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I'M GEORGE KOOB, DIRECTOR OF

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THE NATIONAL INSTITUTE ON

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ALCOHOL AND ALCOHOLISM, I WOULD

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LIKE TO WELCOME YOU TO THE

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SEMINAR.

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SO, OUR PRESENTERS TODAY ARE

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DR. KATHERINE KEYES FROM

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COLUMBIA UNIVERSITY, FOCUS ON

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ALCOHOL USE AMONG OLDER ADULTS,

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DR. SARA JO NIXON FROM

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UNIVERSITY OF FLORIDA WHO WILL

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PRESENT WHAT ARE THE IMPACTS OF

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ALCOHOL USE IN OLDER ADULTS.

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AND DR. CYNTHIA CAMPBELL FROM

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KAISER PERMANENTE AND DR. DEREK

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SATRE FROM UNIVERSITY OF

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CALIFORNIA, SAN FRANCISCO AND

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KAISER PERMANENTE, COVERING WHAT

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CAN WE DO ABOUT IT.

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I THINK MANY OF YOU KNOW AS THE

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POPULATION OF OLDER ADULTS 65

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AND ABOVE EXPANDS RAPIDLY, SO DO

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THE RATES OF ALCOHOL USE AND

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MISUSE AMONG PEOPLE WITHIN THIS

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AGE GROUP.

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THE BODY CHANGES AS WE AGE,

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THESE CHANGES RENDER PEOPLE MORE

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SUSCEPTIBLE TO SOME OF THE HARMS

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THAT STEM FROM ALCOHOL MISUSE.

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WHILE THE PERSONAL OF PEOPLE

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AGES 65 AND OLDER WHO CONSUME

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ALCOHOL EACH MONTH INCREASED BY

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16% BETWEEN 2002 AND 2019, DUE

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TO THE SIZE OF THE AGING BABY

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BOOMER COHORT, THE ACTUAL NUMBER

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OF DRINKERS IN THAT AGE GROUP

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INCREASED 80% DURING THAT TIME.

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THESE DATA HIGHLIGHT THE NEED

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FOR EARLY INTERVENTION, A BROAD

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DISCUSSION ON WHAT WE CAN DO TO

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PREVENT FURTHER UPWARD TRENDS.

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TODAY'S WEBINAR WILL DO JUST

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THAT.

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AND WILL ALSO PROVIDE AN

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IMPORTANT UPDATE ON THE WAY NIAA

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NIAAA CONTINUES TO SUPPORT THE

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RESEARCH WITH ALCOHOL MISUSE AND

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DELIVERY OF APPROACHES TO REDUCE

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ALCOHOL  MISUSE IN OLDER ADULTS.

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I'M EXCITED TO LEARN AND LISTEN

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IN ON WHAT WILL BE A ROBUST

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DISCUSSION AT THE END.

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FINALLY BEFORE I TURN IT OVER TO

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THE SPEAKERS, A FEW HOUSEKEEPING

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NOTES.

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THIS MEETING IS BEING RECORDED,

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WILL BE AVAILABLE ON THE NIH

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VIDEOCAST WEB PAGE.

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THERE WILL BE TIME ALLOTTED FOR

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QUESTIONS AND ANSWERS AFTER THE

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FORMAL PRESENTATION.

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PLEASE SUBMIT YOUR QUESTIONS VIA

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THE SUBMIT LIVE FEEDBACK BUTTON

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LOCATED UNDER THE VIDEO WINDOW

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ON THE VIDEOCAST PAGE.

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I'LL REPEAT THAT.

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PLEASE SUBMIT YOUR QUESTIONS VIA

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THE SUBMIT LIVE FEEDBACK BUTTON

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LOCATED UNDER THE VIDEO WINDOW

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ON THE VIDEOCAST PAGE.

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THANKS FOR JOINING US.

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NOW I'LL TURN IT OVER TO

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KATHERINE KEYES.

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>> THANK YOU FOR THE

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INTRODUCTION. 

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I'LL SHARE MY SCREEN.

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CAN EVERYONE SEE THE SLIDES?

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THERE WE GO.

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CAN EVERYONE SEE THE SLIDES?

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GREAT.

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SO I'M GOING TO DO SOME KIND OF

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10,000-FOOT VIEW STAGE SETTING

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FOR THE DISCUSSION ON TRENDS IN

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ALCOHOL USE AMONG OLDER ADULTS

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AND TALK ABOUT EPIDEMIOLOGICAL

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DATA WE HAVE ON WHAT THESE

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TRENDS ARE.

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SO FIRST WE KNOW THAT ESPECIALLY

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LAST 15 YEARS ALCOHOL USE AMONG

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OLDER ADULTS HAS BEEN

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INCREASING.

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THESE ARE DATA FROM THE NATIONAL

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HOUSEHOLD SURVEY ON DRUG USE AND

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HEALTH, AND THEY SHOW PERCENTAGE

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OF PEOPLE AGE 50 OR HIGHER,

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ENGAGED IN BINGE DRINKING IN THE

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PATH MONTH.

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2005 TO MID-PART OF THE LAST

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DECADE, 2013-2014, THERE WAS A

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RELATIVE INCREASE OF ABOUT 20%

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INCREASES IN THE PROPORTION OF

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PEOPLE OVER AGE 50 WHO ENGAGED

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IN BINGE DRINKING IN THE PAST

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MONTH.

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FURTHERMORE, OTHER DATA FROM THE

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SAME TIME PERIOD ALSO FROM THE

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NATIONAL HOUSEHOLD SURVEY ON

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DRUG USE AND HEALTH FOCUSED ON

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POPULATION 60 ON MORE CONFIRMING

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THESE TRENDS AMONG BOTH MEN AND

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WOMEN, OVER AGE 60, THROUGH

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ABOUT THE MID-POINT OF THE LAST

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DECADE, THERE WERE DE DECLINES N

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ABSTENTION THROUGH THE MID-POINT

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OF THE LAST DECADE.

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ANOTHER DATA SOURCE THAT ALSO

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CONFIRMS THIS IS A META-ANALYSIS

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DONE OF THE SIX NATIONALLY

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REPRESENTATIVE DATASETS WE HAVE

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IN THE UNITED STATES THAT

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CONSISTENTLY MEASURE ALCOHOL USE

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AND BINGE DRINKING.

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AND SHOWN HERE IS THE META

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ANALYZED ESTIMATE BY AGE.

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YOUNG PEOPLE ARE MORE LIKELY TO

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BINGE DRINK THAN OLDER PEOPLE,

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BUT ACTUALLY THE FASTEST

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INCREASES IN BINGE DRINKING,

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META ANALYZED ACROSS SIX

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DATASETS, WAS INDIVIDUALS AGED

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65+, AMONG WHOM THERE WAS A 3.4%

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INCREASE FROM 2000 TO 2015.

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DATA SINCE 2015, WE'VE HAD A LOT

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OF YEARS AND A PANDEMIC, THE

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DATA WE HAVE ISN'T EXACTLY

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COMPARABLE.

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THESE ARE THE TRENDS IN THE

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NATIONAL HOUSEHOLD SURVEY

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THROUGH 2020, THESE BLACK DOTTED

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LINES INDICATE BREAKS IN

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MEASUREMENT OR DESIGN SO WE

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CAN'T ACTUALLY COMPARE TRENDS

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BEFORE AND AFTER THOSE BREAKS,

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LEADING TO SOME AMBIGUITY IN OUR

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UNDERSTANDING OF THE TOTAL TIME

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TREND OVER THAT TIME PERIOD BUT

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WHAT IS CLEAR IS BINGE DRINKING

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HASN'T GONE DOWN.

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INCREASES STARTING REALLY AROUND

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THE 2000s AND HEADING UP

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THROUGH THE MID-POINTS OF THE

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PREVIOUS DECADE THROUGH

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2014-2015 WE DON'T HAVE ANY

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EVIDENCE FROM THE NATIONAL

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HOUSEHOLD SURVEY ON DRUG USE AND

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HEALTH THAT THOSE INCREASES HAVE

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ABATED.

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IF ANYTHING, INCREASES HAVE

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REMAINED RELATIVELY STATIC, WITH

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THE PAST YEAR -- PAST MONTH

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ALCOHOL USE REMAINING RELATIVELY

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STATIC OR EVEN INCREASING SINCE

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THE PANDEMIC, AND FOR PAST MONTH

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WE SAW THOSE INCREASES CONTINUE

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ESPECIALLY AMONG MEN AFTER 2015

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AND SOME EVIDENCE THEY MIGHT BE

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DECREASING SLIGHTLY IN THE PAST

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FEW YEARS BUT NOT TO THE

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PRE-2000 LEVEL.

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SO ALL OF THIS TOGETHER

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INDICATES THAT WE REALLY DO HAVE

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AN INCREASING BURDEN OF ALCOHOL

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USE AMONG OLDER ADULTS.

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AND I'D LIKE TO SPEAK FOR A FEW

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MINUTES ABOUT WHY, WHY ARE WE

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SEEING THESE INCREASES AMONG

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OLDER ADULTS?

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NOW, THIS GOES FROM THE

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EPIDEMIOLOGICAL DATA WHERE WE

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CAN OBSERVE TRENDS TO SOME

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SPECULATION AND HYPOTHESIS

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GENERATION, BUT I DO THINK THE

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DATA CAN SPEAK TO SOME OF THE

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REASONS WHY WE'RE SEEING THESE

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TRENDS.

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AND I SEPARATE THE POTENTIAL

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UNDERLYING DRIVERS OF THE TRENDS

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IN OLDER ADULT DRINKING INTO

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SUPPLY AND DEMAND SIDE FACTORS.

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SO I'LL START WITH DEMAND SIDE

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FACTORS.

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WHY ARE OLDER ADULTS WANTING TO

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DRINK MORE?

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ONE REASON IS NOT ONLY AS DR.

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KOOB MENTIONED DO WE HAVE AN

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INCREASING NUMBER OF OLDER

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ADULTS LIFTING PAST 65 BUT ALSO

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LIVING HEALTHIER.

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SHOWN IS LIFE EXPECT YENS  EXPE,

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WE'VE HAD AN INCREASING LIFE

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EXPECTANCY OCCURRING THROUGHOUT

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THE LAST SEVERAL DECADES.

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WE'VE EXPERIENCED LEVELING OFF

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OF LIFE EXPECTANCY IN THE U.S.,

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ESPECIALLY IN THE LAST FEW

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YEARS, AS THE PANDEMIC HAS

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RAGED, BUT COMPARED TO PRIOR

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GENERATIONS AND PRIOR DECADES

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PEOPLE ARE LIVING MUCH LONGER

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THAN THEY WERE IN PREVIOUS

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DECADES, AND THEY ARE ALSO

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LIVING HEALTHIER LIVES.

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WHY DOES THAT MATTER FOR BINGE

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DRINKING?

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WELL, EPIDEMIOLOGICAL DATA SHOWS

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THAT ACTUALLY THE OLDER ADULTS

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MOST LIKELY TO ENGAGE IN BINGE

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DRINKING ARE THE HEALTHIEST.

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PEOPLE WHO DON'T HAVE MAJOR

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CONTRAINDICATIONS OF ALCOHOL USE

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WITH MEDICATION AND OTHER

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ILLNESSES TEND TO BE THOSE WHO

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ENGAGE IN THE MOST EXCESSIVE

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ALCOHOL USE.

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SO FOR EXAMPLE, THESE ARE DATA

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AMONG ADULTS OVER AGE 50 FROM

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NATIONAL HOUSEHOLD SURVEY ON

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DRUG USE AND HEALTH, AND THE

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PEOPLE WHO ARE MOST LIKELY TO

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BINGE DRINK, OVER 50 YEARS OLD,

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WERE THOSE WITH NO CHRONIC

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CONDITIONS.

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AND EVEN THOSE WITH ONE CHRONIC

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CONDITION.

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HOWEVER, AMONG THOSE WITH TWO OR

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THREE CHRONIC CONDITIONS, THOSE

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ADULTS WERE LESS LIKELY TO BINGE

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DRINK THAN OTHERS.

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SO, AS THE PROPORTION OF PEOPLE

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OVER AGE 50 AND OVER AGE 65 NOT

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ONLY GROWS, BUT FOR WHICH

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THERE'S NO CONTRAINDICATION TO

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ALCOHOL USE, THAT MIGHT BE ONE

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REASON WE'RE SEEING THESE

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INCREASES.

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ANOTHER FACTOR THAT COULD BE

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CONTRIBUTING TO INCREASES AMONG

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OLDER ADULTS IS STRESS.

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ECONOMIC STRESS, ESPECIALLY

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STRESS AROUND RETIREMENT AGE.

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YOU KNOW, WE REALLY STARTED TO

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SEE INCREASES IN OLDER ADULT

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DRINKING RIGHT AROUND THE TIME

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OF THE 2008-2009 RECESSION,

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THAT'S WHEN WE STARTED TO SEE

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RISES IN PEOPLE OVER 50 AND OVER

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65 AT PRECIPICE OF ECONOMIC

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YEARS FOR WHICH ECONOMIC

259
00:09:43,361 --> 00:09:45,563
RECESSION WOULD BE PARTICULARLY

260
00:09:45,563 --> 00:09:46,865
DELETERIOUS TO THEIR LONG-TERM

261
00:09:46,865 --> 00:09:47,932
NET WORTH, THAT'S THE GROUP

262
00:09:47,932 --> 00:09:51,803
WHERE WE STARTED TO SEE REALLY

263
00:09:51,803 --> 00:09:55,640
STRONG INCREASES IN BINGE

264
00:09:55,640 --> 00:09:57,142
DRINKING.

265
00:09:57,142 --> 00:10:01,112
DATA FROM CASE AND DEATON SHOWS

266
00:10:01,112 --> 00:10:06,584
AS MEEDIAN HOUSEHOLD INCOME

267
00:10:06,584 --> 00:10:08,887
DECLEANED WE'VE SEEN MORTALITY

268
00:10:08,887 --> 00:10:10,522
RATES DECLINE FOR PEOPLE 50 TO

269
00:10:10,522 --> 00:10:14,359
54 AS WELL AS PEOPLE AGE 60 TO

270
00:10:14,359 --> 00:10:14,692
69.

271
00:10:14,692 --> 00:10:16,761
WE'VE SEEN DECLINES IN HOUSEHOLD

272
00:10:16,761 --> 00:10:18,496
INCOME, FOR THOSE GROUPS, AND AT

273
00:10:18,496 --> 00:10:27,138
THE SAME TIME INCREASES IN

274
00:10:27,138 --> 00:10:27,405
MORTALITY.

275
00:10:27,405 --> 00:10:29,140
ECONOMIC FACTORS COULD BE

276
00:10:29,140 --> 00:10:31,409
CORRECTING TO INCREASES.

277
00:10:31,409 --> 00:10:32,210
ANOTHER FACTOR IS CO-OCCURRING

278
00:10:32,210 --> 00:10:33,178
SUBSTANCE USE, IN THE SAME AGE

279
00:10:33,178 --> 00:10:36,548
GROUPS OVER THE SAME TIME PERIOD

280
00:10:36,548 --> 00:10:38,316
WE'VE SEEN YEAR-OVER-YEAR

281
00:10:38,316 --> 00:10:40,952
INCREASES IN CANNABIS USE EVEN

282
00:10:40,952 --> 00:10:43,688
AMONG INDIVIDUALS OVER 65, DATA

283
00:10:43,688 --> 00:10:44,889
FROM THE NATIONAL HOUSEHOLD

284
00:10:44,889 --> 00:10:47,692
SURVEY SHOWING TRENDS IN

285
00:10:47,692 --> 00:10:49,494
CANNABIS USE FROM 2013 TO 2022,

286
00:10:49,494 --> 00:10:50,895
ALTHOUGH PEOPLE AGE 65 AND OLDER

287
00:10:50,895 --> 00:10:53,431
HAVE THE LOWEST RATES OF OVERALL

288
00:10:53,431 --> 00:10:56,067
CANNABIS USE WE CAN SEE THEIR

289
00:10:56,067 --> 00:10:57,101
RATES HAVE BEEN INCREASING JUST

290
00:10:57,101 --> 00:10:58,837
AS MUCH AS PEOPLE IN OTHER AGE

291
00:10:58,837 --> 00:10:59,904
GROUPS AS WELL.

292
00:10:59,904 --> 00:11:03,107
SO WE HAVE A CO-OCCURRING FACTOR

293
00:11:03,107 --> 00:11:04,309
THAT'S ASSOCIATED WITH INCREASES

294
00:11:04,309 --> 00:11:05,944
IN ALCOHOL USE, THAT'S ALSO

295
00:11:05,944 --> 00:11:10,515
INCREASING OVER THE SAME TIME.

296
00:11:10,515 --> 00:11:12,517
FINALLY, THOSE ARE THE DEMAND

297
00:11:12,517 --> 00:11:14,052
SIDE FACTORS BUT THERE'S ALSO

298
00:11:14,052 --> 00:11:16,254
SUPPLY SIDE FACTORS THAT MAY BE

299
00:11:16,254 --> 00:11:18,323
CONTRIBUTING TO OLDER ADULT

300
00:11:18,323 --> 00:11:19,557
DRINKING.

301
00:11:19,557 --> 00:11:23,061
SHOWN HERE IS THE PER CAPITA

302
00:11:23,061 --> 00:11:25,296
PERCENTAGE CHANGE IN PER CAPITA

303
00:11:25,296 --> 00:11:25,964
CONSUMPTION FROM 1977 TO 2018 IN

304
00:11:25,964 --> 00:11:28,199
THE UNITED STATES BY BEVERAGE

305
00:11:28,199 --> 00:11:28,533
TYPE.

306
00:11:28,533 --> 00:11:31,636
WE CAN SEE OVERALL, THE BEVERAGE

307
00:11:31,636 --> 00:11:32,971
THAT HAS BEEN INCREASING THE

308
00:11:32,971 --> 00:11:34,439
MOST IN PER CAPITA CONSUMPTION

309
00:11:34,439 --> 00:11:36,107
SINCE THE EARLY PART OF THE

310
00:11:36,107 --> 00:11:37,742
2000s WHEN WE STARTED TO SEE

311
00:11:37,742 --> 00:11:40,378
THIS INCREASE IN OLDER ADULT

312
00:11:40,378 --> 00:11:41,446
DRINKING IS WINE.

313
00:11:41,446 --> 00:11:43,882
WE ALSO KNOW OVER THE LAST TWO

314
00:11:43,882 --> 00:11:45,283
DECADES, THINGS LIKE ALCOHOL

315
00:11:45,283 --> 00:11:47,151
TAXES AND PRICE HAVE NOT KEPT UP

316
00:11:47,151 --> 00:11:48,686
WITH BROADER ECONOMIC FACTORS

317
00:11:48,686 --> 00:11:49,888
SUCH AS INFLATION, WHICH

318
00:11:49,888 --> 00:11:52,323
FUNCTIONALLY LOWERS THE COST OF

319
00:11:52,323 --> 00:11:53,825
ALCOHOL USE FOR EVERYONE.

320
00:11:53,825 --> 00:11:55,460
WE HAVE THE MARKETING AND

321
00:11:55,460 --> 00:11:58,296
ADVERTISING OF ALCOHOL AND

322
00:11:58,296 --> 00:11:59,197
BRANDING OF PRODUCTS TO

323
00:11:59,197 --> 00:12:00,431
ILLUSTRATE ALCOHOL USE MIGHT BE

324
00:12:00,431 --> 00:12:03,902
PART OF A LUXURY LIFESTYLE, PART

325
00:12:03,902 --> 00:12:05,536
OF A CARE-FREE RETIREMENT, AS

326
00:12:05,536 --> 00:12:12,443
WELL AS THE PRICE GOING

327
00:12:12,443 --> 00:12:14,178
FUNCTIONALLY DOWN OVER TIME,

328
00:12:14,178 --> 00:12:17,348
THESE MAY INDICATE A SUPPLY SIDE

329
00:12:17,348 --> 00:12:24,389
DRIVER OVER TIME IN THE ALCOHOL

330
00:12:24,389 --> 00:12:25,156
MARKET ITSELF.

331
00:12:25,156 --> 00:12:28,092
OLDER ADULTS ARE LIVING LONGER

332
00:12:28,092 --> 00:12:32,030
AND HEALTHIER HAVE STAMINA TO

333
00:12:32,030 --> 00:12:32,664
ENGAGE IN HEAVY CONSUMPTION IT

334
00:12:32,664 --> 00:12:38,736
IS EXPENSE FOR THE -- IT IS

335
00:12:38,736 --> 00:12:40,905
CONSEQUENTIAL THE DATA FROM THE

336
00:12:40,905 --> 00:12:44,175
STUDIES THAT WERE FIRST

337
00:12:44,175 --> 00:12:48,780
CONDUCTED IN 2001, 2002, AGAIN

338
00:12:48,780 --> 00:12:49,881
IN 2012-2013, INDICATE INCREASES

339
00:12:49,881 --> 00:12:52,483
IN THE PREVALENCE FOR ALL AGE

340
00:12:52,483 --> 00:13:01,159
GROUPS BUT ESPECIALLY OVER 65

341
00:13:01,159 --> 00:13:02,026
COMPARED TO LOWER RELATIVE

342
00:13:02,026 --> 00:13:12,537
INCREASES IN OTHER AGE GROUPS.

343
00:13:14,038 --> 00:13:16,274
THESE ARE DATA PUBLISHED SEVERAL

344
00:13:16,274 --> 00:13:18,242
YEARS AGO SHOWING BIRTH COHORT

345
00:13:18,242 --> 00:13:19,777
EFFECTS IN CAUSES OF DEATH, SOME

346
00:13:19,777 --> 00:13:21,546
OF WHICH ARE RELATED TO ALCOHOL

347
00:13:21,546 --> 00:13:21,713
USE.

348
00:13:21,713 --> 00:13:23,948
SO EACH OF THESE LINES IS A

349
00:13:23,948 --> 00:13:24,949
PARTICULAR BIRTH COHORT AS THEY

350
00:13:24,949 --> 00:13:26,184
MOVE THROUGH THE LIFE COURSE,

351
00:13:26,184 --> 00:13:29,754
AND WHAT YOU CAN SEE IS IN THIS

352
00:13:29,754 --> 00:13:35,626
50 TO 60 YEAR AGE RANGE DOWN

353
00:13:35,626 --> 00:13:37,395
HERE THERE'S NOT THAT MUCH TREND

354
00:13:37,395 --> 00:13:39,397
IN THE OVERALL MORTALITY RATES,

355
00:13:39,397 --> 00:13:43,901
IT'S WHERE YOU SEE PEOPLE BORN

356
00:13:43,901 --> 00:13:45,403
19 ^50, 1955, 1960, THOSE

357
00:13:45,403 --> 00:13:47,872
ENTERING OLDER AGE GROUPS NOW

358
00:13:47,872 --> 00:13:50,641
WHERE WE STARTED TO SEE

359
00:13:50,641 --> 00:13:51,976
ACCELERATION IN DEATHS RELATED

360
00:13:51,976 --> 00:13:53,277
TO DRUGS, ALCOHOL USE AND

361
00:13:53,277 --> 00:13:53,811
SUICIDE.

362
00:13:53,811 --> 00:13:57,148
I WOULD POINT YOU PARTICULARLY

363
00:13:57,148 --> 00:13:58,983
TO ALCOHOL-RELATED LIVER

364
00:13:58,983 --> 00:14:00,618
DISEASES, AGAIN OLDER COHORTS NO

365
00:14:00,618 --> 00:14:00,818
TREND.

366
00:14:00,818 --> 00:14:08,926
ONCE YOU SEE PEOPLE BORN 1950,

367
00:14:08,926 --> 00:14:11,796
1955, 1960 WE'RE SEEING

368
00:14:11,796 --> 00:14:14,665
ACCELERATION EVEN AT YOUNGER

369
00:14:14,665 --> 00:14:21,205
AGES, PEOPLE IN THEIR EARLY

370
00:14:21,205 --> 00:14:21,639
50s.

371
00:14:21,639 --> 00:14:23,107
THIS FIGURE SHOWS THE AVERAGE

372
00:14:23,107 --> 00:14:27,178
ANNUAL CHANGE IN THE RATE OF

373
00:14:27,178 --> 00:14:27,845
ALCOHOL-ASSOCIATINGED MORTALITY

374
00:14:27,845 --> 00:14:28,880
FROM 1999 TO 2017.

375
00:14:28,880 --> 00:14:30,648
I WOULD POINT YOUR ATTENTION TO

376
00:14:30,648 --> 00:14:36,521
THESE TWO LINES HERE FOR AGE 55

377
00:14:36,521 --> 00:14:39,290
TO 64 AND 65 TO 74, MEN AND

378
00:14:39,290 --> 00:14:41,993
WOMEN, WE'VE SEEN INCREASES IN

379
00:14:41,993 --> 00:14:43,628
ALCOHOL-RELATED MORTALITY, EVEN

380
00:14:43,628 --> 00:14:45,329
ACUTE CAUSES OF ALCOHOL-RELATED

381
00:14:45,329 --> 00:14:47,732
MORTALITY WHERE AMONG PEOPLE AGE

382
00:14:47,732 --> 00:14:50,968
65 TO 74 THERE'S BEEN AN AVERAGE

383
00:14:50,968 --> 00:14:52,203
ANNUAL CHANGE OF 5% FOR THE

384
00:14:52,203 --> 00:14:55,573
PROPORTION OF PEOPLE DYING OF

385
00:14:55,573 --> 00:14:56,340
ACUTE ALCOHOL-RELATED CAUSE, AND

386
00:14:56,340 --> 00:14:59,444
INCREASES OVER TIME FOR BOTH AGE

387
00:14:59,444 --> 00:15:02,580
GROUPS AMONG PEOPLE DYING OF

388
00:15:02,580 --> 00:15:04,949
CHRONIC ALCOHOL-RELATED CAUSES.

389
00:15:04,949 --> 00:15:06,584
THESE DATA END IN 2017.

390
00:15:06,584 --> 00:15:10,721
WE KNOW THE PANDEMIC ONLY

391
00:15:10,721 --> 00:15:11,089
ACCELERATED THE

392
00:15:11,089 --> 00:15:11,789
ALCOHOL-ASSOCIATED MORTALITY

393
00:15:11,789 --> 00:15:14,792
WE'VE SEEN IN PREVIOUS YEARS AS

394
00:15:14,792 --> 00:15:14,992
WELL.

395
00:15:14,992 --> 00:15:17,528
THESE DATA ARE NOT STRATIFIED BY

396
00:15:17,528 --> 00:15:20,798
AGE BUT JUST SHOW THE REAL

397
00:15:20,798 --> 00:15:21,532
ACCELERATION OF MONTHLY

398
00:15:21,532 --> 00:15:23,434
ALCOHOL-RELATED DEATHS IN THE

399
00:15:23,434 --> 00:15:25,069
U.S. POPULATION, DURING THE

400
00:15:25,069 --> 00:15:27,038
COVID PANDEMIC, WE REALLY SAW

401
00:15:27,038 --> 00:15:28,139
THIS ACCELERATION DURING THE

402
00:15:28,139 --> 00:15:36,447
FIRST U.S. ISSUES OF STATE  --

403
00:15:36,447 --> 00:15:37,982
STATE AT-HOME ORDERS.

404
00:15:37,982 --> 00:15:39,083
DATA PUBLISHED JUST SEVERAL

405
00:15:39,083 --> 00:15:42,587
MONTHS AGO FROM THE CDC

406
00:15:42,587 --> 00:15:45,156
CONFIRMED THESE TRENDS HAVE

407
00:15:45,156 --> 00:15:48,392
STABILIZED, EVEN IN MORE RECENT

408
00:15:48,392 --> 00:15:49,160
TIMES.

409
00:15:49,160 --> 00:15:51,462
AND IMPORTANTLY, BY AGE, HERE IS

410
00:15:51,462 --> 00:15:52,997
THE TREND IN DEATHS FROM

411
00:15:52,997 --> 00:15:57,935
EXCESSIVE ALCOHOL USE BY AGE

412
00:15:57,935 --> 00:16:02,306
GROUP FOR 2016-2017, 2018- 2019

413
00:16:02,306 --> 00:16:05,076
AND THE PANDEMIC PERIOD.

414
00:16:05,076 --> 00:16:07,645
FOR THESE AGES AMONG MALES AND

415
00:16:07,645 --> 00:16:09,947
FEMALES, NOT ONLY ARE

416
00:16:09,947 --> 00:16:10,615
ALCOHOL-RELATED DEATHS

417
00:16:10,615 --> 00:16:13,184
INCREASING BUT THEY REALLY

418
00:16:13,184 --> 00:16:15,353
ACCELERATED DURING THE PANDEMIC

419
00:16:15,353 --> 00:16:15,586
PERIOD.

420
00:16:15,586 --> 00:16:17,655
SO IN CONCLUSION I THINK WHAT WE

421
00:16:17,655 --> 00:16:18,956
KNOW FROM THE EPIDEMIOLOGICAL

422
00:16:18,956 --> 00:16:20,591
DATA IS THAT ALCOHOL CONSUMPTION

423
00:16:20,591 --> 00:16:24,428
IS INCREASING IN THE U.S.,

424
00:16:24,428 --> 00:16:25,630
INCLUDING AMONG ALL ADULTS BUT

425
00:16:25,630 --> 00:16:26,764
ALSO EXTENDING TO PEOPLE IN

426
00:16:26,764 --> 00:16:29,267
THOSE OLDER AGE GROUPS AS WELL.

427
00:16:29,267 --> 00:16:31,903
THE REASONS UNDERLYING THESE

428
00:16:31,903 --> 00:16:32,770
INCREASES ARE MULTI-FACTORIAL.

429
00:16:32,770 --> 00:16:35,039
I THINK THEY STEM FROM BOTH

430
00:16:35,039 --> 00:16:36,941
SUPPLY AND DEMAND FACTORS,

431
00:16:36,941 --> 00:16:37,575
SUGGESTING THAT OUR PUBLIC

432
00:16:37,575 --> 00:16:38,776
HEALTH RESPONSE SHOULD BE

433
00:16:38,776 --> 00:16:41,546
ATTUNED TO BOTH OF THOSE DRIVERS

434
00:16:41,546 --> 00:16:42,880
OF ALCOHOL CONSUMPTION AND

435
00:16:42,880 --> 00:16:44,081
RELATED HEALTH PROBLEMS.

436
00:16:44,081 --> 00:16:45,917
BUT WHAT'S DEFINITELY TRUE FROM

437
00:16:45,917 --> 00:16:47,151
THE EPIDEMIOLOGICAL DATA IS

438
00:16:47,151 --> 00:16:48,553
THERE ARE SERIOUS CONSEQUENCES

439
00:16:48,553 --> 00:16:51,455
OF THESE INCREASES TO HUMAN

440
00:16:51,455 --> 00:16:52,623
LIFE, INCLUDING INCREASES IN

441
00:16:52,623 --> 00:16:55,993
ALCOHOL USE DISORDER, ALSO

442
00:16:55,993 --> 00:16:56,928
ALCOHOL-RELATED DEATHS.

443
00:16:56,928 --> 00:16:58,729
I'D LIKE TO THANK NIAAA FOR

444
00:16:58,729 --> 00:16:59,830
GIVING ME THE OPPORTUNITY TO

445
00:16:59,830 --> 00:17:02,833
SPEAK TODAY AND THANK THE

446
00:17:02,833 --> 00:17:06,304
FUNDING I'VE RECEIVED FROM NIAAA

447
00:17:06,304 --> 00:17:07,838
AND LOOK FORWARD TO ADDITIONAL

448
00:17:07,838 --> 00:17:08,372
PRESENTERS AND DISCUSSION.

449
00:17:08,372 --> 00:17:12,543
THANK YOU SO MUCH.

450
00:17:12,543 --> 00:17:15,880
I WOULD LIKE THE TURN THE MIC,

451
00:17:15,880 --> 00:17:17,815
SO TO SPEAK, TO SARA JO NIXON,

452
00:17:17,815 --> 00:17:28,326
UNIVERSITY OF FLORIDA, FOR THE

453
00:17:38,703 --> 00:17:39,837
NEXT PRESENTATION.

454
00:17:39,837 --> 00:17:44,008
>> CAN YOU ALL SEE THE
CORRECT

455
00:17:44,008 --> 00:17:44,242
SLIDES?

456
00:17:44,242 --> 00:17:50,381
PERHAPS NOT.

457
00:17:50,381 --> 00:17:52,416
>> NOT QUITE IN PRESENTER
MODE

458
00:17:52,416 --> 00:17:53,951
YET. 

459
00:17:53,951 --> 00:17:56,387
>> OKAY, THANK YOU. 

460
00:17:56,387 --> 00:17:58,055
AND LET ME GET THIS IN THE RIGHT

461
00:17:58,055 --> 00:18:00,758
PLACE HERE.

462
00:18:00,758 --> 00:18:06,764
 

463
00:18:06,764 --> 00:18:13,638
 

464
00:18:13,638 --> 00:18:15,306
NOW CAN YOU -- NO, I CAN'T.

465
00:18:15,306 --> 00:18:16,841
>> YES, IT'S GOOD.

466
00:18:16,841 --> 00:18:18,709
>> ALL RIGHT, GREAT.

467
00:18:18,709 --> 00:18:20,978
THANK YOU VERY MUCH.

468
00:18:20,978 --> 00:18:21,879
ALL RIGHT.

469
00:18:21,879 --> 00:18:24,882
NOW YOU CAN, RIGHT?

470
00:18:24,882 --> 00:18:28,219
YOU'RE SEEING THE CORRECT --

471
00:18:28,219 --> 00:18:29,654
>> IT FLIPPED BACK.

472
00:18:29,654 --> 00:18:30,354
>> ALL RIGHT.

473
00:18:30,354 --> 00:18:32,623
LET'S GO WITH THIS.

474
00:18:32,623 --> 00:18:34,058
NOW YOU CAN THOUGH.

475
00:18:34,058 --> 00:18:34,325
>> YES.

476
00:18:34,325 --> 00:18:35,259
>> ALL RIGHT.

477
00:18:35,259 --> 00:18:36,661
THANK YOU.

478
00:18:36,661 --> 00:18:38,763
SO, FIRST OF ALL THANK YOU TO

479
00:18:38,763 --> 00:18:41,499
NIAAA FOR FOCUSING ON THIS

480
00:18:41,499 --> 00:18:42,867
REALLY IMPORTANT TOPIC, AND

481
00:18:42,867 --> 00:18:51,976
THANK YOU ALSO TO THE ORGANIZERS

482
00:18:51,976 --> 00:18:54,412
FOR INVITING ME TO BE PART OF

483
00:18:54,412 --> 00:18:55,413
THIS.

484
00:18:55,413 --> 00:18:58,182
AS YOU SAW IN DR. KEYES'

485
00:18:58,182 --> 00:19:00,751
PRESENTATION THESE RATES ARE

486
00:19:00,751 --> 00:19:02,420
ALARMING, AND THEY SORT OF

487
00:19:02,420 --> 00:19:04,121
REMIND US THAT WHEN WE LOOK AT

488
00:19:04,121 --> 00:19:06,123
THE EFFECTS OF ALCOHOL IN OLDER

489
00:19:06,123 --> 00:19:08,459
POPULATIONS WE COULD LOOK AT

490
00:19:08,459 --> 00:19:10,728
ALMOST ANYTHING, ANY DISEASE

491
00:19:10,728 --> 00:19:12,363
STATE, ANY ORGAN CONDITION, ET

492
00:19:12,363 --> 00:19:13,197
CETERA, ET CETERA.

493
00:19:13,197 --> 00:19:15,633
WE DON'T HAVE THAT KIND OF TIME

494
00:19:15,633 --> 00:19:16,634
TODAY.

495
00:19:16,634 --> 00:19:22,740
SO TODAY I'M GOING TO FOCUS ON

496
00:19:22,740 --> 00:19:24,075
THE NEUROBIOBEHAVIORAL IMPACT OF

497
00:19:24,075 --> 00:19:25,643
ALCOHOL USE IN OLDER ADULTS.

498
00:19:25,643 --> 00:19:28,346
MOST OF MY TALK WON'T BE ABOUT

499
00:19:28,346 --> 00:19:29,246
ALCOHOL USE DISORDER, PER SE,

500
00:19:29,246 --> 00:19:31,782
BUT I WANT TO START WITH IT IN

501
00:19:31,782 --> 00:19:33,684
ORDER TO SET THE CONTEXT FOR

502
00:19:33,684 --> 00:19:38,522
WHAT WE'D LIKE TO TALK ABOUT.

503
00:19:38,522 --> 00:19:42,893
THE LARGE LITERATURE AND IN FACT

504
00:19:42,893 --> 00:19:46,797
DSM-V RECOGNIZES THAT THERE ARE

505
00:19:46,797 --> 00:19:47,898
RESIDUAL COGNITIVE CONSEQUENCES

506
00:19:47,898 --> 00:19:52,370
TO THE CHRONIC EXCESSIVE USE OF

507
00:19:52,370 --> 00:19:55,773
ALCOHOL, SUGGESTING 30 TO 40% OF

508
00:19:55,773 --> 00:19:57,608
INDIVIDUALS WHO MEET CRITERIA

509
00:19:57,608 --> 00:20:01,779
FOR AUD WHO ALSO DEMONSTRATE

510
00:20:01,779 --> 00:20:04,548
CLINICALLY SIGNIFICANT COGNITIVE

511
00:20:04,548 --> 00:20:05,850
IMPAIRMENT, AND OTHER STUDIES,

512
00:20:05,850 --> 00:20:08,152
THE EMPIRICAL STUDIES DONE IN

513
00:20:08,152 --> 00:20:10,121
THE FIELD WHERE INDIVIDUALS WITH

514
00:20:10,121 --> 00:20:12,423
ALCOHOL USE DISORDER ARE

515
00:20:12,423 --> 00:20:15,126
COMPARED WITH COMMUNITY CONTROLS

516
00:20:15,126 --> 00:20:21,132
AGE AND EDUCATION MATCHED SO

517
00:20:21,132 --> 00:20:21,599
THERE'S A SIGNIFICANT

518
00:20:21,599 --> 00:20:22,466
ALCOHOL-RELATED IMPAIRMENT 50 TO

519
00:20:22,466 --> 00:20:24,235
80% OF THOSE INDIVIDUALS.

520
00:20:24,235 --> 00:20:25,503
THAT'S NOT CLINICAL IMPAIRMENT

521
00:20:25,503 --> 00:20:26,837
BUT CERTAINLY IMPORTANT WHEN YOU

522
00:20:26,837 --> 00:20:29,373
CONSIDER THE FACT THIS

523
00:20:29,373 --> 00:20:31,909
COMPARISON IS THOSE WITH AUD AND

524
00:20:31,909 --> 00:20:35,513
COMMUNITY GROUPS WHO ARE IN THE

525
00:20:35,513 --> 00:20:37,581
SAME SOCIAL CIRCLES AND IN

526
00:20:37,581 --> 00:20:39,350
COMPETING FOR THE SAME JOBS.

527
00:20:39,350 --> 00:20:41,051
AND THESE IMPAIRMENTS CAN BE

528
00:20:41,051 --> 00:20:44,822
OBTAINED EVEN IN THE ABSENCE OF

529
00:20:44,822 --> 00:20:45,823
CONFOUNDING CO-MORBIDITIES.

530
00:20:45,823 --> 00:20:48,526
BUT THAT DOESN'T DEAL WITH AGE.

531
00:20:48,526 --> 00:20:51,262
AND FOR A DECADE THERE'S BEEN

532
00:20:51,262 --> 00:20:56,434
CONCERN ABOUT HOW THIS STATE OF

533
00:20:56,434 --> 00:20:58,502
AUD INTERSECTS WITH AGE, AND

534
00:20:58,502 --> 00:21:01,572
ACROSS THIS TIME THERE HAVE BEEN

535
00:21:01,572 --> 00:21:03,541
SORT OF TWO GENERAL HYPOTHESES

536
00:21:03,541 --> 00:21:04,975
ABOUT HOW THIS HAPPENS.

537
00:21:04,975 --> 00:21:08,145
EVEN IN HEALTHY AGING AS YOU SEE

538
00:21:08,145 --> 00:21:10,314
IN THE DARK LINES, THERE ARE

539
00:21:10,314 --> 00:21:12,183
CHANGES ACROSS TIME.

540
00:21:12,183 --> 00:21:15,052
OFTENTIMES EARLY ON THESE ARE

541
00:21:15,052 --> 00:21:18,222
COMPENSATED FOR BY VARIOUS KINDS

542
00:21:18,222 --> 00:21:20,291
OF COMPENSATORY MECHANISMS, OR

543
00:21:20,291 --> 00:21:22,460
COGNITIVE RESERVE, BUT OVER TIME

544
00:21:22,460 --> 00:21:26,297
THERE'S CHANGE. 

545
00:21:26,297 --> 00:21:28,265
THE TWO HYPOTHESES ARE ALCOHOL

546
00:21:28,265 --> 00:21:30,568
IMPACTS COGNITIVE AGING OR

547
00:21:30,568 --> 00:21:32,636
INTERSECTS WITH COGNITIVE AGING

548
00:21:32,636 --> 00:21:34,738
IN A MORE ADDITIVE WAY AND THAT

549
00:21:34,738 --> 00:21:38,209
IS THAT AS YOU AGE, THERE ARE

550
00:21:38,209 --> 00:21:39,443
EFFECTS OF ALCOHOL BUT PARALLEL

551
00:21:39,443 --> 00:21:41,946
TO THAT IN HEALTHY AGING ACROSS

552
00:21:41,946 --> 00:21:43,914
THE LIFESPAN.

553
00:21:43,914 --> 00:21:46,217
THE ALTERNATIVE IS ACCELERATED

554
00:21:46,217 --> 00:21:48,185
AGING HYPOTHESIS, IN WHICH YOU

555
00:21:48,185 --> 00:21:52,156
CAN SEE THAT AS AGE INCREASES,

556
00:21:52,156 --> 00:21:58,162
DIFFERENCE BETWEEN HEALTHY AGING

557
00:21:58,162 --> 00:21:59,730
AND THAT EXPERIENCED BY

558
00:21:59,730 --> 00:22:01,131
INDIVIDUALS USING ALCOHOL IN

559
00:22:01,131 --> 00:22:02,500
CHRONIC EXCESSIVE PATTERNS

560
00:22:02,500 --> 00:22:03,200
BECOMES LARGER.

561
00:22:03,200 --> 00:22:05,603
THERE ARE DATA FOR BOTH.

562
00:22:05,603 --> 00:22:10,341
MOST OF THE DATA, HOWEVER,

563
00:22:10,341 --> 00:22:14,044
SUPPORT THE IDEA OF ACCELERATED

564
00:22:14,044 --> 00:22:14,578
AGING HYPOTHESIS.

565
00:22:14,578 --> 00:22:17,982
I WANT TO PROVIDE A SLIDE

566
00:22:17,982 --> 00:22:18,782
ILLUSTRATING THIS BECAUSE WE'LL

567
00:22:18,782 --> 00:22:20,818
RETURN TO THE CONCEPT HOW DO

568
00:22:20,818 --> 00:22:22,820
THESE FACTORS INTERSECT AT THE

569
00:22:22,820 --> 00:22:24,889
END OF THE PRESENTATION.

570
00:22:24,889 --> 00:22:27,925
THESE ARE DATA THAT ARE MODIFIED

571
00:22:27,925 --> 00:22:34,498
FROM A RECENT PRESENTATION OR

572
00:22:34,498 --> 00:22:38,135
PAPER WHERE WE SHOW THE INCREASE

573
00:22:38,135 --> 00:22:41,772
IN AGE AND DECREASE IN

574
00:22:41,772 --> 00:22:44,174
FRONTAL -- WELL, REALLY

575
00:22:44,174 --> 00:22:47,678
INCREASES PARTICULARLY IN THOSE

576
00:22:47,678 --> 00:22:51,949
INDIVIDUALS WHO HAVE AUD. 

577
00:22:51,949 --> 00:22:54,552
BLACK LINE ARE CONTROLS, RED

578
00:22:54,552 --> 00:22:55,653
LINE ARE INDIVIDUALS WITH

579
00:22:55,653 --> 00:22:57,521
ALCOHOL USE DISORDER.

580
00:22:57,521 --> 00:23:00,925
WE ADDED A VERTICAL LINE TO DRAW

581
00:23:00,925 --> 00:23:03,961
YOUR ATTENTION TO HOW THESE

582
00:23:03,961 --> 00:23:04,962
BEGAN TO DIFFERENTIATE.

583
00:23:04,962 --> 00:23:06,730
PART OF THE BEAUTIES OF THIS

584
00:23:06,730 --> 00:23:08,332
PARTICULAR STUDY ARE THE FACT

585
00:23:08,332 --> 00:23:11,101
THAT MANY STUDIES OF THE EFFECT

586
00:23:11,101 --> 00:23:14,705
OF AGE AND AUD ARE

587
00:23:14,705 --> 00:23:15,673
CROSS-SECTIONAL, SO THEY

588
00:23:15,673 --> 00:23:17,875
COMPARED, YOU KNOW, DIFFERENT

589
00:23:17,875 --> 00:23:19,076
PEOPLE AT DIFFERENT AGES RATHER

590
00:23:19,076 --> 00:23:20,411
THAN LONGITUDINALLY AND IN THIS

591
00:23:20,411 --> 00:23:22,646
DATABASE THEY HAVE BEEN ABLE TO

592
00:23:22,646 --> 00:23:24,348
DO BOTH.

593
00:23:24,348 --> 00:23:26,083
SO THAT YOU ALSO SEE

594
00:23:26,083 --> 00:23:27,618
LONGITUDINAL ASSESSMENTS WITH

595
00:23:27,618 --> 00:23:29,153
THESE CONNECTED LINES AND CAN

596
00:23:29,153 --> 00:23:31,188
FOLLOW THOSE PATTERNS AS WELL AS

597
00:23:31,188 --> 00:23:33,791
CROSS-SECTIONAL CHANGES AS A

598
00:23:33,791 --> 00:23:35,960
FUNCTION OF AGE.

599
00:23:35,960 --> 00:23:38,829
BUT AS WE ALSO SAW, ALTHOUGH THE

600
00:23:38,829 --> 00:23:42,433
RATES OF PROBLEM AND HAZARDOUS

601
00:23:42,433 --> 00:23:44,034
DRINKING ARE INCREASING AT

602
00:23:44,034 --> 00:23:44,868
ALARMING RATE AMONG OLDER

603
00:23:44,868 --> 00:23:48,672
ADULTS, THE MAJORITY OF OLDER

604
00:23:48,672 --> 00:23:52,810
ADULTS DO NOT DEVELOP CHANGE

605
00:23:52,810 --> 00:23:53,611
SIGNIFICANTLY THEIR DRINKING

606
00:23:53,611 --> 00:23:53,877
PATTERNS.

607
00:23:53,877 --> 00:23:56,113
THEY ARE SORT OF MAINTAINED MORE

608
00:23:56,113 --> 00:23:57,781
OR LESS, ALTHOUGH I'LL SHOW SOME

609
00:23:57,781 --> 00:24:02,319
ON THAT AS WELL, OVER THIS OVER

610
00:24:02,319 --> 00:24:02,653
THE LIFESPAN.

611
00:24:02,653 --> 00:24:03,854
WHAT DOES THAT MEAN?

612
00:24:03,854 --> 00:24:05,956
WE HEAR A LOT OF ATTENTION ABOUT

613
00:24:05,956 --> 00:24:08,192
IS ALCOHOL GOOD OR BAD OR WHAT

614
00:24:08,192 --> 00:24:11,528
ARE THE CUTOFFS, WHAT'S GOOD AND

615
00:24:11,528 --> 00:24:15,165
BAD, AND WE BEGAN TO ANSWER THAT

616
00:24:15,165 --> 00:24:17,901
QUESTION OR TRY TO BY

617
00:24:17,901 --> 00:24:19,370
CONSIDERING ONE VERY GENERAL

618
00:24:19,370 --> 00:24:21,538
FINDING, AND THAT IS MODERATE

619
00:24:21,538 --> 00:24:24,375
DRINKING OR SOCIAL DRINKING

620
00:24:24,375 --> 00:24:27,011
LIFESTYLES ARE PUNCTUATED BY

621
00:24:27,011 --> 00:24:28,078
ACUTE DRINKING BOUTS.

622
00:24:28,078 --> 00:24:29,346
THAT DREW OUR ATTENTION TO THE

623
00:24:29,346 --> 00:24:31,682
FACT THAT IF YOU LOOK AT THE

624
00:24:31,682 --> 00:24:34,885
KINDS OF CHANGES THAT WE SEE

625
00:24:34,885 --> 00:24:36,654
WITH COGNITIVE DEFICITS, OR

626
00:24:36,654 --> 00:24:39,056
COGNITIVE AGING, AND THOSE

627
00:24:39,056 --> 00:24:40,791
ASSOCIATED WITH ACUTE ALCOHOL

628
00:24:40,791 --> 00:24:45,295
EFFECTS, YOU SEE A GREAT DEAL OF

629
00:24:45,295 --> 00:24:46,363
OVERLAP.

630
00:24:46,363 --> 00:24:48,132
AND WE ASK, MIGHT SOCIALLY

631
00:24:48,132 --> 00:24:50,634
RELEVANT ALCOHOL DOSES, THAT IS

632
00:24:50,634 --> 00:24:52,403
THOSE THAT ARE RELEVANT TO THE

633
00:24:52,403 --> 00:24:54,805
DAILY LIVES OF OLDER ADULTS,

634
00:24:54,805 --> 00:24:59,176
THAT IS THOSE CONSISTENT WITH

635
00:24:59,176 --> 00:25:00,811
SOCIAL DRINKING LIFESTYLES,

636
00:25:00,811 --> 00:25:02,346
ACUTELY COMPROMISED VULNERABLE

637
00:25:02,346 --> 00:25:05,783
PROCESSES IN OLDER DRINKERS. 

638
00:25:05,783 --> 00:25:11,088
THAT IS COULD THERE BE AN

639
00:25:11,088 --> 00:25:12,523
AGE-RELATED VULNERABILITY SUCH

640
00:25:12,523 --> 00:25:13,724
THAT THESE WERE DIFFERENTIALLY

641
00:25:13,724 --> 00:25:16,026
COMPROMISED GIVEN IMPORTANCE OF

642
00:25:16,026 --> 00:25:19,296
THESE KINDS OF PROCESSES, IN

643
00:25:19,296 --> 00:25:22,700
EVERYDAY LIFE THAT SEEM TO BE OF

644
00:25:22,700 --> 00:25:28,539
PARTICULAR RELEVANCE IN OVERALL

645
00:25:28,539 --> 00:25:29,339
WELL-BEING WITH AGE.

646
00:25:29,339 --> 00:25:31,375
WE HAD THE OPPORTUNITY TO

647
00:25:31,375 --> 00:25:33,143
CONDUCT A SERIES OF STUDIES

648
00:25:33,143 --> 00:25:35,212
WHICH WE LOOKED AT

649
00:25:35,212 --> 00:25:37,347
NEUROCOGNITIVE PROCESSES RANGING

650
00:25:37,347 --> 00:25:39,383
FROM FOUNDATIONAL AND VISUAL

651
00:25:39,383 --> 00:25:40,184
ATTENTION THROUGH WORKING

652
00:25:40,184 --> 00:25:43,687
MEMORY, AND THEN UP TO THOSE

653
00:25:43,687 --> 00:25:49,593
KINDS OF TASKS LIKE DRIVING.

654
00:25:49,593 --> 00:25:51,895
ONE OF THE FIRST I WANT TO TALK

655
00:25:51,895 --> 00:25:54,965
ABOUT WHAT THE ALCOHOL DOSES

656
00:25:54,965 --> 00:25:58,135
WERE, WE DID NOT DOSE

657
00:25:58,135 --> 00:26:00,237
INDIVIDUALS GIVEN THE -- WITH

658
00:26:00,237 --> 00:26:01,205
THE IDEA OF GIVING THE SAME

659
00:26:01,205 --> 00:26:03,440
NUMBER OF DRINKS PER PERSON.

660
00:26:03,440 --> 00:26:10,280
RATHER WHAT WE DID WAS TARGET A

661
00:26:10,280 --> 00:26:11,281
PEAK BRAC CONSISTENT WITH A

662
00:26:11,281 --> 00:26:13,050
NIGHT OUT ON THE TOWN WHERE HAD

663
00:26:13,050 --> 00:26:14,818
YOU A DRINK BEFORE DINNER AND

664
00:26:14,818 --> 00:26:17,221
THEN YOU HAD A DRINK AFTER

665
00:26:17,221 --> 00:26:20,224
DINNER AND THEN YOU DROVE HOME

666
00:26:20,224 --> 00:26:20,591
CONTEXT.

667
00:26:20,591 --> 00:26:23,427
SO WE IN THE FIRST STUDY USED

668
00:26:23,427 --> 00:26:30,033
PLACEBO DOSE AND THEN ONE THAT

669
00:26:30,033 --> 00:26:33,437
WOULD BRING VRACs TO .04.

670
00:26:33,437 --> 00:26:39,443
AT PEAK LEVELS, WE ALSO LOOKED

671
00:26:39,443 --> 00:26:42,946
AT PERFORMANCE ON THE POSENER

672
00:26:42,946 --> 00:26:44,281
COVERT VISUAL ATTENTION TASK.

673
00:26:44,281 --> 00:26:47,251
DATA ON LEFT ARE P3 AMPLITUDES

674
00:26:47,251 --> 00:26:49,153
CONTRASTED FOR THE OLDER AND

675
00:26:49,153 --> 00:26:52,156
YOUNGER GROUPS AND THOSE WHO HAD

676
00:26:52,156 --> 00:26:53,590
PLACEBO VERSUS THOSE WHO

677
00:26:53,590 --> 00:26:54,725
RECEIVED THIS REALLY

678
00:26:54,725 --> 00:26:56,660
RELATIVELY -- WELL, VERY LOW

679
00:26:56,660 --> 00:26:57,761
DOSE OF ALCOHOL.

680
00:26:57,761 --> 00:27:01,064
YOU CAN SEE IT ISN'T REALLY THE

681
00:27:01,064 --> 00:27:01,999
ALCOHOL -- THE AGE MAIN EFFECT

682
00:27:01,999 --> 00:27:03,167
THAT WE'RE INTERESTED IN.

683
00:27:03,167 --> 00:27:08,605
WE'RE INTERESTED IN THE

684
00:27:08,605 --> 00:27:09,139
INTERACTION.

685
00:27:09,139 --> 00:27:11,341
WE FOUND THAT THOSE INDIVIDUALS

686
00:27:11,341 --> 00:27:13,744
WHO WERE YOUNGER, THAT IS 25 TO

687
00:27:13,744 --> 00:27:18,582
35 IN THIS PARTICULAR STUDY,

688
00:27:18,582 --> 00:27:22,419
EXHIBITED A HIGHER AMPLITUDE FOR

689
00:27:22,419 --> 00:27:24,154
THE P3 UNDER THE ALCOHOL

690
00:27:24,154 --> 00:27:27,424
CONDITIONS THAN UNDER THE

691
00:27:27,424 --> 00:27:27,658
PLACEBO.

692
00:27:27,658 --> 00:27:29,326
ON THE OTHER HAND, WHEN WE

693
00:27:29,326 --> 00:27:31,061
LOOKED AT THE OLDER INDIVIDUALS

694
00:27:31,061 --> 00:27:33,030
AND IN THIS PARTICULAR STUDY

695
00:27:33,030 --> 00:27:35,966
THESE OLDER INDIVIDUALS WERE

696
00:27:35,966 --> 00:27:37,968
ACTUALLY RELATIVELY YOUNG, 55 TO

697
00:27:37,968 --> 00:27:38,535
70.

698
00:27:38,535 --> 00:27:40,938
WE FIND NOT ONLY THE OVER ALL

699
00:27:40,938 --> 00:27:43,307
REDUCTION THAT WE EXPECTED BUT

700
00:27:43,307 --> 00:27:46,310
ALSO AN INVERSION, OR A

701
00:27:46,310 --> 00:27:50,714
DIVERGENT RESPONSE, TO THE

702
00:27:50,714 --> 00:27:51,949
NEURODYNAMICS UNDERLYING

703
00:27:51,949 --> 00:27:55,285
RESPONSE TO THE PRESENTATION OF

704
00:27:55,285 --> 00:27:56,987
THE ACTUAL PERFORMANCE, DURING

705
00:27:56,987 --> 00:28:01,058
THE PRESENTATION OF THE RESPONSE

706
00:28:01,058 --> 00:28:02,492
LOOKING AT ELECTROPHYSIOLOGY.

707
00:28:02,492 --> 00:28:04,895
THIS WAS, WE FELT, A GOOD START,

708
00:28:04,895 --> 00:28:06,964
PARTICULARLY SINCE IT WAS AT

709
00:28:06,964 --> 00:28:11,568
SUCH A VERY LOW ALCOHOL DOSE.

710
00:28:11,568 --> 00:28:14,538
FROM THERE, WE MOVED TO LOOKING

711
00:28:14,538 --> 00:28:19,710
AT WORKING MEMORY, USING A

712
00:28:19,710 --> 00:28:21,345
REMEMBER-IGNORE TASK,

713
00:28:21,345 --> 00:28:23,213
INDIVIDUALS ARE SHOWN THESE GRAY

714
00:28:23,213 --> 00:28:26,149
FACES AND/OR SCENES, AND IN SOME

715
00:28:26,149 --> 00:28:27,918
CONDITIONS THEY ARE TOLD PLEASE

716
00:28:27,918 --> 00:28:29,119
REMEMBER THE FACES AND IN OTHERS

717
00:28:29,119 --> 00:28:31,521
THEY ARE TOLD TO IGNORE THE

718
00:28:31,521 --> 00:28:32,356
FACE.

719
00:28:32,356 --> 00:28:36,460
THEY GET A SERIES OF IMAGES,

720
00:28:36,460 --> 00:28:39,162
THERE'S A DELAY, THERE'S A

721
00:28:39,162 --> 00:28:39,897
RESPONSE.

722
00:28:39,897 --> 00:28:44,167
WE WERE ABLE THEREBY TO LOOK AT

723
00:28:44,167 --> 00:28:47,371
ACCURACY OF RESPONSE BUT ALSO

724
00:28:47,371 --> 00:28:49,306
NEURAL OSCILLATIONS DURING THIS

725
00:28:49,306 --> 00:28:51,909
VERY IMPORTANT DELAY PHASE, WHEN

726
00:28:51,909 --> 00:28:57,381
AN INDIVIDUAL HAS TO ENGAGE

727
00:28:57,381 --> 00:28:58,916
WORKING MEMORY MAINTENANCE

728
00:28:58,916 --> 00:28:59,283
PROCESSES.

729
00:28:59,283 --> 00:29:00,784
AND HERE'S WHAT WE FOUND.

730
00:29:00,784 --> 00:29:04,588
WE FOUND THAT AT THE PLACEBO,

731
00:29:04,588 --> 00:29:07,157
THE POSTERIOR ALPHA POWER, THAT

732
00:29:07,157 --> 00:29:10,661
IS SORT OF SUPPOSED TO REFLECT A

733
00:29:10,661 --> 00:29:13,363
GATING MECHANISM, A WAY IN WHICH

734
00:29:13,363 --> 00:29:14,698
INFORMATION -- IT'S AN

735
00:29:14,698 --> 00:29:17,868
INDICATION THAT INFORMATION IS

736
00:29:17,868 --> 00:29:18,769
BEING PROTECTED FROM

737
00:29:18,769 --> 00:29:22,306
DISTRACTION, AND IT IS GENERALLY

738
00:29:22,306 --> 00:29:26,109
OBSERVED BY COLLECTION OF SCALP

739
00:29:26,109 --> 00:29:28,145
ACTIVITY, OF THE ALPHA

740
00:29:28,145 --> 00:29:29,379
WAVELENGTH, AND WE FOUND

741
00:29:29,379 --> 00:29:31,448
PLACEBO, THERE WAS NO

742
00:29:31,448 --> 00:29:32,416
DIFFERENCE.

743
00:29:32,416 --> 00:29:33,517
HOWEVER, ONCE YOU ADMINISTERED

744
00:29:33,517 --> 00:29:35,953
ALCOHOL AND HERE WE USE TWO

745
00:29:35,953 --> 00:29:37,454
DOSES, AGAIN THE LOW DOSE THAT

746
00:29:37,454 --> 00:29:39,456
WE HAD USED IN OUR VERY INITIAL

747
00:29:39,456 --> 00:29:42,159
WORK AND THEN WE USED A SLIGHTLY

748
00:29:42,159 --> 00:29:45,662
HIGHER DOSE TO PERHAPS BETTER

749
00:29:45,662 --> 00:29:47,297
REPRESENT THE TYPICAL DRINKING

750
00:29:47,297 --> 00:29:48,165
CONTEXT.

751
00:29:48,165 --> 00:29:51,668
AND, AGAIN, WHAT WE FOUND WAS

752
00:29:51,668 --> 00:29:54,938
DIVERGING RESPONSES.

753
00:29:54,938 --> 00:29:56,907
THE YOUNGER ADULTS SHOWED

754
00:29:56,907 --> 00:29:58,375
GREATER ALPHA POWER UNDER

755
00:29:58,375 --> 00:29:59,710
ALCOHOL CONDITIONS, WHICH WE

756
00:29:59,710 --> 00:30:05,482
WOULD EXPECT THAT..

757
00:30:05,482 --> 00:30:06,883
THEY ARE ENGAGING PROCESSES TO

758
00:30:06,883 --> 00:30:07,684
PROTECT INFORMATION, WITH

759
00:30:07,684 --> 00:30:09,319
ADMINISTRATION OF ALCOHOL THAT'S

760
00:30:09,319 --> 00:30:09,886
INCREASED.

761
00:30:09,886 --> 00:30:12,289
IN CONTRAST, THE OLDER ADULTS

762
00:30:12,289 --> 00:30:18,729
SHOWED A DECREASE, WHICH

763
00:30:18,729 --> 00:30:23,133
INCREASED VO 65 BUT NOT

764
00:30:23,133 --> 00:30:23,734
EQUIVALENT TO YOUNGER ADULTS,

765
00:30:23,734 --> 00:30:26,403
DID NOT DIFFER AT PLACEBO.

766
00:30:26,403 --> 00:30:28,605
NOW WE HAVE DIVERGENT RESPONSES

767
00:30:28,605 --> 00:30:30,674
IN TWO MEASURES, UNDERLYING

768
00:30:30,674 --> 00:30:32,309
NEURAL ACTIVITY, BOTH P3 WHICH

769
00:30:32,309 --> 00:30:36,446
IS SUPPOSED TO REFLECT A CONTEXT

770
00:30:36,446 --> 00:30:38,849
RELEVANCE AND MEMORY UPDATING

771
00:30:38,849 --> 00:30:42,586
KIND OF PROCESS, AND THE PAP,

772
00:30:42,586 --> 00:30:44,888
SUPPOSEDLY REFLECTING A KIND OF

773
00:30:44,888 --> 00:30:46,790
ATTENTIONAL INHIBITION AND

774
00:30:46,790 --> 00:30:48,959
PROTECTION OF INFORMATION.

775
00:30:48,959 --> 00:30:52,462
WHEN WE LOOKED AT THE BEHAVIOR,

776
00:30:52,462 --> 00:30:57,167
WE ALSO FOUND SOME INTERESTING

777
00:30:57,167 --> 00:30:58,602
DATA. 

778
00:30:58,602 --> 00:30:59,403
WE WERE PARTICULARLY INTERESTED

779
00:30:59,403 --> 00:31:02,773
IN THE EFFECTS OF ALCOHOL ON THE

780
00:31:02,773 --> 00:31:06,376
CAPACITY TO IGNORE 

781
00:31:06,376 --> 00:31:08,712
IRRELEVANTANCY, AFTER LOOKING AT

782
00:31:08,712 --> 00:31:10,547
THE DATA FOR PERFORMANCE IN

783
00:31:10,547 --> 00:31:12,416
INDIVIDUALS WITH AUD, FINDING

784
00:31:12,416 --> 00:31:15,152
THAT VERY OFTEN THE DEFICIT

785
00:31:15,152 --> 00:31:18,121
RESIDED IN INABILITY TO IGNORE

786
00:31:18,121 --> 00:31:20,090
RELEVANCY, RATHER THAN JUST

787
00:31:20,090 --> 00:31:22,426
ABILITY TO ATTEND TO THAT WHICH

788
00:31:22,426 --> 00:31:25,162
WAS RELEVANT.

789
00:31:25,162 --> 00:31:26,897
SO, IN THIS PARTICULAR SLIDE,

790
00:31:26,897 --> 00:31:30,734
WHAT I'M SHOWING YOU IS THE

791
00:31:30,734 --> 00:31:32,135
CORRECT REJECTION EFFICIENCY FOR

792
00:31:32,135 --> 00:31:33,136
FACES.

793
00:31:33,136 --> 00:31:35,972
THAT IS DID THEY APPROPRIATELY

794
00:31:35,972 --> 00:31:37,607
IDENTIFY FACES AS BEING NOVEL,

795
00:31:37,607 --> 00:31:41,745
THAT IS NOT HAVING BEEN SHOWN

796
00:31:41,745 --> 00:31:42,746
BEFORE, DURING THAT

797
00:31:42,746 --> 00:31:47,117
DECISION-MAKING PROCESS, AND WE

798
00:31:47,117 --> 00:31:51,088
USE EFFICIENCY WHERE WE HAVE

799
00:31:51,088 --> 00:31:52,189
PERCENT ACCURATE OVER MEAN

800
00:31:52,189 --> 00:31:53,490
REACTION TIME.

801
00:31:53,490 --> 00:31:56,460
UNDER PLACEBO WHEN USING THIS

802
00:31:56,460 --> 00:31:58,428
EFFICIENCY RATIO WE INDEED SEE

803
00:31:58,428 --> 00:32:01,498
SOME INDICATION OF AN AGE

804
00:32:01,498 --> 00:32:03,133
DIFFERENCE, AND WE SEE THAT

805
00:32:03,133 --> 00:32:06,002
OLDER MEN AT THE PLACEBO ARE

806
00:32:06,002 --> 00:32:07,938
PERFORMING MORE POORLY, ALTHOUGH

807
00:32:07,938 --> 00:32:11,208
THESE ARE NOT SIGNIFICANT

808
00:32:11,208 --> 00:32:11,875
DIFFERENCES.

809
00:32:11,875 --> 00:32:14,511
AS WE ADMINISTER ALCOHOL, AGAIN,

810
00:32:14,511 --> 00:32:15,145
THE PATTERN CHANGES.

811
00:32:15,145 --> 00:32:18,582
I WANT YOU TO PAY PARTICULAR

812
00:32:18,582 --> 00:32:19,983
ATTENTION TO THIS TRIANGLE,

813
00:32:19,983 --> 00:32:23,019
THESE ARE THE OLDER WOMEN, AND

814
00:32:23,019 --> 00:32:27,491
IN THIS PARTICULAR STUDY THE AGE

815
00:32:27,491 --> 00:32:30,260
RANGE WAS AGAIN TO AGE 70, BUT

816
00:32:30,260 --> 00:32:33,530
BEGAN AT ABOUT -- ACTUALLY 60 TO

817
00:32:33,530 --> 00:32:37,367
75, I'M SORRY, AND WE SEE THAT

818
00:32:37,367 --> 00:32:41,638
THE OLDER WOMEN SHOW A GREATER

819
00:32:41,638 --> 00:32:42,806
PROBLEM WITH THEIR ABILITY TO

820
00:32:42,806 --> 00:32:44,741
SEPARATE THAT WHICH THEY HAVE

821
00:32:44,741 --> 00:32:46,109
SEEN BEFORE VERSUS THAT WHICH

822
00:32:46,109 --> 00:32:49,079
THEY HAVE NOT, THEY ARE

823
00:32:49,079 --> 00:32:51,081
CONFUSING THOSE MORE THAN THE

824
00:32:51,081 --> 00:32:53,250
YOUNGER WOMEN WHO DO

825
00:32:53,250 --> 00:32:54,985
PARTICULARLY BETTER.

826
00:32:54,985 --> 00:32:59,589
SO NOW WE HAVE AN AGE BY SEX

827
00:32:59,589 --> 00:33:00,790
INTERACTION, AND ALCOHOL.

828
00:33:00,790 --> 00:33:05,162
SO THE HIGHER THE DOSE, THE MORE

829
00:33:05,162 --> 00:33:06,563
POORLY THE OLDER WOMEN

830
00:33:06,563 --> 00:33:09,533
PERFORMED, AND THE BETTER THE

831
00:33:09,533 --> 00:33:12,636
YOUNGER WOMEN PERFORMED.

832
00:33:12,636 --> 00:33:13,970
AGAIN, DIVERGING RESPONSES AS A

833
00:33:13,970 --> 00:33:17,274
RESULT OF AGE AND ALCOHOL.

834
00:33:17,274 --> 00:33:19,476
THIS MAKES US THINK ABOUT -- -

835
00:33:19,476 --> 00:33:22,212
THIS IS NOT GOING TO BE A SIMPLE

836
00:33:22,212 --> 00:33:23,079
QUESTION TO ANSWER.

837
00:33:23,079 --> 00:33:25,148
IT ISN'T JUST THAT YOU GET

838
00:33:25,148 --> 00:33:25,916
WORSE.

839
00:33:25,916 --> 00:33:28,418
IT ISN'T JUST THAT THE NEURAL

840
00:33:28,418 --> 00:33:30,720
DYNAMICS CHANGE, BUT THEY CHANGE

841
00:33:30,720 --> 00:33:32,689
IN DIVERGING TIMES OF

842
00:33:32,689 --> 00:33:35,659
CONDITIONS, SO THAT SOMETIMES WE

843
00:33:35,659 --> 00:33:36,960
HAVE PERFORMANCE THAT IS

844
00:33:36,960 --> 00:33:38,662
AFFECTED, OTHER TIMES WE MAY

845
00:33:38,662 --> 00:33:41,531
HAVE NEURAL DYNAMICS THAT ARE

846
00:33:41,531 --> 00:33:43,900
AFFECTED WITHOUT CHANGES, IN THE

847
00:33:43,900 --> 00:33:44,935
BEHAVIOR.

848
00:33:44,935 --> 00:33:46,937
SORT OF THE COMPLICATED PROCESS

849
00:33:46,937 --> 00:33:51,074
BY WHICH AGE AND ACUTE ALCOHOL

850
00:33:51,074 --> 00:33:51,341
INTERACT.

851
00:33:51,341 --> 00:33:55,679
WE THEN HAD THE OPPORTUNITY TO

852
00:33:55,679 --> 00:33:57,480
LOOK AT DRIVING SCENARIOS.

853
00:33:57,480 --> 00:34:01,585
AND IN THIS WE HAVE SEVERAL

854
00:34:01,585 --> 00:34:02,586
DRIVING CONDITIONS.

855
00:34:02,586 --> 00:34:06,223
THE FIRST ONE, THIS IS ACTUALLY

856
00:34:06,223 --> 00:34:09,459
A PICTURE OF THE METROPOLIS,

857
00:34:09,459 --> 00:34:11,561
STICKY DRIVE, ONE IN WHICH THEY

858
00:34:11,561 --> 00:34:13,964
SIMPLY HAD TO STAY ON THE ROAD

859
00:34:13,964 --> 00:34:14,297
BASICALLY.

860
00:34:14,297 --> 00:34:15,799
THAT IS, IT'S A PRECISION DRIVE,

861
00:34:15,799 --> 00:34:18,001
THEY ARE SUPPOSED TO ADHERE TO

862
00:34:18,001 --> 00:34:21,504
THE SPEED LIMIT, STAY ON THE

863
00:34:21,504 --> 00:34:25,108
ROAD, AND THERE ARE NO STIMULI

864
00:34:25,108 --> 00:34:27,444
THAT SHOULD BE DISTRACTING.

865
00:34:27,444 --> 00:34:30,247
HOWEVER, WHAT WE FOUND EVEN

866
00:34:30,247 --> 00:34:33,149
UNDER THOSE CONDITIONS WERE AN

867
00:34:33,149 --> 00:34:35,752
INTERACTION OF AGE AND ALCOHOL.

868
00:34:35,752 --> 00:34:38,021
AND IF YOU LOOK ONLY AT THE GRAY

869
00:34:38,021 --> 00:34:39,389
ONES, WE CAN DISCUSS THE OTHERS

870
00:34:39,389 --> 00:34:43,260
LATER, BUT IF YOU LOOK AT THE

871
00:34:43,260 --> 00:34:45,161
GRAY BARS HERE YOU'LL SEE THIS

872
00:34:45,161 --> 00:34:47,764
IS THAT MODERATE DOSE,

873
00:34:47,764 --> 00:34:50,433
INDIVIDUALS WHO RECEIVED THE

874
00:34:50,433 --> 00:34:54,571
.065 OR TARGETED PEAK, .06  5,

875
00:34:54,571 --> 00:34:55,672
AND OLDER ADULTS THE STEERING

876
00:34:55,672 --> 00:34:58,174
RATE HAS TO DO WITH HOW MUCH

877
00:34:58,174 --> 00:35:00,477
THEY MOVE THE STEERING WHEEL.

878
00:35:00,477 --> 00:35:02,112
THEY MOVED THE STEERING WHEEL.

879
00:35:02,112 --> 00:35:05,081
WE MIGHT CALL IT JERKY, IF YOU

880
00:35:05,081 --> 00:35:06,916
EVER RIDE WITH ANYBODY THAT

881
00:35:06,916 --> 00:35:08,485
DRIVES LIKE THAT YOU CERTAINLY

882
00:35:08,485 --> 00:35:09,586
CALL IT JERKY.

883
00:35:09,586 --> 00:35:11,988
AND THEN WE LOOKED AT THE

884
00:35:11,988 --> 00:35:12,656
STANDARD DEVIATION FOR SPEED,

885
00:35:12,656 --> 00:35:15,058
AND THAT MEANING THE KIND OF

886
00:35:15,058 --> 00:35:16,293
VARIABILITY, HOW MUCH DO THEY

887
00:35:16,293 --> 00:35:20,297
SPEED UP AND SLOW DOWN, WITH

888
00:35:20,297 --> 00:35:21,731
THIS SUSTAIN CONSTANT SPEED, AND

889
00:35:21,731 --> 00:35:24,467
HERE AGAIN IF YOU LOOK AT THE

890
00:35:24,467 --> 00:35:27,203
065 GROUP YOU'LL SEE THEY DIFFER

891
00:35:27,203 --> 00:35:29,172
SIGNIFICANTLY FROM THE YOUNGER

892
00:35:29,172 --> 00:35:32,108
GROUP, BY THE WAY IN NONE OF

893
00:35:32,108 --> 00:35:35,512
THESE WERE DIFFERENCES AMONG THE

894
00:35:35,512 --> 00:35:36,980
YOUNGER PARTICIPANTS AFFECTED BY

895
00:35:36,980 --> 00:35:38,148
THE ALCOHOL DOSE.

896
00:35:38,148 --> 00:35:41,651
AND WITH THE OLDER OF COURSE

897
00:35:41,651 --> 00:35:43,420
THEY WERE WITH THE 065 SHOWING

898
00:35:43,420 --> 00:35:45,522
DRAMATIC CHANGE.

899
00:35:45,522 --> 00:35:48,124
SO THAT'S THE PRECISION.

900
00:35:48,124 --> 00:35:51,494
AND THAT TO ME IS KIND OF SCARY

901
00:35:51,494 --> 00:35:52,495
FOR SURE.

902
00:35:52,495 --> 00:35:56,766
BUT WE ALSO LOOKED AT RESPONSE

903
00:35:56,766 --> 00:35:58,401
TO RELEVANT VERSUS IRRELEVANT

904
00:35:58,401 --> 00:36:01,838
DISTRACTERS, IN THESE VARIOUS

905
00:36:01,838 --> 00:36:02,172
SCENARIOS.

906
00:36:02,172 --> 00:36:04,874
WE LOOKED AT THE SORT OF COUNTRY

907
00:36:04,874 --> 00:36:07,911
DRIVE, SMALL TOWN, AND THEN THE

908
00:36:07,911 --> 00:36:08,411
METROPOLIS.

909
00:36:08,411 --> 00:36:10,914
AND THE METROPOLIS DATA WERE

910
00:36:10,914 --> 00:36:12,015
PARTICULARLY INTERESTING.

911
00:36:12,015 --> 00:36:15,552
THIS IS THE DEGREE TO WHICH THEY

912
00:36:15,552 --> 00:36:20,523
DECELERATED, WHEN THEY WERE

913
00:36:20,523 --> 00:36:23,126
CONFRONTED WITH WHAT WAS

914
00:36:23,126 --> 00:36:23,760
IRRELEVANT HAVEN'T DISTRACTER.

915
00:36:23,760 --> 00:36:26,396
FOR INSTANCE A PERSON WALKING

916
00:36:26,396 --> 00:36:28,932
DOWN THE SIDEWALK AND WALKING

917
00:36:28,932 --> 00:36:30,033
THEIR DOG.

918
00:36:30,033 --> 00:36:32,102
OR SOMEBODY WITH A CHILD WALKING

919
00:36:32,102 --> 00:36:33,303
DOWN THE STREET.

920
00:36:33,303 --> 00:36:35,372
BUT NOT CROSSING IN FRONT OF

921
00:36:35,372 --> 00:36:35,939
THEM.

922
00:36:35,939 --> 00:36:36,840
A CONDITION WHICH THEY WOULD

923
00:36:36,840 --> 00:36:39,209
NEED TO MAKE NO CHANGE IN THEIR

924
00:36:39,209 --> 00:36:40,410
CURRENT DRIVING.

925
00:36:40,410 --> 00:36:44,881
AND YET WHAT WE FOUND WAS YES

926
00:36:44,881 --> 00:36:46,416
 YES,

927
00:36:46,416 --> 00:36:47,417
INDEED THERE WAS AN AGE

928
00:36:47,417 --> 00:36:51,154
DIFFERENCE, BUT IT WAS GREATLY

929
00:36:51,154 --> 00:36:52,088
INCREASED UNDER ALCOHOL

930
00:36:52,088 --> 00:36:52,389
CONDITIONS.

931
00:36:52,389 --> 00:36:53,523
IN OTHER WORDS, THEY WERE

932
00:36:53,523 --> 00:36:55,191
SLOWING DOWN IN THE MIDDLE OF

933
00:36:55,191 --> 00:36:56,926
THE STREET, EVEN WHEN THERE WAS

934
00:36:56,926 --> 00:36:59,429
NOTHING GOING ON AROUND THEM,

935
00:36:59,429 --> 00:37:02,732
THAT WOULD REQUIRE THAT KIND OF

936
00:37:02,732 --> 00:37:02,999
RESPONSE.

937
00:37:02,999 --> 00:37:05,201
THIS HAS REAL WORLD FUNCTIONAL

938
00:37:05,201 --> 00:37:08,738
IMPACT WHEN YOU ARE THINKING

939
00:37:08,738 --> 00:37:10,707
ABOUT DRIVING HOME AFTER HAVING

940
00:37:10,707 --> 00:37:13,343
DINNER AND A DRINK.

941
00:37:13,343 --> 00:37:15,979
NOW, WHAT ABOUT NEURAL ACTIVITY?

942
00:37:15,979 --> 00:37:17,714
LET'S RETURN TO THAT POSTERIOR

943
00:37:17,714 --> 00:37:20,316
ALPHA POWER THAT I TALKED ABOUT

944
00:37:20,316 --> 00:37:22,652
A WHILE AGO IN THE CONTEXT OF

945
00:37:22,652 --> 00:37:23,620
WORKING MEMORY MAINTENANCE

946
00:37:23,620 --> 00:37:24,187
PROCESSES.

947
00:37:24,187 --> 00:37:28,224
HERE WE'RE LOOKING AT IT AS THEY

948
00:37:28,224 --> 00:37:30,293
ARE DRIVING.

949
00:37:30,293 --> 00:37:35,365
AND WHAT WE CAN SAY IS, YES,

950
00:37:35,365 --> 00:37:35,765
AGAIN.

951
00:37:35,765 --> 00:37:38,067
YES AGAIN WE GET DIVERGING

952
00:37:38,067 --> 00:37:39,936
RESPONSES, AND DURING THE

953
00:37:39,936 --> 00:37:42,672
DRIVING YOU WOULD EXPECT THAT

954
00:37:42,672 --> 00:37:46,075
INDIVIDUALS ARE NOT TRYING TO

955
00:37:46,075 --> 00:37:47,944
NECESSARILY HARBOR INFORMATION

956
00:37:47,944 --> 00:37:49,012
AND PROTECT IT.

957
00:37:49,012 --> 00:37:51,147
IN FACT, DRIVING IS AN ENGAGING

958
00:37:51,147 --> 00:37:51,648
TASK.

959
00:37:51,648 --> 00:37:53,316
YOU NEED TO BE AWARE OF THINGS

960
00:37:53,316 --> 00:37:56,152
THAT ARE GOING ON AROUND YOU.

961
00:37:56,152 --> 00:37:57,987
AND YOU WOULD EXPECT THAT

962
00:37:57,987 --> 00:38:03,593
PERHAPS THE YOUNGER ONES WITH

963
00:38:03,593 --> 00:38:05,128
ALCOHOL GIVEN PRIOR EXPERIENCE

964
00:38:05,128 --> 00:38:07,096
WOULD BE ABLE TO CONSTRAIN THAT

965
00:38:07,096 --> 00:38:09,265
AND PAY ATTENTION TO WHAT THEY

966
00:38:09,265 --> 00:38:14,103
ARE DOING WHEREAS OLDER DRINKERS

967
00:38:14,103 --> 00:38:15,171
DID NOT.

968
00:38:15,171 --> 00:38:16,706
SO, OPPOSITE EFFECTS WHETHER

969
00:38:16,706 --> 00:38:20,009
YOU'RE TALKING ABOUT THE NEURAL

970
00:38:20,009 --> 00:38:22,412
DYNAMICS OF PAYING ATTENTION TO

971
00:38:22,412 --> 00:38:26,249
THE WORLD OR BEING ABLE TO

972
00:38:26,249 --> 00:38:27,217
INHIBIT AND PROTECT INFORMATION,

973
00:38:27,217 --> 00:38:30,620
WHETHER OR NOT YOU RESPOND

974
00:38:30,620 --> 00:38:31,688
APPROPRIATELY TO IRRELEVANT

975
00:38:31,688 --> 00:38:33,156
STIMULI, WHICH CAN RESULT IN YOU

976
00:38:33,156 --> 00:38:35,792
SLAMMING ON THE BRAKES IN THE

977
00:38:35,792 --> 00:38:39,028
MIDDLE OF THE STREET, OR INDEED

978
00:38:39,028 --> 00:38:40,930
WORKING MEMORY AND INTENTIONAL

979
00:38:40,930 --> 00:38:41,331
PROCESSES.

980
00:38:41,331 --> 00:38:42,999
MOST OFTEN AT THIS POINT PEOPLE

981
00:38:42,999 --> 00:38:45,735
SAY, WELL, YEAH, BUT THAT'S DUE

982
00:38:45,735 --> 00:38:48,271
TO, WELL, AGE DIFFERENCES OR SEX

983
00:38:48,271 --> 00:38:50,573
DIFFERENCES OR DOSE AND THE FACT

984
00:38:50,573 --> 00:38:53,743
THAT THESE ARE ALL THE FUNCTION

985
00:38:53,743 --> 00:38:54,310
OF DIFFERENCES IN

986
00:38:54,310 --> 00:38:56,679
PHARMACOKINETICS, AND THEY ARE

987
00:38:56,679 --> 00:38:57,680
NOT.

988
00:38:57,680 --> 00:39:00,617
WHEN YOU TARGET A PARTICULAR

989
00:39:00,617 --> 00:39:03,419
BRAC RATHER THAN GIVING EVERYONE

990
00:39:03,419 --> 00:39:07,724
THE SAME DOSE, SAME NUMBER OF

991
00:39:07,724 --> 00:39:08,358
DRINKS, YOU CAN DISENTANGLE

992
00:39:08,358 --> 00:39:13,630
THOSE THINGS AND IT'S NOT ABOUT

993
00:39:13,630 --> 00:39:14,030
PHARMACOKINETICS.

994
00:39:14,030 --> 00:39:19,002
IT IS ABOUT A RATHER UNIQUE

995
00:39:19,002 --> 00:39:20,236
AGE-RELATED VULNERABILITY TO

996
00:39:20,236 --> 00:39:23,740
EFFECTS OF ALCOHOL EVEN AT DOSES

997
00:39:23,740 --> 00:39:26,910
VERY CONSISTENT WITH DRINKING

998
00:39:26,910 --> 00:39:30,880
PATTERNS IN OLDER ADULTS.

999
00:39:30,880 --> 00:39:33,716
SO, KNOWING THAT, WE BEGAN TO

1000
00:39:33,716 --> 00:39:36,019
REALLY CONCLUDE THAT THESE ACUTE

1001
00:39:36,019 --> 00:39:38,755
DOSES DO CARRY RISK, AND THEY

1002
00:39:38,755 --> 00:39:40,823
CARRY RISK BECAUSE OF DIRECT

1003
00:39:40,823 --> 00:39:43,226
EFFECT OF ALCOHOL, ALSO BECAUSE

1004
00:39:43,226 --> 00:39:45,862
OF POTENTIAL SECONDARY OR

1005
00:39:45,862 --> 00:39:47,297
INDIRECT EFFECTS OF ALCOHOL.

1006
00:39:47,297 --> 00:39:51,301
BUT THAT'S NOT THE ONLY

1007
00:39:51,301 --> 00:39:51,568
QUESTION.

1008
00:39:51,568 --> 00:39:53,870
IMPORTANTLY, WE'RE ALL CONCERNED

1009
00:39:53,870 --> 00:39:55,572
ABOUT OUR COGNITIVE INTEGRITY

1010
00:39:55,572 --> 00:39:57,674
AND STABILITY ACROSS OUR ADULT

1011
00:39:57,674 --> 00:40:00,176
LIFESPAN, AND I'VE BEEN TALKING

1012
00:40:00,176 --> 00:40:02,912
LARGELY ABOUT ACUTE EFFECT.

1013
00:40:02,912 --> 00:40:04,013
WELL, THE MORE STRAIGHTFORWARD

1014
00:40:04,013 --> 00:40:06,416
QUESTION IS PERHAPS HOW DOES

1015
00:40:06,416 --> 00:40:09,719
CONTINUED DRINKING AMONG OLDER

1016
00:40:09,719 --> 00:40:12,088
ADULTS IMPACT AGE-RELATED

1017
00:40:12,088 --> 00:40:13,089
COGNITIVE DECLINE?

1018
00:40:13,089 --> 00:40:15,058
I STARTED WITH THIS IDEA WHEN WE

1019
00:40:15,058 --> 00:40:17,460
WERE TALKING ABOUT ALCOHOL USE

1020
00:40:17,460 --> 00:40:17,860
DISORDER.

1021
00:40:17,860 --> 00:40:21,731
WHAT HAPPENS WHEN WE LOOK AT THE

1022
00:40:21,731 --> 00:40:24,601
LITERATURE ON THE IMPACT OF

1023
00:40:24,601 --> 00:40:26,035
ALCOHOL ON COGNITIVE DECLINE AND

1024
00:40:26,035 --> 00:40:29,072
IMPAIRMENT, AND THE ANSWER IS IT

1025
00:40:29,072 --> 00:40:29,639
DEPENDS.

1026
00:40:29,639 --> 00:40:31,941
SOME STUDIES SUGGEST THERE'S NO

1027
00:40:31,941 --> 00:40:34,877
HARM IF NOT BENEFIT FOR HAVING

1028
00:40:34,877 --> 00:40:38,081
AS MANY AS THREE DRINKS A DAY,

1029
00:40:38,081 --> 00:40:40,049
AND FOUR FOR MEN REALLY DO NOT,

1030
00:40:40,049 --> 00:40:42,251
WHILE OTHERS SAY THERE'S NO

1031
00:40:42,251 --> 00:40:44,120
LEVEL OF DRINKING THAT LENDS

1032
00:40:44,120 --> 00:40:47,490
BENEFIT, AND THAT EVEN WITH LOW

1033
00:40:47,490 --> 00:40:52,428
LEVELS THERE IS ADDED RISK OF

1034
00:40:52,428 --> 00:40:56,366
COGNITIVE DECLINE OR COGNITIVE

1035
00:40:56,366 --> 00:40:56,766
IMPAIRMENT.

1036
00:40:56,766 --> 00:40:56,933
WHY?

1037
00:40:56,933 --> 00:40:59,502
WELL, IF YOU LOOK AT THE STUDY

1038
00:40:59,502 --> 00:41:03,573
YOU FIND THE EXISTING LITERATURE

1039
00:41:03,573 --> 00:41:04,874
HAS A LOT OF DIFFERENCES,

1040
00:41:04,874 --> 00:41:07,410
STUDIES VARY GREATLY IN TERMS OF

1041
00:41:07,410 --> 00:41:08,111
OPERATIONAL DEFINITIONS AND

1042
00:41:08,111 --> 00:41:09,912
COMPARISON GROUPS.

1043
00:41:09,912 --> 00:41:12,649
FOR INSTANCE, SOMETIMES

1044
00:41:12,649 --> 00:41:14,183
ABSTAINERS ARE INCLUDED AS A

1045
00:41:14,183 --> 00:41:15,818
CONTROL GROUP, AND IN THAT CASE

1046
00:41:15,818 --> 00:41:18,655
WHAT DO YOU HAVE?

1047
00:41:18,655 --> 00:41:21,424
YOU HAVE SICK QUITTERS, OR DO

1048
00:41:21,424 --> 00:41:24,060
YOU HAVE INDIVIDUALS LIFELONG

1049
00:41:24,060 --> 00:41:25,928
ABSTAINERS, IN SOME CASES

1050
00:41:25,928 --> 00:41:29,098
MODERATE VERSUS HEAVY IS A

1051
00:41:29,098 --> 00:41:30,833
LITTLE HARD TO DIFFERENTIATE,

1052
00:41:30,833 --> 00:41:33,903
AND AGAIN VERY OFTEN STUDIES OF

1053
00:41:33,903 --> 00:41:34,537
CROSS-SECTIONAL VERSUS

1054
00:41:34,537 --> 00:41:34,904
LONGITUDINAL.

1055
00:41:34,904 --> 00:41:36,973
THAT'S NOT ALWAYS THE CASE,

1056
00:41:36,973 --> 00:41:39,142
THERE ARE SOME VERY NICE

1057
00:41:39,142 --> 00:41:40,576
LONGITUDINAL ASSESSMENTS BUT

1058
00:41:40,576 --> 00:41:44,280
VERY OFTEN THEN THE ASSESSMENT

1059
00:41:44,280 --> 00:41:45,782
OF DRINKING IS NOT NECESSARILY

1060
00:41:45,782 --> 00:41:48,551
TAKEN IN CLOSE PROXIMITY WITH

1061
00:41:48,551 --> 00:41:50,186
THE ONGOING ASSESSMENTS AND

1062
00:41:50,186 --> 00:41:52,622
PATTERNS HAVE CHANGED.

1063
00:41:52,622 --> 00:41:55,792
SO, WE HAD THE OPPORTUNITY AGAIN

1064
00:41:55,792 --> 00:41:58,861
WITH SUPPORT FROM NIAAA TO TRY

1065
00:41:58,861 --> 00:41:59,595
TO --

1066
00:41:59,595 --> 00:42:00,997
>> SARA, YOU'RE RUNNING A
LITTLE

1067
00:42:00,997 --> 00:42:01,731
LATE HERE.

1068
00:42:01,731 --> 00:42:01,998
>> OKAY.

1069
00:42:01,998 --> 00:42:04,500
LET ME GET TO THE VERY END THEN.

1070
00:42:04,500 --> 00:42:10,173
SO THE MOST IMPORTANT PART IS

1071
00:42:10,173 --> 00:42:11,474
THIS.

1072
00:42:11,474 --> 00:42:12,909
QFI AND WORKING MEMORY, QUANTITY

1073
00:42:12,909 --> 00:42:15,211
FREQUENCY INDEX AND WORKING

1074
00:42:15,211 --> 00:42:17,246
MEMORY, IN BASELINE, IN

1075
00:42:17,246 --> 00:42:20,817
INDIVIDUALS 65 TO 80 THERE'S A

1076
00:42:20,817 --> 00:42:22,518
NEGATIVE CORRELATION, IT'S

1077
00:42:22,518 --> 00:42:23,119
SMALL, NOT QUITE SIGNIFICANT,

1078
00:42:23,119 --> 00:42:24,854
THIS IS ONLY AT BASELINE.

1079
00:42:24,854 --> 00:42:28,124
BEFORE WE LOOK OVER TIME, AND WE

1080
00:42:28,124 --> 00:42:29,325
LOOKED AT ISOLATION.

1081
00:42:29,325 --> 00:42:30,860
THERE'S BEEN LOTS OF CONCERN,

1082
00:42:30,860 --> 00:42:33,496
WHAT DO WE FIND?

1083
00:42:33,496 --> 00:42:36,265
MEN ARE AFFECTED BY BEING

1084
00:42:36,265 --> 00:42:37,967
ISOLATED BY DRINKING LESS,

1085
00:42:37,967 --> 00:42:41,137
WHEREAS IT'S NOT IMPACTFUL FOR

1086
00:42:41,137 --> 00:42:42,572
WOMEN. 

1087
00:42:42,572 --> 00:42:44,774
AND WHAT ABOUT STABILITY?

1088
00:42:44,774 --> 00:42:45,975
LOOK AT INDIVIDUALS ACROSS TIME,

1089
00:42:45,975 --> 00:42:49,245
YOU CAN SEE THERE'S A GREAT DEAL

1090
00:42:49,245 --> 00:42:51,214
OF DIFFERENCES, THESE ARE

1091
00:42:51,214 --> 00:42:52,515
COLLECTED EVERY FOUR MONTHS IN

1092
00:42:52,515 --> 00:42:53,916
THE COURSE OF THIS STUDY.

1093
00:42:53,916 --> 00:42:56,486
WE'LL HAVE TO LOOK AT THAT

1094
00:42:56,486 --> 00:42:56,719
IMPACT.

1095
00:42:56,719 --> 00:42:58,788
AND THEN AS WE LOOK AT THE

1096
00:42:58,788 --> 00:43:01,290
OVERALL PANEL WE CAN SEE WE'RE

1097
00:43:01,290 --> 00:43:02,759
GOING TO UNDERSTAND THIS, WE

1098
00:43:02,759 --> 00:43:05,361
HAVE TO LOOK AT VERY MANY

1099
00:43:05,361 --> 00:43:05,728
DOMAINS.

1100
00:43:05,728 --> 00:43:08,898
AND THAT CAN HAPPEN ONLY WITH

1101
00:43:08,898 --> 00:43:10,199
REALLY SYSTEMATIC AND LONG-TERM

1102
00:43:10,199 --> 00:43:12,502
STUDY.

1103
00:43:12,502 --> 00:43:16,205
WE THINK PART IS WE'VE NOT

1104
00:43:16,205 --> 00:43:17,740
EFFECTIVELY DEALT WITH

1105
00:43:17,740 --> 00:43:19,175
VULNERABILITY AND DIFFERENTIAL

1106
00:43:19,175 --> 00:43:20,276
VULNERABILITY IN THESE SAMPLES,

1107
00:43:20,276 --> 00:43:24,847
AND THAT WE SHOULD BE ABLE TO

1108
00:43:24,847 --> 00:43:26,749
SEPARATE RESILIENCE, MODERATE

1109
00:43:26,749 --> 00:43:27,583
DRINKERS, AND VULNERABLE BY

1110
00:43:27,583 --> 00:43:30,453
PAYING MORE ATTENTION TO THE

1111
00:43:30,453 --> 00:43:32,221
INTERSECTION OF ACUTE EFFECTS

1112
00:43:32,221 --> 00:43:34,624
AND CHRONIC PATTERNS OF USE.

1113
00:43:34,624 --> 00:43:37,460
COULDN'T BE DONE WITHOUT ALL OF

1114
00:43:37,460 --> 00:43:38,761
THESE PEOPLE, AND I APOLOGIZE

1115
00:43:38,761 --> 00:43:39,428
FOR GOING OVER.

1116
00:43:39,428 --> 00:43:41,430
CAN YOU TELL I LOVE THIS STUFF?

1117
00:43:41,430 --> 00:43:51,874
AND THANK YOU VERY MUCH. 

1118
00:43:52,208 --> 00:43:57,814
>> NOW WE'RE GOING TO PASS
THE

1119
00:43:57,814 --> 00:43:59,715
BATON TO CYNTHIA CAMPBELL.

1120
00:43:59,715 --> 00:43:59,982
CYNTHIA?

1121
00:43:59,982 --> 00:44:01,851
>> GREAT.

1122
00:44:01,851 --> 00:44:05,788
THANK YOU SO MUCH.

1123
00:44:05,788 --> 00:44:10,827
CAN YOU SEE WHAT I'M SHARING?

1124
00:44:10,827 --> 00:44:13,029
>> YES, BUT YOU NEED TO
MOVE TO

1125
00:44:13,029 --> 00:44:14,564
PRESENTER MODE.

1126
00:44:14,564 --> 00:44:17,400
YES, THERE YOU GO.

1127
00:44:17,400 --> 00:44:23,439
 

1128
00:44:23,439 --> 00:44:31,447
 

1129
00:44:31,447 --> 00:44:35,151
 

1130
00:44:35,151 --> 00:44:36,686
 

1131
00:44:36,686 --> 00:44:38,454
>> DEREK AND I WILL TALK
AFTER

1132
00:44:38,454 --> 00:44:39,956
THOSE TWO GREAT PRESENTATIONS

1133
00:44:39,956 --> 00:44:41,190
SETTING UP THE QUESTION WHAT CAN

1134
00:44:41,190 --> 00:44:42,725
WE DO ABOUT IT AND WE'RE

1135
00:44:42,725 --> 00:44:43,626
APPRECIATIVE OF THE OPPORTUNITY

1136
00:44:43,626 --> 00:44:45,561
TO SPEAK WITH YOU TODAY AND

1137
00:44:45,561 --> 00:44:48,531
THANK NIAAA FOR THEIR SUPPORT.

1138
00:44:48,531 --> 00:44:50,199
SO OUR OVERALL MESSAGE IS REALLY

1139
00:44:50,199 --> 00:44:52,902
TODAY THAT TREATMENT FOR OLDER

1140
00:44:52,902 --> 00:44:55,004
ADULTS FOR ADDICTION IS

1141
00:44:55,004 --> 00:44:56,505
EFFECTIVE, IT WORKS, BUT THEY

1142
00:44:56,505 --> 00:44:58,274
FACE UNIQUE CHALLENGES TO ACCESS

1143
00:44:58,274 --> 00:45:01,110
AND ENGAGEMENT.

1144
00:45:01,110 --> 00:45:03,779
WE REALLY WANT TO ADDRESS OLDER

1145
00:45:03,779 --> 00:45:04,513
ADULTS AND PROBLEMATIC DRINKING

1146
00:45:04,513 --> 00:45:07,316
THROUGH A RANGE OF CARE SETTINGS

1147
00:45:07,316 --> 00:45:10,119
AND PROVIDERS WITH AN OPEN DOOR

1148
00:45:10,119 --> 00:45:10,353
POLICY.

1149
00:45:10,353 --> 00:45:12,521
WE WANT TO MEET PATIENTS, OLDER

1150
00:45:12,521 --> 00:45:16,125
ADULTS WHERE THEY ARE AND

1151
00:45:16,125 --> 00:45:17,260
WHEREVER THEY PRESENT.

1152
00:45:17,260 --> 00:45:20,496
DEREK WILL TALK ABOUT SPECIALTY

1153
00:45:20,496 --> 00:45:21,731
ADDICTION TREATMENT AND EVIDENCE

1154
00:45:21,731 --> 00:45:25,134
THERE AND I'LL TALK MORE ABOUT

1155
00:45:25,134 --> 00:45:29,372
IDENTIFYING PATIENTS AND

1156
00:45:29,372 --> 00:45:30,273
TREATMENT ADAPTATIONS.

1157
00:45:30,273 --> 00:45:31,574
>> THANKS, CYNTHIA.

1158
00:45:31,574 --> 00:45:35,177
HERE I WANTED TO GIVE AN

1159
00:45:35,177 --> 00:45:36,379
OVERVIEW OF A COUPLE STUDIES

1160
00:45:36,379 --> 00:45:38,581
LOOKING AT HOW OLDER ADULTS ARE

1161
00:45:38,581 --> 00:45:40,549
DIFFERENT FROM YOUNGER ADULTS IN

1162
00:45:40,549 --> 00:45:41,784
SPECIALTY ADDICTION TREATMENT.

1163
00:45:41,784 --> 00:45:45,154
SO EVEN THOUGH WE KNOW THERE ARE

1164
00:45:45,154 --> 00:45:47,123
ACCESS BARRIERS AS CYNTHIA

1165
00:45:47,123 --> 00:45:49,592
MENTIONED, WE HAVE LOOKED AT

1166
00:45:49,592 --> 00:45:50,760
WHAT ARE OLDER PATIENTS LIKE

1167
00:45:50,760 --> 00:45:51,928
ONCE THEY GET TO ADDICTION

1168
00:45:51,928 --> 00:45:53,362
TREATMENT AND HOW DO THEY DO.

1169
00:45:53,362 --> 00:45:58,734
THIS IS A SUMMARY OF DATA FROM

1170
00:45:58,734 --> 00:45:59,535
STUDIES CONDUCTED IN KAISER

1171
00:45:59,535 --> 00:46:01,904
PERMANENTE NORTHERN CALIFORNIA

1172
00:46:01,904 --> 00:46:04,774
IN LARGE OUTPATIENT DAY

1173
00:46:04,774 --> 00:46:05,207
TREATMENT PROGRAMS.

1174
00:46:05,207 --> 00:46:08,711
AND WE LOOKED AT DIFFERENCES

1175
00:46:08,711 --> 00:46:10,246
BETWEEN ADULTS AGES 55 AND OVER

1176
00:46:10,246 --> 00:46:12,581
VERSUS YOUNGER IN TERMS OF

1177
00:46:12,581 --> 00:46:14,850
CLINICAL CHARACTERISTICS, AND

1178
00:46:14,850 --> 00:46:17,186
HOW THEY DID IN CARE.

1179
00:46:17,186 --> 00:46:19,889
SO, BROADLY WHAT WE FOUND WAS

1180
00:46:19,889 --> 00:46:21,857
THAT OLDER PATIENTS WERE LESS

1181
00:46:21,857 --> 00:46:23,993
LIKELY THAN YOUNGER ADULTS TO

1182
00:46:23,993 --> 00:46:25,594
MEET ALCOHOL USE DISORDER

1183
00:46:25,594 --> 00:46:27,029
CRITERIA YET THEY WERE STILL IN

1184
00:46:27,029 --> 00:46:31,534
TREATMENT SO THIS GOES TO AN

1185
00:46:31,534 --> 00:46:33,736
ISSUE ABOUT DIFFERENCES IN

1186
00:46:33,736 --> 00:46:35,571
VALIDITY OF DIAGNOSES ACROSS AGE

1187
00:46:35,571 --> 00:46:37,039
GROUP DIFFERENCES, SO THEY MAY

1188
00:46:37,039 --> 00:46:39,442
BE LESS LIKELY TO MEET

1189
00:46:39,442 --> 00:46:41,077
DEPENDENCE CRITERIA BUT STILL

1190
00:46:41,077 --> 00:46:42,244
NEEDED CARE.

1191
00:46:42,244 --> 00:46:44,413
LESS LIKELY TO REPORT SUBSTANCE

1192
00:46:44,413 --> 00:46:46,582
USE OTHER THAN ALCOHOL, THEY

1193
00:46:46,582 --> 00:46:50,286
ALSO HAD LOWER PSYCHIATRIC

1194
00:46:50,286 --> 00:46:51,187
SEVERITY, THEY HAD GREATER

1195
00:46:51,187 --> 00:46:53,923
MEDICAL CO-MORBIDITIES, AND MORE

1196
00:46:53,923 --> 00:46:56,325
LIKELY TO REPORT ABSTINENCE AS

1197
00:46:56,325 --> 00:46:58,861
TREATMENT GOAL, SO I SHOULD SAY

1198
00:46:58,861 --> 00:47:01,998
ALSO THAT IN MOST SPECIALTY CARE

1199
00:47:01,998 --> 00:47:03,232
TREATMENT SET ALSO INCLUDING

1200
00:47:03,232 --> 00:47:04,567
OURS OLDER ADULTS WERE THE

1201
00:47:04,567 --> 00:47:06,235
MINORITY IN TREATMENT BUT THE

1202
00:47:06,235 --> 00:47:10,172
WAY TREATMENT IS TYPICALLY

1203
00:47:10,172 --> 00:47:11,240
STRUCTURED PEOPLE GET TOGETHER

1204
00:47:11,240 --> 00:47:14,977
IN THE SAME PROGRAMS SO THIS IS

1205
00:47:14,977 --> 00:47:16,412
A SNAPSHOT OF CLINICAL

1206
00:47:16,412 --> 00:47:16,846
DIFFERENCES.

1207
00:47:16,846 --> 00:47:19,815
AND THEN IF YOU GO TO THE NEXT

1208
00:47:19,815 --> 00:47:23,519
SLIDE, WE ALSO LOOKED AT

1209
00:47:23,519 --> 00:47:27,723
DIFFERENCES IN TREATMENT

1210
00:47:27,723 --> 00:47:29,325
PARTICIPATION AND RETENTION, AND

1211
00:47:29,325 --> 00:47:30,993
THESE DATA REALLY SHOWED A

1212
00:47:30,993 --> 00:47:32,595
POSITIVE INDICATOR IN TERMS OF

1213
00:47:32,595 --> 00:47:34,663
TREATMENT PROGNOSIS FOR OLDER

1214
00:47:34,663 --> 00:47:35,865
ADULTS, SO SPECIFICALLY WE FOUND

1215
00:47:35,865 --> 00:47:40,803
THAT AGAIN THOSE OLDER ADULTS 55

1216
00:47:40,803 --> 00:47:42,204
AND OLDER HAD LONGER RETENTION

1217
00:47:42,204 --> 00:47:49,311
AND CARE, THERE WERE SOME SOCIAL

1218
00:47:49,311 --> 00:47:50,513
NETWORK DIFFERENCES FOR SUPPORT,

1219
00:47:50,513 --> 00:47:52,281
LESS LIKELY TO CONTINUE IN

1220
00:47:52,281 --> 00:47:53,049
CERTAIN FORMS OF AFTERCARE, SUCH

1221
00:47:53,049 --> 00:47:59,288
AS  A.A.

1222
00:47:59,288 --> 00:48:00,823
SOCIAL NETWORK DIFFERENCES,

1223
00:48:00,823 --> 00:48:02,558
SMALLER SOCIAL NETWORKS, A

1224
00:48:02,558 --> 00:48:03,859
NORMAL AGE-RELATED TREND.

1225
00:48:03,859 --> 00:48:04,960
MORE LIKELY TO BE MARRIED.

1226
00:48:04,960 --> 00:48:07,163
BUT THEY ALSO WERE LESS LIKELY

1227
00:48:07,163 --> 00:48:10,466
TO HAVE ANYONE ACTIVELY

1228
00:48:10,466 --> 00:48:12,968
ENCOURAGE THEIR SUBSTANCE USE.

1229
00:48:12,968 --> 00:48:15,371
HIGHER RATES OF ABSTINENCE

1230
00:48:15,371 --> 00:48:17,773
ESPECIALLY OLDER WOMEN, AND THEY

1231
00:48:17,773 --> 00:48:20,176
ALSO HAD GREATER REDUCTION IN

1232
00:48:20,176 --> 00:48:22,144
HEAVY EPISODIC DRINKING AMONG

1233
00:48:22,144 --> 00:48:24,680
ADULTS NOT ABSTINENT SO REALLY A

1234
00:48:24,680 --> 00:48:25,247
POSITIVE TREATMENT PICTURE.

1235
00:48:25,247 --> 00:48:28,751
IF YOU GO TO THE NEXT SLIDE,

1236
00:48:28,751 --> 00:48:31,353
WANTED TO THROW THIS IN AS

1237
00:48:31,353 --> 00:48:33,022
REALLY HELPFUL TREATMENT

1238
00:48:33,022 --> 00:48:33,289
RESOURCE.

1239
00:48:33,289 --> 00:48:36,826
SO THIS IS THE SAMHSA TREATMENT

1240
00:48:36,826 --> 00:48:38,894
PROTOCOL TREATING SUBSTANCE USE

1241
00:48:38,894 --> 00:48:41,097
DISORDER IN OLDER ADULTS,

1242
00:48:41,097 --> 00:48:41,964
SPECIALTY CARE, THIS WOULD BE A

1243
00:48:41,964 --> 00:48:45,367
GOOD PLACE TO THROW IT IN BUT IT

1244
00:48:45,367 --> 00:48:46,235
DOES ADDRESS INTERVENTION

1245
00:48:46,235 --> 00:48:47,803
STRATEGIES ACROSS THE RANGE OF

1246
00:48:47,803 --> 00:48:49,071
SETTINGS.

1247
00:48:49,071 --> 00:48:50,840
SO THIS IS A CONSENSUS PANEL

1248
00:48:50,840 --> 00:48:53,776
THAT WAS LED BY FRED LOWE AND I

1249
00:48:53,776 --> 00:48:55,077
ALSO PARTICIPATED ON THIS PANEL.

1250
00:48:55,077 --> 00:48:56,745
IT WAS UPDATED A FEW YEARS AGO

1251
00:48:56,745 --> 00:48:59,381
IN 2020 AND THIS IS FREELY

1252
00:48:59,381 --> 00:49:04,487
AVAILABLE ONLINE AND I WANTED TO

1253
00:49:04,487 --> 00:49:06,388
HIGHLIGHT THIS AS A USEFUL

1254
00:49:06,388 --> 00:49:06,722
RESOURCE.

1255
00:49:06,722 --> 00:49:08,757
I'LL HAND IT BACK OVER TO

1256
00:49:08,757 --> 00:49:12,528
CYNTHIA TO TALK ABOUT TREATMENT

1257
00:49:12,528 --> 00:49:13,963
ACCESS ISSUES AND INTERVENTIONS

1258
00:49:13,963 --> 00:49:16,465
AND A RANGE OF SETTINGS.

1259
00:49:16,465 --> 00:49:18,467
>> THANK YOU.

1260
00:49:18,467 --> 00:49:19,101
I'LL GO QUICKLY.

1261
00:49:19,101 --> 00:49:21,437
I WANT TO HAVE TIME FOR

1262
00:49:21,437 --> 00:49:21,904
QUESTIONS.

1263
00:49:21,904 --> 00:49:23,706
BEAR WITH ME.

1264
00:49:23,706 --> 00:49:25,441
WE'VE HEARD FROM DEREK HOW

1265
00:49:25,441 --> 00:49:26,976
TREATMENT WORKS FOR OLDER ADULTS

1266
00:49:26,976 --> 00:49:29,178
BUT KNOW THAT MOST OLDER ADULTS

1267
00:49:29,178 --> 00:49:30,246
WHO NEED TREATMENT DO NOT

1268
00:49:30,246 --> 00:49:32,014
RECEIVE IT.

1269
00:49:32,014 --> 00:49:34,984
SO THIS FIGURE SHOWS ON THE LEFT

1270
00:49:34,984 --> 00:49:37,419
PERCENTAGE IN THE LAST YEAR WHO

1271
00:49:37,419 --> 00:49:39,255
NEEDED SUBSTANCE USE TREATMENT,

1272
00:49:39,255 --> 00:49:41,257
11% OF OLDER ADULTS, AND THIS

1273
00:49:41,257 --> 00:49:46,295
FIGURE ON THE RIGHT, PIE SHOWS

1274
00:49:46,295 --> 00:49:47,830
AMONG THOSE ABOUT 3  5% WHO

1275
00:49:47,830 --> 00:49:48,597
NEEDED TREATMENT RECEIVED IT,

1276
00:49:48,597 --> 00:49:51,567
STILL A GAP THAT WE NEED TO

1277
00:49:51,567 --> 00:49:51,934
ADDRESS.

1278
00:49:51,934 --> 00:49:54,703
AND THIS IS BASED ON 2022 DATA

1279
00:49:54,703 --> 00:49:56,805
FROM NATIONAL SURVEY ON DRUG USE

1280
00:49:56,805 --> 00:49:57,907
AND HEALTH.

1281
00:49:57,907 --> 00:50:00,543
AND BEYOND THAT WHEN TALKING

1282
00:50:00,543 --> 00:50:01,911
ABOUT PATIENTS IN SPECIALTY

1283
00:50:01,911 --> 00:50:03,045
TREATMENT, THOSE ARE PATIENTS

1284
00:50:03,045 --> 00:50:05,214
WITH ALCOHOL USE DISORDER SO

1285
00:50:05,214 --> 00:50:07,816
THIS IS THE PYRAMID YOU MAY BE

1286
00:50:07,816 --> 00:50:09,151
FAMILIAR WITH, PATIENTS WITH AUD

1287
00:50:09,151 --> 00:50:11,120
ARE AT THE TOP.

1288
00:50:11,120 --> 00:50:12,087
A SMALL PERCENTAGE RELATIVE TO

1289
00:50:12,087 --> 00:50:13,756
THE REST.

1290
00:50:13,756 --> 00:50:17,059
THOSE ARE PATIENTS APPROPRIATE

1291
00:50:17,059 --> 00:50:18,027
FOR SPECIALTY TREATMENT, BUT

1292
00:50:18,027 --> 00:50:20,563
THERE ARE LARGE GROUPS IN THE

1293
00:50:20,563 --> 00:50:23,365
MIDDLE HERE SO HIGH RISK

1294
00:50:23,365 --> 00:50:25,668
DRINKING, MODERATE, LOW-RISK

1295
00:50:25,668 --> 00:50:26,168
DRINKING.

1296
00:50:26,168 --> 00:50:27,870
THOSE PATIENTS CAN STILL BENEFIT

1297
00:50:27,870 --> 00:50:29,738
FROM CARE, AND OLDER ADULTS ARE

1298
00:50:29,738 --> 00:50:31,340
PARTICULARLY AT RISK EVEN AT

1299
00:50:31,340 --> 00:50:32,241
LOWER LEVELS OF DRINKING AS

1300
00:50:32,241 --> 00:50:33,642
WE'VE HEARD FROM THE PREVIOUS

1301
00:50:33,642 --> 00:50:35,377
TWO PRESENTERS.

1302
00:50:35,377 --> 00:50:37,146
SO WE REALLY WANT TO TRY TO

1303
00:50:37,146 --> 00:50:38,881
REACH THESE GROUPS AS WELL.

1304
00:50:38,881 --> 00:50:41,217
SO, EVEN THOUGH MOST OLDER

1305
00:50:41,217 --> 00:50:42,284
ADULTS HAVE LOWER SEVERITY HOW

1306
00:50:42,284 --> 00:50:45,454
DO WE REACH THIS MIDDLE GROUP

1307
00:50:45,454 --> 00:50:46,755
AND HELP THEM?

1308
00:50:46,755 --> 00:50:47,856
IMPORTANT TOOL IS SCREENING

1309
00:50:47,856 --> 00:50:52,695
BRIEF INTERVENTION AND REFERRAL

1310
00:50:52,695 --> 00:50:53,529
TO TREATMENT, SBIRT.

1311
00:50:53,529 --> 00:50:55,064
UNITED STATES TASK FORCE

1312
00:50:55,064 --> 00:50:55,764
RECOMMENDS SCREENING FOR

1313
00:50:55,764 --> 00:50:58,067
UNHEALTHY ALCOHOL USE IN PRIMARY

1314
00:50:58,067 --> 00:51:02,538
CARE IN ADULTS FOLLOWED BY BRIEF

1315
00:51:02,538 --> 00:51:02,972
INTERVENTION.

1316
00:51:02,972 --> 00:51:04,373
YOU CAN SEE THE CRITERIA ON THE

1317
00:51:04,373 --> 00:51:04,573
SLIDE.

1318
00:51:04,573 --> 00:51:09,878
THERE IS A FAIR AMOUNT OF

1319
00:51:09,878 --> 00:51:12,915
EVIDENCE THIS IS EFFECTIVE.

1320
00:51:12,915 --> 00:51:15,017
JUST VERY BRIEFLY SBIRT FOR

1321
00:51:15,017 --> 00:51:16,652
THOSE WHO AREN'T FAMILIAR THE

1322
00:51:16,652 --> 00:51:19,822
FIRST STEP IS SCREENING OR

1323
00:51:19,822 --> 00:51:20,589
ASSESSING RISKY ALCOHOL USE WITH

1324
00:51:20,589 --> 00:51:22,091
STANDARDIZED ASSESSMENT TOOL TO

1325
00:51:22,091 --> 00:51:24,426
IDENTIFY APPROPRIATE LEVEL OF

1326
00:51:24,426 --> 00:51:26,128
CARE AND THERE ARE SEVERAL TOOLS

1327
00:51:26,128 --> 00:51:27,296
USED WITH OLDER ADULTS.

1328
00:51:27,296 --> 00:51:30,699
THIS IS FOLLOWED BY BRIEF

1329
00:51:30,699 --> 00:51:32,067
INTERVENTION SEMI STRUCTURED

1330
00:51:32,067 --> 00:51:33,135
CONVERSATION FOCUSED ON

1331
00:51:33,135 --> 00:51:37,072
INCREASING SUBSTANCE USE

1332
00:51:37,072 --> 00:51:38,674
AWARENESS AND USING MOTIVATION

1333
00:51:38,674 --> 00:51:41,677
CHANGE, 10 TO 15 MINUTES, AND

1334
00:51:41,677 --> 00:51:43,746
MORE SEVERE PATIENTS ARE THEN

1335
00:51:43,746 --> 00:51:45,180
REFERRED FOR SERVICES IDEALLY

1336
00:51:45,180 --> 00:51:46,815
WITH A WARM HANDOFF.

1337
00:51:46,815 --> 00:51:49,018
IT'S IMPORTANT SCREENING FOR

1338
00:51:49,018 --> 00:51:50,853
OLDER ADULTS IS UNIVERSAL AND

1339
00:51:50,853 --> 00:51:51,520
POPULATION BASED.

1340
00:51:51,520 --> 00:51:55,424
AND THAT IT'S DONE ANNUALLY FOR

1341
00:51:55,424 --> 00:51:56,859
THOSE OVER 60, THE

1342
00:51:56,859 --> 00:52:01,997
RECOMMENDATION FROM THE EXPERT

1343
00:52:01,997 --> 00:52:04,300
PANEL FROM SAMHSA, AND DONE AT

1344
00:52:04,300 --> 00:52:05,000
MAJOR LIFE TRANSITIONS TRIGGERS

1345
00:52:05,000 --> 00:52:15,878
FOR PROBLEM THE  FOR BRIDGING. ,

1346
00:52:21,817 --> 00:52:25,154
FREQUENT FALLS, CHALLENGES WITH

1347
00:52:25,154 --> 00:52:26,088
DAILY ACTIVITY IS ANOTHER GOOD

1348
00:52:26,088 --> 00:52:28,624
TIME TO BE SCREENING FOR

1349
00:52:28,624 --> 00:52:30,059
PROBLEMATIC ALCOHOL USE.

1350
00:52:30,059 --> 00:52:32,695
SCREENING BRIEF INTERVENTION IS

1351
00:52:32,695 --> 00:52:34,296
EFFECTIVE, ALCOHOL PROBLEMS WITH

1352
00:52:34,296 --> 00:52:35,631
OFTEN OVERLOOKED AND

1353
00:52:35,631 --> 00:52:38,467
UNDERTREATED IN OLDER ADULTS.

1354
00:52:38,467 --> 00:52:40,002
STACY STERLING HAS BEEN LEADING

1355
00:52:40,002 --> 00:52:42,871
WORK IN OUR TEAM FOUND AT OLDER

1356
00:52:42,871 --> 00:52:45,607
ADULT LESS LIKELY TO BE SCREENED

1357
00:52:45,607 --> 00:52:46,508
AND RECEIVE INTERVENTION, OLDER

1358
00:52:46,508 --> 00:52:48,811
WOMEN LESS LIKELY THAN OLDER

1359
00:52:48,811 --> 00:52:51,580
MEN, WE ALSO SEE VARIATION BY

1360
00:52:51,580 --> 00:52:54,850
RACE AT LOWER RATES OF BI AMONG

1361
00:52:54,850 --> 00:52:56,685
BLACK PATIENTS AND FOUND IN

1362
00:52:56,685 --> 00:52:58,020
OTHER STUDIES AS WELL.

1363
00:52:58,020 --> 00:53:00,656
WE CURRENTLY HAVE A STUDY

1364
00:53:00,656 --> 00:53:03,492
EXAMINING DISPARITIES AMONG

1365
00:53:03,492 --> 00:53:06,128
AGING WOMEN, CARE DELIVERY,

1366
00:53:06,128 --> 00:53:06,995
BECAUSE IDENTIFYING SUBGROUP

1367
00:53:06,995 --> 00:53:11,367
DIFFERENCES IN DISPARITIES IS SO

1368
00:53:11,367 --> 00:53:11,633
IMPORTANT.

1369
00:53:11,633 --> 00:53:12,935
SO WE THINK BROADLY ABOUT WHO

1370
00:53:12,935 --> 00:53:15,104
CAN IDENTIFY PATIENTS AND WHERE.

1371
00:53:15,104 --> 00:53:17,072
WE KNOW OLDER ADULTS HAVE

1372
00:53:17,072 --> 00:53:18,607
CONTACT WITH HEALTH SYSTEM,

1373
00:53:18,607 --> 00:53:19,942
DIFFERENT TYPES OF PROVIDERS, SO

1374
00:53:19,942 --> 00:53:21,577
THAT PRESENTS A RANGE OF

1375
00:53:21,577 --> 00:53:23,345
OPPORTUNITY TO IDENTIFY AND

1376
00:53:23,345 --> 00:53:24,313
INTERVENE WITH OLDER ADULTS,

1377
00:53:24,313 --> 00:53:28,684
DONE NOT JUST IN PRIMARY CARE

1378
00:53:28,684 --> 00:53:30,319
BUT DIFFERENT SETTINGS,

1379
00:53:30,319 --> 00:53:32,621
EMERGENCY DEPARTMENT, URGENT

1380
00:53:32,621 --> 00:53:35,791
CARE, YOU CAN SEE DIFFERENT

1381
00:53:35,791 --> 00:53:37,493
PROVIDERS LISTED HERE.

1382
00:53:37,493 --> 00:53:38,227
IN-HOME PROVIDERS CAN BE KEY

1383
00:53:38,227 --> 00:53:40,295
BECAUSE THEY ARE IN THE HOME, IN

1384
00:53:40,295 --> 00:53:42,164
THE ENVIRONMENT AND CAN SEE

1385
00:53:42,164 --> 00:53:43,465
THINGS THAT WE CAN'T ALWAYS SEE

1386
00:53:43,465 --> 00:53:45,334
IN THE HEALTH SYSTEM OTHERWISE.

1387
00:53:45,334 --> 00:53:48,303
AND COMMUNITY PROVIDERS ARE ALSO

1388
00:53:48,303 --> 00:53:49,805
VERY IMPORTANT, FAITH BASED,

1389
00:53:49,805 --> 00:53:51,774
PEER SUPPORT, SENIOR CENTERS, SO

1390
00:53:51,774 --> 00:53:52,975
REALLY CONNECTING WITH OLDER

1391
00:53:52,975 --> 00:53:57,379
ADULTS WHEREVER THEY ARE

1392
00:53:57,379 --> 00:53:57,679
PRESENTING.

1393
00:53:57,679 --> 00:53:59,648
THIS SLIDE IS FULL BUT IN ORDER

1394
00:53:59,648 --> 00:54:02,284
TO UNDERSTAND HOW WE CAN ADAPT

1395
00:54:02,284 --> 00:54:03,852
TREATMENT TO BETTER ENGAGE OLDER

1396
00:54:03,852 --> 00:54:05,154
ADULTS WE HAVE TO UNDERSTAND

1397
00:54:05,154 --> 00:54:06,989
WHAT THE BARRIERS ARE SO I'LL

1398
00:54:06,989 --> 00:54:08,624
HIGHLIGHT A FEW.

1399
00:54:08,624 --> 00:54:09,858
OFTEN OLDER ADULTS DO NOT

1400
00:54:09,858 --> 00:54:11,260
RECOGNIZE THEY HAVE A PROBLEM.

1401
00:54:11,260 --> 00:54:13,429
THEY HAVE BEEN DRINKING LIKE

1402
00:54:13,429 --> 00:54:14,997
THIS FOR YEARS SO IT FEELS

1403
00:54:14,997 --> 00:54:17,699
NORMAL TO THEM.

1404
00:54:17,699 --> 00:54:19,234
THEY DON'T REALIZE THEY ARE MORE

1405
00:54:19,234 --> 00:54:20,969
VULNERABLE AS THEY AGE TO THE

1406
00:54:20,969 --> 00:54:22,871
NEGATIVE CONSEQUENCES.

1407
00:54:22,871 --> 00:54:24,640
THEY CAN BE SOCIALLY ISOLATED,

1408
00:54:24,640 --> 00:54:26,041
MAY NOT HAVE A PARTNER ANYMORE

1409
00:54:26,041 --> 00:54:27,943
OR FAMILY THAT LIVES CLOSE BY,

1410
00:54:27,943 --> 00:54:29,545
SO THEY DON'T HAVE THE SUPPORTS

1411
00:54:29,545 --> 00:54:31,513
TO HELP THEM RECOGNIZE THE

1412
00:54:31,513 --> 00:54:32,948
PROBLEMS, ENCOURAGE THEM TO GET

1413
00:54:32,948 --> 00:54:33,615
TO TREATMENT.

1414
00:54:33,615 --> 00:54:38,253
THEY MAY ALSO HAVE AN ATTITUDE

1415
00:54:38,253 --> 00:54:41,723
OF WHY BOTHER, I DON'T HAVE MUCH

1416
00:54:41,723 --> 00:54:45,027
LONGER, I WANT TO KEEP DRINKING.

1417
00:54:45,027 --> 00:54:47,629
ON THE PROVIDER SIDE, IT'S A

1418
00:54:47,629 --> 00:54:48,831
YOUNGER PERSON'S PROBLEM,

1419
00:54:48,831 --> 00:54:50,599
ORDINARY ADULTS DON'T HAVE THESE

1420
00:54:50,599 --> 00:54:51,600
PROBLEMS, HARD TO DISTINGUISH

1421
00:54:51,600 --> 00:54:53,535
FROM OTHER MENTAL HEALTH

1422
00:54:53,535 --> 00:54:54,403
CHALLENGES FROM COGNITIVE

1423
00:54:54,403 --> 00:54:55,537
DECLINE, AND OLDER PEOPLE DON'T

1424
00:54:55,537 --> 00:54:57,739
HAVE THE SAME ACTIVITIES THAT

1425
00:54:57,739 --> 00:54:59,875
YOUNGER ADULTS THAT CAN HELP

1426
00:54:59,875 --> 00:55:00,843
IDENTIFY PROBLEMS, THEY ARE NOT

1427
00:55:00,843 --> 00:55:08,150
ACTIVE  WORKFORCE, DON'T HAVE TE

1428
00:55:08,150 --> 00:55:09,751
SAME RESPONSIBILITIES, AN

1429
00:55:09,751 --> 00:55:12,588
ATTITUDE WE SHOULD JUST LET THEM

1430
00:55:12,588 --> 00:55:17,192
DO WHAT THEY WANT,  THEY DON'T

1431
00:55:17,192 --> 00:55:22,431
HAVE A LOT OF TIME LEFT, AGEISM,

1432
00:55:22,431 --> 00:55:24,066
BECAUSE WE WOULDN'T APPROACH

1433
00:55:24,066 --> 00:55:29,104
YOUNGER ADULTS THE SAME WAY.

1434
00:55:29,104 --> 00:55:30,739
HOW CAN WE ENGAGE ACROSS THE

1435
00:55:30,739 --> 00:55:31,406
CONTINUUM, AGE SENSITIVE CARE

1436
00:55:31,406 --> 00:55:31,974
COMES IN.

1437
00:55:31,974 --> 00:55:34,910
THERE MAY BE OPPORTUNITIES TO

1438
00:55:34,910 --> 00:55:35,511
PROVIDE AGE-SPECIFIC ADDICTION

1439
00:55:35,511 --> 00:55:36,912
TREATMENT, SO FOR EXAMPLE

1440
00:55:36,912 --> 00:55:38,447
AGE-SPECIFIC GROUPS, BUT THAT

1441
00:55:38,447 --> 00:55:39,548
ISN'T AS COMMON, HARDER TO

1442
00:55:39,548 --> 00:55:42,951
SUPPORT, MAY NOT BE THE NUMBERS,

1443
00:55:42,951 --> 00:55:43,952
TREATMENT PROGRAMS TO SUPPORT

1444
00:55:43,952 --> 00:55:44,186
THAT.

1445
00:55:44,186 --> 00:55:46,655
BUT WE CAN STRIVE TO MAKE CARE

1446
00:55:46,655 --> 00:55:48,624
AGE SENSITIVE SO ADAPTING

1447
00:55:48,624 --> 00:55:53,395
EXISTING SERVICES TO ACCOMMODATE

1448
00:55:53,395 --> 00:55:54,429
OLDER ADULT NEEDS.

1449
00:55:54,429 --> 00:55:55,497
IN THE INTEREST OF TIME THESE

1450
00:55:55,497 --> 00:56:01,303
ARE ALL AVAILABLE ON THE SAMHSA

1451
00:56:01,303 --> 00:56:01,970
TIP, A FANTASTIC RESOURCE,

1452
00:56:01,970 --> 00:56:05,274
TREATMENT NEEDS TO BE SUPPORTED,

1453
00:56:05,274 --> 00:56:07,142
NOT CONFRONTATIONAL, HARM

1454
00:56:07,142 --> 00:56:08,677
REDUCTION AND NOT ABSTINENCE,

1455
00:56:08,677 --> 00:56:11,079
USING SHARED DECISION MAKING,

1456
00:56:11,079 --> 00:56:12,648
TREATMENT CAN BE ADAPTED TO THE

1457
00:56:12,648 --> 00:56:15,150
LEVEL OF SPECIFIC AND COGNITIVE

1458
00:56:15,150 --> 00:56:17,119
FUNCTIONING OF THE OLDER ADULT

1459
00:56:17,119 --> 00:56:19,087
SO ADDRESSING DIFFICULTIES THAT

1460
00:56:19,087 --> 00:56:21,189
OLDER ADULTS HAVE MIGHT INCLUDE

1461
00:56:21,189 --> 00:56:24,259
SHORTER SESSIONS, SLOWER PACE,

1462
00:56:24,259 --> 00:56:25,227
REPEATING INFORMATION, PROVIDING

1463
00:56:25,227 --> 00:56:30,699
INFORMATION IN MULTIPLE FORMATS

1464
00:56:30,699 --> 00:56:32,601
NOT JUST VERBAL BUT PRINT.

1465
00:56:32,601 --> 00:56:34,269
WE KNOW THERE'S A LOT OF CONCERN

1466
00:56:34,269 --> 00:56:37,406
ABOUT DIGITAL DIVIDE BUT THERE'S

1467
00:56:37,406 --> 00:56:38,607
EVIDENCE OLDER ADULTS ACCEPT

1468
00:56:38,607 --> 00:56:41,043
TELEHEALTH AND FIND IT VALUABLE.

1469
00:56:41,043 --> 00:56:44,079
SO FOR PATIENTS WITH LESS

1470
00:56:44,079 --> 00:56:45,180
MOBILITY, WHO LACK

1471
00:56:45,180 --> 00:56:45,881
TRANSPORTATION, ARE NOT DRIVING,

1472
00:56:45,881 --> 00:56:47,883
THIS IS WHERE TELEHEALTH COULD

1473
00:56:47,883 --> 00:56:49,418
BE A VERY USEFUL TOOL.

1474
00:56:49,418 --> 00:56:52,054
AND WE NEED CONTENT THAT

1475
00:56:52,054 --> 00:56:54,590
ADDRESSES ISOLATION, LONELINESS,

1476
00:56:54,590 --> 00:56:55,223
GRIEF.

1477
00:56:55,223 --> 00:56:57,726
SO THESE ARE JUST KEY THINGS

1478
00:56:57,726 --> 00:56:59,728
THAT DRIVE PROBLEMATIC DRINKING

1479
00:56:59,728 --> 00:57:07,169
IN OLDER ADULTS, SO HOW CAN WE

1480
00:57:07,169 --> 00:57:08,470
DEVELOP IMPROVED COPING OF

1481
00:57:08,470 --> 00:57:09,237
SOCIAL SKILLS IN THIS

1482
00:57:09,237 --> 00:57:09,905
POPULATION?

1483
00:57:09,905 --> 00:57:12,007
THAT COULD BE STRENGTHENING

1484
00:57:12,007 --> 00:57:13,775
SOCIAL CONNECTIONS WITH

1485
00:57:13,775 --> 00:57:14,943
NON-DRINKING FRIENDS, JOINING

1486
00:57:14,943 --> 00:57:17,679
MUTUAL HEALTH GROUPS, STRENGTHEN

1487
00:57:17,679 --> 00:57:19,114
CONNECTIONS THEY DO HAVE.

1488
00:57:19,114 --> 00:57:21,283
IT'S REALLY IMPORTANT TO INVOLVE

1489
00:57:21,283 --> 00:57:24,786
FAMILY AND CAREGIVERS, EDUCATING

1490
00:57:24,786 --> 00:57:26,088
THEM, ENCOURAGING THEIR

1491
00:57:26,088 --> 00:57:27,623
INVOLVEMENT, TRAINING STAFF TO

1492
00:57:27,623 --> 00:57:28,724
BE AGE SENSITIVE.

1493
00:57:28,724 --> 00:57:30,292
MEDICATIONS ARE AN OPTION WITH

1494
00:57:30,292 --> 00:57:32,127
MONITORING FOR THIS GROUP,

1495
00:57:32,127 --> 00:57:33,228
PARTICULARLY WITH MEDICATION

1496
00:57:33,228 --> 00:57:34,896
INTERACTIONS WE KNOW OLDER

1497
00:57:34,896 --> 00:57:36,632
ADULTS ARE TAKING MULTIPLE

1498
00:57:36,632 --> 00:57:38,533
MEDICATIONS, SO THAT HAS TO BE

1499
00:57:38,533 --> 00:57:39,901
REVIEWED PERIODICALLY.

1500
00:57:39,901 --> 00:57:43,071
AND WE WANT TO TAILOR TREATMENT

1501
00:57:43,071 --> 00:57:43,872
FOR DIVERSITY.

1502
00:57:43,872 --> 00:57:51,413
OLDER ADULTS ARE A HETEROGENEOUS

1503
00:57:51,413 --> 00:57:53,615
POPULATION, WE WANT TO BE

1504
00:57:53,615 --> 00:57:59,988
SENSITIVE TO GENDER DIVERSITY,

1505
00:57:59,988 --> 00:58:00,589
 DIFFERENCES

1506
00:58:00,589 --> 00:58:01,323
AND CULTURAL DIFFERENCES AS

1507
00:58:01,323 --> 00:58:01,590
WELL.

1508
00:58:01,590 --> 00:58:04,226
A LOT CAN BE DONE TO IDENTIFY IN

1509
00:58:04,226 --> 00:58:06,128
A HOLISTIC WAY, THERE'S A LOT OF

1510
00:58:06,128 --> 00:58:07,629
ROOM FOR IMPROVEMENT, WE WANT TO

1511
00:58:07,629 --> 00:58:08,664
REACH OLDER ADULTS WHERE THEY

1512
00:58:08,664 --> 00:58:11,800
ARE, WE TALKED ABOUT THE HEALTH

1513
00:58:11,800 --> 00:58:13,168
SYSTEM TODAY, BUT THERE'S A LOT

1514
00:58:13,168 --> 00:58:15,771
OF OPPORTUNITY IN THE COMMUNITY

1515
00:58:15,771 --> 00:58:16,938
AND REACHING PATIENTS, FOR

1516
00:58:16,938 --> 00:58:18,774
EXAMPLE, IN SENIOR CENTERS AND

1517
00:58:18,774 --> 00:58:21,009
FOCUSING ON PREVENTION AS WELL.

1518
00:58:21,009 --> 00:58:24,312
AND THEN A MESSAGE THAT HAS BEEN

1519
00:58:24,312 --> 00:58:26,848
MEANINGFUL AND STRUCK ME IS WHEN

1520
00:58:26,848 --> 00:58:30,986
I'VE HEARD FRED BLOWE, AN

1521
00:58:30,986 --> 00:58:31,887
EXPERT, TALK ABOUT HOW IT'S

1522
00:58:31,887 --> 00:58:35,190
NEVER TOO LATE FOR OLDER ADULTS,

1523
00:58:35,190 --> 00:58:38,026
WE SHOULDN'T GIVE UP ON TRYING

1524
00:58:38,026 --> 00:58:39,161
TO ADDRESS ALCOHOL PROBLEMS

1525
00:58:39,161 --> 00:58:41,963
BECAUSE WE CAN IMPROVE QUALITY

1526
00:58:41,963 --> 00:58:45,367
OF LIFE AND EXTEND THEIR LIFE.

1527
00:58:45,367 --> 00:58:47,002
I THANK THE COLLABORATORS ON THE

1528
00:58:47,002 --> 00:58:50,272
TEAM AS WELL AS END WITH

1529
00:58:50,272 --> 00:58:51,173
ADDITIONAL RESOURCES FOR PEOPLE

1530
00:58:51,173 --> 00:58:52,674
INTERESTED, AND I'LL TURN IT

1531
00:58:52,674 --> 00:58:54,609
BACK TO DR. KOOB FOR QUESTIONS

1532
00:58:54,609 --> 00:58:58,280
AND ANSWERS.

1533
00:58:58,280 --> 00:58:58,714
THANK YOU.

1534
00:58:58,714 --> 00:59:00,248
>> THANK YOU VERY MUCH,
ALL FOUR

1535
00:59:00,248 --> 00:59:02,551
OF YOU SPEAKERS FOR EXCELLENT

1536
00:59:02,551 --> 00:59:03,085
TALKS.

1537
00:59:03,085 --> 00:59:05,487
I LEARNED A GOOD BIT TODAY

1538
00:59:05,487 --> 00:59:06,254
MYSELF.

1539
00:59:06,254 --> 00:59:11,426
WE HAVE A QUESTION FROM PAT, I'M

1540
00:59:11,426 --> 00:59:13,962
ASSUMING FOR DEREK OR CYNTHIA.

1541
00:59:13,962 --> 00:59:16,598
WHAT APPROACH HAS BEEN GIVEN TO

1542
00:59:16,598 --> 00:59:17,899
PROVIDING SENIOR SERVICES SUCH

1543
00:59:17,899 --> 00:59:20,001
AS COMMUNITY HOUSING WHICH WOULD

1544
00:59:20,001 --> 00:59:22,070
ADDRESS LONELINESS, LACK OF

1545
00:59:22,070 --> 00:59:25,140
COMMUNITY, AND ACTIVITY

1546
00:59:25,140 --> 00:59:26,808
AVAILABILITY, INCREASED ACCESS

1547
00:59:26,808 --> 00:59:27,776
TO CARE AND AFTER-CARE, ET

1548
00:59:27,776 --> 00:59:34,282
CETERA, DO YOU WANT TO TAKE A

1549
00:59:34,282 --> 00:59:35,884
SHOT AT THAT?

1550
00:59:35,884 --> 00:59:37,619
>> THERE'S A DESPERATE
NEED FOR

1551
00:59:37,619 --> 00:59:38,420
HOUSING, I KNOW IN THE SAN

1552
00:59:38,420 --> 00:59:41,590
FRANCISCO BAY AREA THERE'S AN

1553
00:59:41,590 --> 00:59:43,225
URGENT NEED, AND NATIONWIDE

1554
00:59:43,225 --> 00:59:48,597
THERE'S HUGE DEMAND THAT CAN

1555
00:59:48,597 --> 00:59:49,664
ADDRESS THESE ISSUES.

1556
00:59:49,664 --> 00:59:52,968
THERE'S AN ISSUE IN A LOT OF

1557
00:59:52,968 --> 00:59:54,069
SENIOR HOUSING SITUATIONS, WHERE

1558
00:59:54,069 --> 00:59:57,672
HAPPY HOUR AND DRINKING CAN BE

1559
00:59:57,672 --> 00:59:59,741
PROBLEMATIC IN FOCUS, SO IT CAN

1560
00:59:59,741 --> 01:00:00,942
CUT BOTH WAYS.

1561
01:00:00,942 --> 01:00:03,378
IT'S CRITICAL TO ADDRESS

1562
01:00:03,378 --> 01:00:05,580
LONELINESS ISSUES, KEEP AN EYE

1563
01:00:05,580 --> 01:00:07,449
THAT ALCOHOL ISN'T BEING

1564
01:00:07,449 --> 01:00:11,453
PROMOTED TOO HEAVILY AS AN

1565
01:00:11,453 --> 01:00:15,724
ACTIVITY. 

1566
01:00:15,724 --> 01:00:15,991
>> YEAH.

1567
01:00:15,991 --> 01:00:17,425
>> ANOTHER QUESTION, FOR
DR.

1568
01:00:17,425 --> 01:00:19,594
KEYES, DO YOU KNOW WHETHER OLDER

1569
01:00:19,594 --> 01:00:20,996
ADULTS HAVE INCREASED THEIR

1570
01:00:20,996 --> 01:00:24,332
DRINKING OVER TIME OR DOES THIS

1571
01:00:24,332 --> 01:00:26,735
BIRTH COHORT HAVE HIGHER LEVELS

1572
01:00:26,735 --> 01:00:29,771
OF DRINKING THAN PREVIOUS BIRTH

1573
01:00:29,771 --> 01:00:30,005
COHORTS?

1574
01:00:30,005 --> 01:00:34,276
>> THANK YOU FOR THE
QUESTION.

1575
01:00:34,276 --> 01:00:37,579
THAT'S A GREAT QUESTION.

1576
01:00:37,579 --> 01:00:40,081
ESPECIALLY FOR THESE COHORTS NOW

1577
01:00:40,081 --> 01:00:41,650
AGING INTO 50s AND 60s THEY

1578
01:00:41,650 --> 01:00:43,618
HAD DID HAVE HIGHER LEVELS IN

1579
01:00:43,618 --> 01:00:46,087
YOUNG ADULTHOOD BUT ARE ALSO

1580
01:00:46,087 --> 01:00:48,390
ACCELERATING LEVELS OF DRINKING

1581
01:00:48,390 --> 01:00:50,458
COMPARED TO THOSE OLDER ADULTS

1582
01:00:50,458 --> 01:00:54,963
IN PREVIOUS COHORTS MORE

1583
01:00:54,963 --> 01:00:55,430
RAPIDLY.

1584
01:00:55,430 --> 01:00:57,799
SO, BOTH HIGHER LEVEL OF

1585
01:00:57,799 --> 01:00:59,067
CONSUMPTION COMPARED TO PREVIOUS

1586
01:00:59,067 --> 01:01:00,435
COHORTS THAT FROM WHICH WE --

1587
01:01:00,435 --> 01:01:02,537
BASED ON THE BEST AVAILABLE

1588
01:01:02,537 --> 01:01:04,739
DATA, WHICH IS IMPERFECT, AND

1589
01:01:04,739 --> 01:01:08,877
THERE IS A FASTER ACCELERATION

1590
01:01:08,877 --> 01:01:12,647
IN OLDER ADULTHOOD AS WELL.

1591
01:01:12,647 --> 01:01:15,483
>> I'LL ASK A QUESTION OF
SARA

1592
01:01:15,483 --> 01:01:15,650
JO.

1593
01:01:15,650 --> 01:01:20,422
JUST TO BE FAIR TO GET EVERYBODY

1594
01:01:20,422 --> 01:01:20,722
A QUESTION.

1595
01:01:20,722 --> 01:01:22,457
BUT ALSO BECAUSE THIS IS ONE OF

1596
01:01:22,457 --> 01:01:26,428
THE BIG QUESTIONS OF COURSE.

1597
01:01:26,428 --> 01:01:27,729
SO, BRIEFLY, SARA JO, BECAUSE

1598
01:01:27,729 --> 01:01:30,498
THIS IS A LONG ANSWER, WHAT

1599
01:01:30,498 --> 01:01:32,434
ABOUT ALZHEIMER'S DISEASE AND

1600
01:01:32,434 --> 01:01:33,635
ALCOHOL, GIVEN THE COGNITIVE

1601
01:01:33,635 --> 01:01:35,937
ISSUES THAT YOU RAISED IN YOUR

1602
01:01:35,937 --> 01:01:36,504
TALK?

1603
01:01:36,504 --> 01:01:38,907
>> YEAH, THANKS FOR ASKING
THAT.

1604
01:01:38,907 --> 01:01:40,976
YOU KNOW, THAT'S TRICKIER THAN

1605
01:01:40,976 --> 01:01:42,644
IT SHOULD BE.

1606
01:01:42,644 --> 01:01:44,946
AND THERE'S SO MANY INTERFACES,

1607
01:01:44,946 --> 01:01:47,716
WE HAVE TO ALSO SUBTRACT OUT OR

1608
01:01:47,716 --> 01:01:49,451
ACCOUNT FOR DIFFERENCES IN

1609
01:01:49,451 --> 01:01:50,952
IMPAIRMENT VERSUS DECLINE.

1610
01:01:50,952 --> 01:01:54,155
SO, WHEN WE JUST LOOK AT GROUP

1611
01:01:54,155 --> 01:01:55,690
DIFFERENCES, WE'RE LOOKING AT

1612
01:01:55,690 --> 01:01:57,325
IMPAIRMENT, AND WE SEE

1613
01:01:57,325 --> 01:01:59,895
IMPAIRMENT WITH CHRONIC ALCOHOL,

1614
01:01:59,895 --> 01:02:01,897
AND IT'S LARGER AND OLDER

1615
01:02:01,897 --> 01:02:05,767
ADULTS, BUT IS THAT ACTUALLY

1616
01:02:05,767 --> 01:02:06,468
DEMENTIA?

1617
01:02:06,468 --> 01:02:08,703
AND WE HAVE TO HAVE LONGITUDINAL

1618
01:02:08,703 --> 01:02:11,106
STUDIES TO BE ABLE TO

1619
01:02:11,106 --> 01:02:12,340
EFFECTIVELY ANSWER THAT.

1620
01:02:12,340 --> 01:02:16,244
THERE ARE PROBABLY A GROUP OF

1621
01:02:16,244 --> 01:02:17,679
VULNERABLE DRINKERS WHO, OVER

1622
01:02:17,679 --> 01:02:20,415
TIME, IN THAT INTERFACE, ARE AT

1623
01:02:20,415 --> 01:02:22,784
INCREASED RISK DUE TO GENETICS

1624
01:02:22,784 --> 01:02:25,153
AND PERHAPS AND THEN THE

1625
01:02:25,153 --> 01:02:27,789
INTERACTION OF THE ALCOHOL AND

1626
01:02:27,789 --> 01:02:29,324
COGNITIVE AGING EFFECTS COME

1627
01:02:29,324 --> 01:02:31,059
TOGETHER TO PLACE THEM INDEED AT

1628
01:02:31,059 --> 01:02:36,431
INCREASED RISK FOR THAT KIND OF

1629
01:02:36,431 --> 01:02:37,499
DEMENTIA OUTCOME.

1630
01:02:37,499 --> 01:02:37,799
>> GREAT.

1631
01:02:37,799 --> 01:02:38,099
THANK YOU.

1632
01:02:38,099 --> 01:02:39,601
I THINK THAT'S A GREAT SUMMARY

1633
01:02:39,601 --> 01:02:42,304
OF WHERE WE'RE AT RIGHT NOW.

1634
01:02:42,304 --> 01:02:47,275
AND IT IS AN ABIDING QUESTION.

1635
01:02:47,275 --> 01:02:49,811
ANOTHER QUESTION FROM THE

1636
01:02:49,811 --> 01:02:52,881
WEBINAR, FROM ALLISON MOORE, FOR

1637
01:02:52,881 --> 01:02:53,882
DR. CAMPBELL.

1638
01:02:53,882 --> 01:02:56,217
HOW ABOUT ONLINE OR OTHER

1639
01:02:56,217 --> 01:02:57,452
VIRTUAL MEANS OF ADDRESSING

1640
01:02:57,452 --> 01:03:00,388
UNHEALTHY DRINKING IN OLDER

1641
01:03:00,388 --> 01:03:00,622
ADULTS?

1642
01:03:00,622 --> 01:03:01,623
I SKIPPED A QUESTION THAT I'LL

1643
01:03:01,623 --> 01:03:02,824
COME BACK TO.

1644
01:03:02,824 --> 01:03:05,460
>> YEAH, I THINK THAT
COULD BE A

1645
01:03:05,460 --> 01:03:06,728
REALLY USEFUL TOOL.

1646
01:03:06,728 --> 01:03:08,630
IT'S NOT GOING TO WORK FOR

1647
01:03:08,630 --> 01:03:10,131
EVERYONE BUT WE'RE SEEING

1648
01:03:10,131 --> 01:03:11,900
EVIDENCE THAT FOR SOME OLDER

1649
01:03:11,900 --> 01:03:13,268
ADULTS THAT CAN WORK AND CAN

1650
01:03:13,268 --> 01:03:16,471
HELP ADDRESS SOME OF THE

1651
01:03:16,471 --> 01:03:17,238
LONELINESS.

1652
01:03:17,238 --> 01:03:18,573
I THINK IT'S SOMETHING THAT, YOU

1653
01:03:18,573 --> 01:03:20,875
KNOW, MAYBE THAT COULD BE PART

1654
01:03:20,875 --> 01:03:24,379
OF PRACTICE, YOU KNOW, WHEN

1655
01:03:24,379 --> 01:03:25,680
YOU'RE -- OLDER ADULTS COULD

1656
01:03:25,680 --> 01:03:27,082
PRACTICE WITH THE TECHNOLOGY, I

1657
01:03:27,082 --> 01:03:30,051
THINK THERE'S BEEN EVIDENCE

1658
01:03:30,051 --> 01:03:32,988
AROUND TEXT MESSAGING AND OTHER

1659
01:03:32,988 --> 01:03:35,223
STUDIES THAT SHOW THAT IT CAN

1660
01:03:35,223 --> 01:03:36,524
WORK FOR SOME PEOPLE, SO

1661
01:03:36,524 --> 01:03:37,592
PARTICULARLY AFTER THE COVID

1662
01:03:37,592 --> 01:03:39,594
PANDEMIC PEOPLE ARE MORE USED TO

1663
01:03:39,594 --> 01:03:42,330
IT, AND EVEN IN OUR OWN HEALTH

1664
01:03:42,330 --> 01:03:43,631
SYSTEM NOT JUST BEHAVIORAL

1665
01:03:43,631 --> 01:03:47,002
HEALTH WE'RE SEEING OLDER ADULTS

1666
01:03:47,002 --> 01:03:47,635
USE TELEHEALTH AT HIGHER RATES.

1667
01:03:47,635 --> 01:03:49,004
I DON'T KNOW IF THERE'S ANYTHING

1668
01:03:49,004 --> 01:03:51,840
YOU WANT TO ADD, DEREK.

1669
01:03:51,840 --> 01:03:53,908
>> I WOULD AGREE
COMPLETELY.

1670
01:03:53,908 --> 01:03:56,911
EXCEPT MAYBE TO ADD BECAUSE OF

1671
01:03:56,911 --> 01:03:58,880
ISSUES LIKE MOBILITY OR CONCERN

1672
01:03:58,880 --> 01:04:01,116
ABOUT NOT JUST GETTING COVID BUT

1673
01:04:01,116 --> 01:04:04,886
GETTING THE FLU OR A COLD THAT

1674
01:04:04,886 --> 01:04:06,788
SOMETIMES PEOPLE PREFER THIS

1675
01:04:06,788 --> 01:04:08,056
MODALITY THAN A BIG GROUP

1676
01:04:08,056 --> 01:04:10,592
SETTING LIKE A.A. OR SELF-HELP

1677
01:04:10,592 --> 01:04:13,428
GROUPS AS WELL AS OF COURSE

1678
01:04:13,428 --> 01:04:14,963
MEETING WITH PROVIDERS AND IT

1679
01:04:14,963 --> 01:04:15,597
LOOKS LIKE REIMBURSEMENT FOR

1680
01:04:15,597 --> 01:04:16,731
TELEHEALTH IS GOING TO BE

1681
01:04:16,731 --> 01:04:21,436
EXTENDED FOR QUITE SOME TIME SO

1682
01:04:21,436 --> 01:04:28,543
THAT'S GREAT. 

1683
01:04:28,543 --> 01:04:29,511
>> I SKIPPED THIS
QUESTION,

1684
01:04:29,511 --> 01:04:29,844
TRACY.

1685
01:04:29,844 --> 01:04:31,112
IS THERE A MENTAL HEALTH

1686
01:04:31,112 --> 01:04:32,981
PSYCHOLOGICAL REASON FOR

1687
01:04:32,981 --> 01:04:40,055
INCREASE IN ALCOHOL CON  CONSUM,

1688
01:04:40,055 --> 01:04:44,359
NOT JUST MID-CLASS

1689
01:04:44,359 --> 01:04:45,794
STRESS/RETIREMENT, MAYBE

1690
01:04:45,794 --> 01:04:46,294
KATHERINE?

1691
01:04:46,294 --> 01:04:48,696
>> THIS REMAINS AN OPEN

1692
01:04:48,696 --> 01:04:50,098
HYPOTHESIS, CERTAINLY CASE AND

1693
01:04:50,098 --> 01:04:52,634
DEATON HAVE MADE THE CASE FOR

1694
01:04:52,634 --> 01:04:55,503
DEPTHS OF DESPAIR INCREASING IN

1695
01:04:55,503 --> 01:04:58,039
THIS AGE GROUP OVERALL COMBINES

1696
01:04:58,039 --> 01:04:59,507
SUICIDE AND MENTAL

1697
01:04:59,507 --> 01:05:01,609
HEALTH-RELATED MORTALITY RATES

1698
01:05:01,609 --> 01:05:03,244
INCLUDING DRUG OVERDOSE WITH

1699
01:05:03,244 --> 01:05:05,547
ALCOHOL-RELATED CAUSES AS WELL

1700
01:05:05,547 --> 01:05:07,949
SO THERE'S THIS HYPOTHESIS THAT

1701
01:05:07,949 --> 01:05:08,650
INCREASES IN ALCOHOL-RELATED

1702
01:05:08,650 --> 01:05:10,919
CONSEQUENCES ARE WRAPPED UP IN

1703
01:05:10,919 --> 01:05:13,421
THESE OTHER SO-CALLED DEPTHS OF

1704
01:05:13,421 --> 01:05:14,956
DESPAIR.

1705
01:05:14,956 --> 01:05:16,357
WE HAVE META ANALYZED DEPRESSION

1706
01:05:16,357 --> 01:05:17,959
AVAILABLE DATA NATIONALLY IN THE

1707
01:05:17,959 --> 01:05:20,028
U.S. FROM ACROSS ALL AGE GROUPS

1708
01:05:20,028 --> 01:05:22,263
AND CERTAINLY WHEN YOU LOOK NOT

1709
01:05:22,263 --> 01:05:23,865
JUST AT MORTALITY-RELATED MENTAL

1710
01:05:23,865 --> 01:05:25,300
HEALTH BUT UNDERLYING STUDIES OF

1711
01:05:25,300 --> 01:05:27,469
MENTAL HEALTH CONDITIONS LIKE

1712
01:05:27,469 --> 01:05:28,403
DEPRESSIVE SYMPTOMS, THERE WE

1713
01:05:28,403 --> 01:05:30,839
SEE REALLY MOST OF THE ACTION IN

1714
01:05:30,839 --> 01:05:33,041
TERMS OF COHORT EFFECT, YOUNG

1715
01:05:33,041 --> 01:05:33,274
PEOPLE.

1716
01:05:33,274 --> 01:05:34,275
THERE HAVE BEEN EXTRAORDINARY

1717
01:05:34,275 --> 01:05:35,543
INCREASES IN MENTAL HEALTH

1718
01:05:35,543 --> 01:05:37,345
PROBLEMS AMONG ADOLESCENTS AND

1719
01:05:37,345 --> 01:05:38,246
YOUNG ADULTS, WE'RE NOT SEEING

1720
01:05:38,246 --> 01:05:41,483
THAT AS MUCH IN OLDER ADULTS.

1721
01:05:41,483 --> 01:05:45,653
THE DATA I'VE LOOKED AT, BEYOND

1722
01:05:45,653 --> 01:05:46,921
DEPTHS OF DESPAIR NARRATIVE,

1723
01:05:46,921 --> 01:05:48,356
DOES NOT SUPPORT MENTAL HEALTH

1724
01:05:48,356 --> 01:05:50,024
BEING THE UNDERLYING DRIVER OF

1725
01:05:50,024 --> 01:05:52,193
THE INCREASES IN OLDER ADULTS

1726
01:05:52,193 --> 01:05:54,963
BUT CERTAINLY I THINK OF COURSE

1727
01:05:54,963 --> 01:05:56,397
A COMPONENT OF INCREASED RATES

1728
01:05:56,397 --> 01:05:59,033
OF DRINKING IN THAT AGE GROUP AS

1729
01:05:59,033 --> 01:06:00,301
WELL.

1730
01:06:00,301 --> 01:06:03,171
>> THANK YOU.

1731
01:06:03,171 --> 01:06:06,674
A QUESTION FROM ANDRE, FOR SARA

1732
01:06:06,674 --> 01:06:13,348
JO NIXON. 

1733
01:06:13,348 --> 01:06:16,417
CAN EXCESSIVE/OVERCAUTIOUS

1734
01:06:16,417 --> 01:06:18,086
BRAKING DURING DRIVE, ALCOHOL,

1735
01:06:18,086 --> 01:06:18,953
AFFECT OVERCAUTIOUS BRAKING

1736
01:06:18,953 --> 01:06:21,122
DURING DRIVING IN OLDER ADULTS,

1737
01:06:21,122 --> 01:06:23,858
SOUNDS LIKE YOU WERE BEHIND

1738
01:06:23,858 --> 01:06:29,931
SOMEBODY WHO WAS DOING THAT.

1739
01:06:29,931 --> 01:06:31,332
>> BESIDES BEING TERRIBLY

1740
01:06:31,332 --> 01:06:34,068
ANNOYING, INDEED, THAT SORT OF

1741
01:06:34,068 --> 01:06:37,138
OVERLY CAUTIOUS APPROACH TO

1742
01:06:37,138 --> 01:06:38,773
DRIVING LIKELY IS A COMPENSATORY

1743
01:06:38,773 --> 01:06:40,642
MECHANISM FOR THE IDEA THAT IF I

1744
01:06:40,642 --> 01:06:42,744
DON'T SLOW DOWN FAST ENOUGH OR I

1745
01:06:42,744 --> 01:06:44,279
NEED TO WATCH WHAT'S HAPPENING

1746
01:06:44,279 --> 01:06:48,683
AROUND ME OR I'LL MISS IT, COULD

1747
01:06:48,683 --> 01:06:49,984
CERTAINLY BE A PART.

1748
01:06:49,984 --> 01:06:52,253
SO THEY THINK IT'S ADAPTIVE

1749
01:06:52,253 --> 01:06:53,588
UNLESS YOU'RE BEHIND THEM; AND

1750
01:06:53,588 --> 01:06:55,890
THEN YOU SWEAR IT'S NOT ADAPTIVE

1751
01:06:55,890 --> 01:06:59,928
AT ALL. 

1752
01:06:59,928 --> 01:07:04,966
>> AND THEN A QUESTION
FROM

1753
01:07:04,966 --> 01:07:06,201
MARILYN WHITE CAMPBELL.

1754
01:07:06,201 --> 01:07:06,501
GREAT TALK.

1755
01:07:06,501 --> 01:07:10,672
I THINK THIS IS FOR YOU, OR FOR

1756
01:07:10,672 --> 01:07:10,939
EVERYBODY.

1757
01:07:10,939 --> 01:07:12,307
THANK YOU ALL.

1758
01:07:12,307 --> 01:07:15,143
WHAT ARE THE RATES OF COGNITIVE

1759
01:07:15,143 --> 01:07:16,811
IMPAIRMENT OR ALCOHOL-RELATED

1760
01:07:16,811 --> 01:07:19,314
DEMENTIA IN OLDER ADULTS AND CAN

1761
01:07:19,314 --> 01:07:20,882
YOU COMMENT ON REVERSIBILITY IN

1762
01:07:20,882 --> 01:07:24,552
THIS AGE GROUP WITH ABSTINENCE?

1763
01:07:24,552 --> 01:07:27,222
I GUESS EITHER SARA JO OR

1764
01:07:27,222 --> 01:07:28,323
KATHERINE KEYS OR ANY ONE OF YOU

1765
01:07:28,323 --> 01:07:30,425
MIGHT WANT TO COMMENT ON THAT.

1766
01:07:30,425 --> 01:07:35,096
>> OR MAYBE NONE OF US.

1767
01:07:35,096 --> 01:07:38,433
THIS IS REALLY A TOUGH ISSUE TO

1768
01:07:38,433 --> 01:07:39,367
BE ABLE TO ADDRESS.

1769
01:07:39,367 --> 01:07:44,772
AND HOW MUCH OF THE EFFECT IS

1770
01:07:44,772 --> 01:07:45,373
REALLY AN ALCOHOL-RELATED

1771
01:07:45,373 --> 01:07:46,407
DEFICIT RATHER THAN TRUE

1772
01:07:46,407 --> 01:07:47,375
DEMENTIA, HOW DO YOU FOLLOW THAT

1773
01:07:47,375 --> 01:07:48,142
OVER TIME?

1774
01:07:48,142 --> 01:07:50,578
HOW DO OTHER RISK FACTORS IMPACT

1775
01:07:50,578 --> 01:07:52,213
THE OUTCOMES ON THAT?

1776
01:07:52,213 --> 01:07:53,948
IT'S TERRIBLY IMPORTANT THAT WE

1777
01:07:53,948 --> 01:07:57,252
KNOW THAT BUT WE ARE GOING TO

1778
01:07:57,252 --> 01:07:57,986
HAVE SYSTEMATIC LONGITUDINAL

1779
01:07:57,986 --> 01:08:00,521
STUDIES TO BE ABLE TO ANSWER IT.

1780
01:08:00,521 --> 01:08:07,428
>> YEAH, I WOULD ECHO,
TRENDS

1781
01:08:07,428 --> 01:08:08,630
DON'T NECESSARILY LINE UP WITH

1782
01:08:08,630 --> 01:08:11,799
TRENDS IN ALCOHOL USE AS WELL

1783
01:08:11,799 --> 01:08:13,468
BUT ALCOHOL USE CAUSED

1784
01:08:13,468 --> 01:08:14,669
CONSEQUENCE, WE KNOW THERE'S A

1785
01:08:14,669 --> 01:08:17,605
CRITICAL ROLE FOR ALCOHOL USE IN

1786
01:08:17,605 --> 01:08:18,740
COGNITIVE IMPAIRMENT AND

1787
01:08:18,740 --> 01:08:19,874
COGNITIVE DECLINE SO I THINK

1788
01:08:19,874 --> 01:08:23,845
THAT'S WHERE A LOT OF US ARE

1789
01:08:23,845 --> 01:08:25,713
PUTTING EFFORT.

1790
01:08:25,713 --> 01:08:26,581
>> FROM ACHIEVEMENT
PERSPECTIVE

1791
01:08:26,581 --> 01:08:29,417
I WANT TO COMMENT SOMETIMES WHAT

1792
01:08:29,417 --> 01:08:30,385
I'VE HEARD FROM PROVIDERS IS

1793
01:08:30,385 --> 01:08:33,688
THAT A PATIENT WILL SHOW UP AT A

1794
01:08:33,688 --> 01:08:34,889
MEMORY CLINIC AND THEY WON'T

1795
01:08:34,889 --> 01:08:36,424
ACCEPT THEM BECAUSE THEY ARE

1796
01:08:36,424 --> 01:08:37,725
DRINKING AND PRESENTS A TRICKY

1797
01:08:37,725 --> 01:08:39,827
CLINICAL ISSUE WHERE YOU DON'T

1798
01:08:39,827 --> 01:08:41,362
WANT TO POSTPONE THAT CARE,

1799
01:08:41,362 --> 01:08:41,696
RIGHT?

1800
01:08:41,696 --> 01:08:43,898
BUT THE MEMORY CLINIC IS LIKE,

1801
01:08:43,898 --> 01:08:45,199
WELL, THEY THINK IT'S THE

1802
01:08:45,199 --> 01:08:47,935
ALCOHOL AND WANT TO TEASE THAT

1803
01:08:47,935 --> 01:08:50,138
OUT. 

1804
01:08:50,138 --> 01:08:52,240
IT'S A HARD TOPIC.

1805
01:08:52,240 --> 01:08:54,075
>> WHILE YOU'RE SPEAKING,

1806
01:08:54,075 --> 01:08:55,810
CYNTHIA, THE NEXT QUESTION IS

1807
01:08:55,810 --> 01:08:59,314
CAN WE MITIGATE THE WAY

1808
01:08:59,314 --> 01:09:02,817
AGE-RELATED COGNITIVE DECLINE  E

1809
01:09:02,817 --> 01:09:04,686
ACTS AS A BARRIER TO NAVIGATING

1810
01:09:04,686 --> 01:09:05,253
TREATMENT AND TREATMENT

1811
01:09:05,253 --> 01:09:06,754
CONDITIONS, SORT OF ALMOST

1812
01:09:06,754 --> 01:09:07,655
ANSWERED THAT.

1813
01:09:07,655 --> 01:09:10,491
BUT IT'S IN THE REVERSE WAY.

1814
01:09:10,491 --> 01:09:13,528
SO HOW DO WE MITIGATE

1815
01:09:13,528 --> 01:09:15,530
AGE-RELATED COGNITIVE ACT AS A

1816
01:09:15,530 --> 01:09:17,932
BARRIER TO NAVIGATING ACCESS TO

1817
01:09:17,932 --> 01:09:19,233
TREATMENT AND TREATMENT OPTIONS?

1818
01:09:19,233 --> 01:09:20,802
>> YEAH, I MEAN, I WISH I
HAD A

1819
01:09:20,802 --> 01:09:22,904
GREAT ANSWER TO THAT.

1820
01:09:22,904 --> 01:09:26,908
I THINK IT CAN BE A BARRIER, AND

1821
01:09:26,908 --> 01:09:29,010
THERE'S THIS MOVEMENT TOWARDS

1822
01:09:29,010 --> 01:09:29,877
MORE AGE-FRIENDLY HEALTH

1823
01:09:29,877 --> 01:09:30,478
SYSTEMS.

1824
01:09:30,478 --> 01:09:33,781
AND I THINK SORT OF TRAINING

1825
01:09:33,781 --> 01:09:36,651
PROVIDERS TO REALLY BE AWARE AND

1826
01:09:36,651 --> 01:09:40,054
RECOGNIZE WHAT ARE AGE-FRIENDLY

1827
01:09:40,054 --> 01:09:41,456
APPROACHES AND NOT PUTTING UP

1828
01:09:41,456 --> 01:09:45,093
BARRIERS IS CRITICAL.

1829
01:09:45,093 --> 01:09:46,260
IT'S NOT FAST, OF COURSE.

1830
01:09:46,260 --> 01:09:47,929
BUT I THINK IT'S REALLY

1831
01:09:47,929 --> 01:09:48,629
IMPORTANT SO THAT WHEREVER YOU

1832
01:09:48,629 --> 01:09:51,899
ARE IN THE HEALTH SYSTEM, NOT

1833
01:09:51,899 --> 01:09:55,069
JUST ADDICTION TREATMENT, YOU'RE

1834
01:09:55,069 --> 01:09:55,703
AWARE OF THESE ISSUES.

1835
01:09:55,703 --> 01:09:57,905
I DON'T KNOW IF DEREK HAS

1836
01:09:57,905 --> 01:09:58,239
ANYTHING.

1837
01:09:58,239 --> 01:09:59,006
>> MAYBE JUST TO ADD THERE
HAS

1838
01:09:59,006 --> 01:10:00,975
BEEN A TREND IN OUR SYSTEM AND

1839
01:10:00,975 --> 01:10:02,210
SOME OTHERS ABOUT INTEGRATED

1840
01:10:02,210 --> 01:10:04,812
BEHAVIORAL HEALTH SERVICES AND

1841
01:10:04,812 --> 01:10:08,750
PRIMARY CARE, SO HAVING MASTER'S

1842
01:10:08,750 --> 01:10:09,684
LEVEL CLINICIANS, SOCIAL

1843
01:10:09,684 --> 01:10:13,154
WORKERS, COUNSELORS, INTEGRATED

1844
01:10:13,154 --> 01:10:15,690
INTO PRIMARY CARE THAT CAN

1845
01:10:15,690 --> 01:10:17,325
ADDRESS, WOULD BE WELL PLACED TO

1846
01:10:17,325 --> 01:10:21,262
ADDRESS THIS AS WELL AS OTHER

1847
01:10:21,262 --> 01:10:22,663
COMORBID MENTAL HEALTH ISSUES.

1848
01:10:22,663 --> 01:10:24,999
PEOPLE MAY NOT BE APPROPRIATE OR

1849
01:10:24,999 --> 01:10:27,368
WILLING TO GO TO SPECIALTY

1850
01:10:27,368 --> 01:10:28,302
ADDICTION TREATMENT.

1851
01:10:28,302 --> 01:10:34,809
>> THAT QUESTION IS FROM
HANNAH.

1852
01:10:34,809 --> 01:10:37,145
ONE MORE, THANK YOU FOR STUDYING

1853
01:10:37,145 --> 01:10:38,246
AND SHARING THIS IMPORTANT

1854
01:10:38,246 --> 01:10:38,446
TOPIC.

1855
01:10:38,446 --> 01:10:39,180
FOR ALL OF YOU.

1856
01:10:39,180 --> 01:10:43,251
DID YOU LOOK AT THE POSSIBLE

1857
01:10:43,251 --> 01:10:46,220
RELATIONSHIPS WITH EARLY ONSET

1858
01:10:46,220 --> 01:10:51,726
OF DRINKING, UNDER-AGE DRINKING

1859
01:10:51,726 --> 01:10:52,560
FOR INSTANCE?

1860
01:10:52,560 --> 01:10:53,761
>> ANYBODY WANT TO TAKE
THAT

1861
01:10:53,761 --> 01:10:54,195
ONE?

1862
01:10:54,195 --> 01:10:55,930
>> WE'VE LOOKED AT THAT TO
SOME

1863
01:10:55,930 --> 01:10:57,932
EXTENT BY LOOKING AT AGE OF

1864
01:10:57,932 --> 01:11:02,370
ONSET OF LIKE REGULAR DRINKING.

1865
01:11:02,370 --> 01:11:06,007
AND WE ARE NOT, IN THIS GROUP OF

1866
01:11:06,007 --> 01:11:06,641
COMMUNITY DRINKERS, FINDING THE

1867
01:11:06,641 --> 01:11:10,278
KINDS OF RELATIONSHIPS THAT YOU

1868
01:11:10,278 --> 01:11:13,114
SOMETIMES FIND IN POPULATIONS

1869
01:11:13,114 --> 01:11:14,282
WITH ALCOHOL USE DISORDER.

1870
01:11:14,282 --> 01:11:18,820
THERE DOES SEEM TO BE AN

1871
01:11:18,820 --> 01:11:20,054
AGE-RELATED VULNERABILITY

1872
01:11:20,054 --> 01:11:21,322
SOMEWHAT DIFFERENT THAN A FACTOR

1873
01:11:21,322 --> 01:11:29,330
OF CHRONICITY OR AGE OF INITIAL

1874
01:11:29,330 --> 01:11:31,098
USE IN THESE DRINKERS.

1875
01:11:31,098 --> 01:11:32,633
>> ONE COMMENT FOR
UNDERAGE

1876
01:11:32,633 --> 01:11:35,002
DRINKING, WHAT'S INTERESTING,

1877
01:11:35,002 --> 01:11:37,438
THE COHORTS NOW IN THEIR 50's

1878
01:11:37,438 --> 01:11:39,507
AND 60s, OLDER ADULTS, THEY

1879
01:11:39,507 --> 01:11:41,175
ARE FROM HEAVY DRINKING UNDERAGE

1880
01:11:41,175 --> 01:11:41,509
COHORTS.

1881
01:11:41,509 --> 01:11:43,711
WHEN WE LOOK AT COHORTS WITH

1882
01:11:43,711 --> 01:11:47,315
HIGHEST RATES OF BINGE DRINKING,

1883
01:11:47,315 --> 01:11:48,516
COHORTS THAT WERE TEENAGERS IN

1884
01:11:48,516 --> 01:11:52,019
THE LATE '70s AND EARLY

1885
01:11:52,019 --> 01:11:53,988
'80s, ONE THING THAT'S

1886
01:11:53,988 --> 01:11:55,089
INTERESTING FROM THE

1887
01:11:55,089 --> 01:11:56,524
EPIDEMIOLOGICAL DATA SINCE THAT

1888
01:11:56,524 --> 01:11:58,392
TIME UNDERAGE DRINKING HAS

1889
01:11:58,392 --> 01:12:00,328
DECLINED THROUGHOUT THE '90s,

1890
01:12:00,328 --> 01:12:04,165
2000s, YOU KNOW, AGE 18

1891
01:12:04,165 --> 01:12:07,235
DRINKING IS GOING DOWN QUITE

1892
01:12:07,235 --> 01:12:07,502
RAPIDLY.

1893
01:12:07,502 --> 01:12:10,304
AT THE SAME TIME WE IN

1894
01:12:10,304 --> 01:12:11,272
EPIDEMIOLOGY, IN ALCOHOL

1895
01:12:11,272 --> 01:12:13,508
EPIDEMIOLOGY, CALL THE REVERSAL.

1896
01:12:13,508 --> 01:12:16,077
AS UNDERAGE DRINKING DECLINED,

1897
01:12:16,077 --> 01:12:18,379
THERE'S BEEN AN ACCELERATION OF

1898
01:12:18,379 --> 01:12:19,280
DRINKING IN TRANSITION TO

1899
01:12:19,280 --> 01:12:20,147
ADULTHOOD, EVEN THOUGH TEENAGERS

1900
01:12:20,147 --> 01:12:23,084
ARE DRINKING LESS THAN EVER,

1901
01:12:23,084 --> 01:12:25,720
THEY ARE EXITING THE TRANSITION

1902
01:12:25,720 --> 01:12:28,456
TO ADULTHOOD AGE BAN WITH

1903
01:12:28,456 --> 01:12:29,891
ACCELERATING RATES COMPARED TO

1904
01:12:29,891 --> 01:12:34,362
PREVIOUS COHORTS, IT'S A

1905
01:12:34,362 --> 01:12:35,663
FASCINATING TOPIC CHANGE OF AGE

1906
01:12:35,663 --> 01:12:37,565
DISTRIBUTION OF ALCOHOL USE AND

1907
01:12:37,565 --> 01:12:41,135
PROBLEMS RELATED TO ALCOHOL USE

1908
01:12:41,135 --> 01:12:42,336
THAT WILL IMPLICATIONS FOR ALL

1909
01:12:42,336 --> 01:12:44,205
AREAS WE TOUCHED ON TODAY IN THE

1910
01:12:44,205 --> 01:12:47,141
COMING DECADES.

1911
01:12:47,141 --> 01:12:49,777
>> YEAH, THANK YOU.

1912
01:12:49,777 --> 01:12:52,747
AND THEN WE HAVE A QUESTION FROM

1913
01:12:52,747 --> 01:12:53,848
MARY CARTO.

1914
01:12:53,848 --> 01:13:01,489
I READ A BOOK, SPIRIT-LED

1915
01:13:01,489 --> 01:13:02,757
SOBRIETY, BY PAULETTE KINEG,

1916
01:13:02,757 --> 01:13:04,225
THROUGH A COMBINATION OF RELYING

1917
01:13:04,225 --> 01:13:08,496
ON FAITH AND LEARNING SCIENCE

1918
01:13:08,496 --> 01:13:11,132
BEHIND AUD, NEURAL PLASTICITY IS

1919
01:13:11,132 --> 01:13:11,465
THE PROCESS.

1920
01:13:11,465 --> 01:13:17,805
WHAT ARE YOUR THOUGHTS ABOUT

1921
01:13:17,805 --> 01:13:18,339
SPIRITUALITY AND SCIENCE

1922
01:13:18,339 --> 01:13:19,173
COMBINING?

1923
01:13:19,173 --> 01:13:20,641
>> THIS IS AN IMPORTANT
TREND IN

1924
01:13:20,641 --> 01:13:25,346
THE ADDICTION TREATMENT THAT

1925
01:13:25,346 --> 01:13:28,649
PEOPLE ARE INTEGRATING,

1926
01:13:28,649 --> 01:13:29,750
EDUCATION, SCIENCE-BASED

1927
01:13:29,750 --> 01:13:32,019
BEHAVIORAL INTERVENTIONS, AS

1928
01:13:32,019 --> 01:13:34,221
WELL AS AUD MEDICATIONS, BUT

1929
01:13:34,221 --> 01:13:40,061
THEN ALSO BEING OPEN TO

1930
01:13:40,061 --> 01:13:41,696
SPIRITUAL-BASED TOOLS INCLUDING

1931
01:13:41,696 --> 01:13:42,797
MINDFULNESS, BEING INVOLVED IN

1932
01:13:42,797 --> 01:13:44,765
A.A., AND WHATEVER THAT MEANS TO

1933
01:13:44,765 --> 01:13:45,633
PEOPLE INDIVIDUALLY.

1934
01:13:45,633 --> 01:13:49,136
SO DEFINITELY SEEING IT AS

1935
01:13:49,136 --> 01:13:50,271
COMPLEMENTARY TO UNDERSTAND THE

1936
01:13:50,271 --> 01:13:52,673
PROCESS OF AUD AS WELL AS FULL

1937
01:13:52,673 --> 01:13:54,575
RANGE OF BEHAVIORAL AND

1938
01:13:54,575 --> 01:14:00,147
SPIRITUAL TOOLS PEOPLE CAN USE.

1939
01:14:00,147 --> 01:14:02,016
>> AND ONE FROM JUDY HAHN.

1940
01:14:02,016 --> 01:14:04,185
BARRIERS TO DETERMINING WHAT IS

1941
01:14:04,185 --> 01:14:06,087
COGNITIVE DECLINE VERSUS ALCOHOL

1942
01:14:06,087 --> 01:14:10,224
USE, HOW ABOUT THE ROLE OF

1943
01:14:10,224 --> 01:14:12,326
ALCOHOL BIOMARKERS?

1944
01:14:12,326 --> 01:14:14,061
MAYBE SARA JO, YOU'VE BEEN

1945
01:14:14,061 --> 01:14:15,162
WORKING IN THIS DOMAIN.

1946
01:14:15,162 --> 01:14:19,867
>> WELL, I WOULD SAY JUDY,
THOSE

1947
01:14:19,867 --> 01:14:22,069
ARE GREAT QUESTIONS ABOUT HOW TO

1948
01:14:22,069 --> 01:14:23,804
ABSOLUTELY DO THAT, SEPARATING

1949
01:14:23,804 --> 01:14:24,772
THOSE OUT.

1950
01:14:24,772 --> 01:14:26,974
AND WE NEED TO HAVE VERY GOOD

1951
01:14:26,974 --> 01:14:27,341
MEASURES.

1952
01:14:27,341 --> 01:14:30,611
I THINK ALCOHOL BIOMARKERS ARE A

1953
01:14:30,611 --> 01:14:34,782
WAY OF TRACKING ACTUAL USE

1954
01:14:34,782 --> 01:14:37,051
RATHER THAN REPORTED USE OVER

1955
01:14:37,051 --> 01:14:37,885
TIME.

1956
01:14:37,885 --> 01:14:40,388
WE DO FIND THERE'S RELATIVELY

1957
01:14:40,388 --> 01:14:41,822
STABLE DRINKING PATTERNS THAT

1958
01:14:41,822 --> 01:14:44,358
THAT DOESN'T MEAN THEY DON'T

1959
01:14:44,358 --> 01:14:45,426
INTERACT WITH OTHER FACTORS,

1960
01:14:45,426 --> 01:14:48,963
THAT PLACE INDIVIDUALS AT

1961
01:14:48,963 --> 01:14:51,132
INCREASED RISK FOR DECLINE,

1962
01:14:51,132 --> 01:14:53,768
REGARDLESS OF ALCOHOL USE, SO

1963
01:14:53,768 --> 01:14:55,069
THOSE THINGS COME TOGETHER.

1964
01:14:55,069 --> 01:14:57,138
WE WILL NEED EXACTLY THIS KIND

1965
01:14:57,138 --> 01:14:58,673
OF SYSTEMATIC KIND OF THING

1966
01:14:58,673 --> 01:15:00,107
YOU'RE TALKING ABOUT FROM

1967
01:15:00,107 --> 01:15:04,612
BIOMARKERS AND OTHER WAYS OF

1968
01:15:04,612 --> 01:15:08,349
MEASURING USE AND MAYBE EMA,

1969
01:15:08,349 --> 01:15:10,084
OTHER WAYS OF TRACKING THESE

1970
01:15:10,084 --> 01:15:11,552
FACTORS, ALL AT THE SAME TIME.

1971
01:15:11,552 --> 01:15:13,154
WE'LL HAVE TO GET CREATIVE HOW

1972
01:15:13,154 --> 01:15:16,123
WE WANT TO DO THAT, TO ANSWER

1973
01:15:16,123 --> 01:15:17,124
THAT QUESTION.

1974
01:15:17,124 --> 01:15:18,659
>> AND THEN FINAL QUESTION
FROM

1975
01:15:18,659 --> 01:15:23,064
EDIE SULLIVAN, WHO DID SOME OF

1976
01:15:23,064 --> 01:15:26,534
THE WORK THAT SARA JO SHOWED IN

1977
01:15:26,534 --> 01:15:28,869
THAT SLIDE.

1978
01:15:28,869 --> 01:15:30,671
EDIE'S QUESTION IS, WITH

1979
01:15:30,671 --> 01:15:32,106
LONGITUDINAL COGNITIVE AND MOTOR

1980
01:15:32,106 --> 01:15:33,541
STUDY OF REDUCING DRINKING IN

1981
01:15:33,541 --> 01:15:35,176
OLDER PEOPLE WE MIGHT OBSERVE

1982
01:15:35,176 --> 01:15:39,647
REVERSAL OF DECLINE IN THEY DO

1983
01:15:39,647 --> 01:15:40,548
NOT ALSO HAVE IRREVERSIBLE

1984
01:15:40,548 --> 01:15:41,615
NON-AUD DEMENTIA.

1985
01:15:41,615 --> 01:15:44,819
IS THERE ANY EFFORT TO EDUCATE

1986
01:15:44,819 --> 01:15:46,253
MEMORY DISORDER CAREGIVERS TO

1987
01:15:46,253 --> 01:15:49,156
INCLUDE FOLKS WITH AUD, HELP

1988
01:15:49,156 --> 01:15:50,391
THEM REDUCE DRINKING, WHICH

1989
01:15:50,391 --> 01:15:54,862
COULD REVEAL WHO HAS AUD-RELATED

1990
01:15:54,862 --> 01:15:56,764
DECLINE VERSUS NON-AUD-RELATED

1991
01:15:56,764 --> 01:16:00,201
DECLINE? 

1992
01:16:00,201 --> 01:16:02,136
AND SO I'M GOING TO GO FIRST TO

1993
01:16:02,136 --> 01:16:04,605
DEREK AND CYNTHIA TO SEE WHAT

1994
01:16:04,605 --> 01:16:08,642
YOU GUYS THINK. 

1995
01:16:08,642 --> 01:16:10,978
>> I WOULD SAY THIS IS A

1996
01:16:10,978 --> 01:16:11,712
CRITICAL DISTINCTION, PROVIDERS

1997
01:16:11,712 --> 01:16:15,750
DO NEED TO BE AWARE OF, THAT

1998
01:16:15,750 --> 01:16:21,689
THEY ARE DIFFERENT FACTORS THAT

1999
01:16:21,689 --> 01:16:22,556
INFLUENCE, THAT CAUSE DEMENTIA,

2000
01:16:22,556 --> 01:16:24,091
SOME MAY ARE MORE REVERSIBLE

2001
01:16:24,091 --> 01:16:25,226
THAN OTHERS.

2002
01:16:25,226 --> 01:16:27,828
AND TO BE DEFINITELY AWARE OF

2003
01:16:27,828 --> 01:16:30,164
THE POTENTIAL FOR IMPROVEMENT

2004
01:16:30,164 --> 01:16:31,899
WITH ABSTINENCE, BUT THEN

2005
01:16:31,899 --> 01:16:34,435
PERHAPS ALSO TO BE AWARE THERE

2006
01:16:34,435 --> 01:16:35,770
COULD BE ADDITIONAL PROCESSES

2007
01:16:35,770 --> 01:16:37,905
GOING ON.

2008
01:16:37,905 --> 01:16:41,242
>> YEAH, I THINK IT GOES
BACK TO

2009
01:16:41,242 --> 01:16:43,978
THE TRAINING OF PROVIDERS,

2010
01:16:43,978 --> 01:16:45,146
DIFFERENT TYPES OF PROVIDERS,

2011
01:16:45,146 --> 01:16:48,215
ABOUT HOW TO BE AWARE AND

2012
01:16:48,215 --> 01:16:49,650
IDENTIFY PROBLEMS AND IT CAN BE

2013
01:16:49,650 --> 01:16:51,085
HARD BUT I THINK THERE'S A LOT

2014
01:16:51,085 --> 01:16:53,220
OF WORK THAT COULD BE DONE

2015
01:16:53,220 --> 01:16:55,756
STILL.

2016
01:16:55,756 --> 01:16:56,791
 

2017
01:16:56,791 --> 01:16:58,526
BY DIFFERENT TYPES OF PROVIDERS.

2018
01:16:58,526 --> 01:17:01,028
>> I'LL MAKE A FINAL
COMMENT,

2019
01:17:01,028 --> 01:17:02,696
THIS HAS BEEN EXCELLENT, THE

2020
01:17:02,696 --> 01:17:04,265
DISCUSSION IN PARTICULAR,

2021
01:17:04,265 --> 01:17:07,301
BECAUSE IT BROUGHT OUT A LOT OF

2022
01:17:07,301 --> 01:17:09,236
THINGS WE COULDN'T COVER BUT

2023
01:17:09,236 --> 01:17:10,538
BROUGHT OUT OVERARCHING THEMES

2024
01:17:10,538 --> 01:17:14,642
WE PICKED UP ON NIAAA,

2025
01:17:14,642 --> 01:17:15,810
CONSIDERING ALCOHOL A VITAL SIGN

2026
01:17:15,810 --> 01:17:18,279
FOR ALL HEALTH CARE PROVIDERS IS

2027
01:17:18,279 --> 01:17:18,579
ONE.

2028
01:17:18,579 --> 01:17:21,215
IT'S A WINDOW ON MEDICAL

2029
01:17:21,215 --> 01:17:21,849
CONDITIONS.

2030
01:17:21,849 --> 01:17:23,050
WE'VE TALKED A GREAT DEAL TODAY

2031
01:17:23,050 --> 01:17:25,786
ABOUT IT, THE WINDOW ON

2032
01:17:25,786 --> 01:17:26,187
COGNITIVE ISSUES.

2033
01:17:26,187 --> 01:17:28,889
BUT THERE'S ALSO THE ISSUE OF

2034
01:17:28,889 --> 01:17:30,758
INTEGRATED CARE, WORKING WITH

2035
01:17:30,758 --> 01:17:32,593
LIVER DOCS AT NIAAA, ACTUALLY

2036
01:17:32,593 --> 01:17:36,230
VERY ACTIVELY RIGHT NOW ABOUT

2037
01:17:36,230 --> 01:17:39,733
INTEGRATED CARE, BUT AS YOU

2038
01:17:39,733 --> 01:17:41,902
POINT OUT COULD BE GENERALIZED

2039
01:17:41,902 --> 01:17:43,537
TO INTEGRATED CARE OF ANY

2040
01:17:43,537 --> 01:17:49,577
DISORDER THAT IS EXACERBATED BY

2041
01:17:49,577 --> 01:17:56,283
ALCOHOL AND VICE VERSA.

2042
01:17:56,283 --> 01:17:58,085
TRACKING KATHERINE IS DOING,

2043
01:17:58,085 --> 01:18:01,422
WORKING OUT WHERE ARE

2044
01:18:01,422 --> 01:18:02,289
VULNERABILITIES, HAVE PICKED UP

2045
01:18:02,289 --> 01:18:04,358
ON THIS ISSUE THAT, YES, WE'VE

2046
01:18:04,358 --> 01:18:05,759
SEEN A 20-YEAR DECLINE IN

2047
01:18:05,759 --> 01:18:06,894
UNDERAGE DRINKING BUT WE'RE ALSO

2048
01:18:06,894 --> 01:18:11,031
SEEING A SHIFT NOW TO THIS

2049
01:18:11,031 --> 01:18:13,133
OLDER, YOU KNOW, YOUNGER ADULT

2050
01:18:13,133 --> 01:18:15,202
AGE GROUP THAT'S DRINKING A LOT

2051
01:18:15,202 --> 01:18:18,339
AND WHAT DOES THAT BODE FOR WHEN

2052
01:18:18,339 --> 01:18:19,974
THEY MOVE INTO THEIR 60s AND

2053
01:18:19,974 --> 01:18:21,342
SO ON AND SO FORTH.

2054
01:18:21,342 --> 01:18:22,743
I THINK EVERYBODY OUT THERE, YOU

2055
01:18:22,743 --> 01:18:25,913
CAN SEE THIS IS A TOPIC WE

2056
01:18:25,913 --> 01:18:28,115
TOUCHED ON TODAY THAT ACTUALLY

2057
01:18:28,115 --> 01:18:30,951
GENERALIZES TO A LOT OF

2058
01:18:30,951 --> 01:18:31,886
CHALLENGES THAT NIAAA FACES IN

2059
01:18:31,886 --> 01:18:33,153
OUR MISSION.

2060
01:18:33,153 --> 01:18:35,422
I THINK I'M GOING TO USE THAT AS

2061
01:18:35,422 --> 01:18:37,291
A SEGUE TO SAY GOOD-BYE TO

2062
01:18:37,291 --> 01:18:39,360
EVERYBODY, AND THANK AGAIN OUR

2063
01:18:39,360 --> 01:18:41,262
SPEAKERS AND ALL THE

2064
01:18:41,262 --> 01:18:43,097
PARTICIPANTS WHO GAVE US SOME

2065
01:18:43,097 --> 01:18:45,499
REALLY, REALLY EXCELLENT

2066
01:18:45,499 --> 01:18:47,034
QUESTIONS.

2067
01:18:47,034 --> 01:18:48,335
THANKS, EVERYBODY.

2068
01:18:48,335 --> 01:18:50,204
>> THANK YOU.

2069
01:18:50,204 --> 01:19:00,204
>> THANKS SO MUCH.