age and life transitions on alcohol and drug treatment outcome over nine years.
abstract: OBJECTIVE
  The purpose of this study was to examine the effects of age, common life transitions, treatment, and social support on outcomes 5-9 years after alcohol and other drug (AOD) treatment intake.
  
  
  METHODS
  Participants were patients from a large outpatient AOD treatment program in an integrated health plan. There were 1,951 participants interviewed at intake, of whom 1,646 (84%) completed one or more telephone follow-up interviews at 5, 7, and 9 years. Measures included AOD use based on the Addiction Severity Index; treatment; and changes in marital, employment, and health status in the years between each follow-up. We compared participants by age group (18-39, 40-54, and ≥55 years old at intake) and examined factors (time invariant and time varying) associated with outcomes at 5, 7, and 9 years by fitting mixed-effects logistic random intercept models.
  
  
  RESULTS
  Changes in marital, employment, and health status varied significantly by age. Factors associated with remission across Years 5-9 included being in the middle-aged versus younger group (p < .001); female gender (p < .001); not losing a partner to separation, divorce, or death (p < .001); not experiencing a decline in health (p = .021); having any close friends supportive of recovery (p < .001); and not having any close friends who encourage AOD use (p < .001). Additional predictors, including employment changes, varied by drug versus alcohol abstinence outcome measures.
  
  
  CONCLUSIONS
  Negative life transitions vary by age and are associated with worse outcomes. Older age and social support are associated with long-term AOD remission and abstinence. Findings inform treatment strategies to enhance recovery across the life span.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA 94143, USA. dereks@lppi.ucsf.edu
authors.forename: Derek D
authors.initials: DD
authors.lastname: Satre
authors.forename: Felicia W
authors.initials: FW
authors.lastname: Chi
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Mertens
authors.forename: Constance M
authors.initials: CM
authors.lastname: Weisner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000534:rehabilitation*; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D012944:Social Support; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult