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Alcoholism Treatment Adherence: Older Age Predicts Better Adherence and Drinking Outcomes

      Objective

      Adherence to treatment has been demonstrated to be an important factor for remission from alcohol dependence. The authors compared therapy and medication adherence for treatment of alcohol dependence in older adults with adherence in younger adults.

      Methods

      All subjects were participants in a randomized, double-blind, placebo-controlled efficacy trial of naltrexone for the treatment of alcohol dependence. All subjects received a medically-based psychosocial intervention focused on motivating patients to change and on adherence to treatment. The therapy is nonconfrontational and is delivered by a nurse-practitioner.

      Results

      Compared with younger adults, older adults had greater attendance at therapy sessions and greater adherence to the medication. Age-group was the only pretreatment factor associated with adherence. The greater adherence in older adults translated to less relapse than in younger adults

      Conclusions

      Treatment for alcohol dependence can be effective for older adults. Older adults appear to respond well to a medically-oriented program that is supportive and individualized. In fact, findings from this study suggest that older adults can be treated in mixed-age treatment settings when psychotherapeutic strategies are used that are age-appropriate and delivered on an individual basis.
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      References

        • Liberto JG
        • Oslin DW
        • Ruskin PE
        Alcoholism in older persons: a review of the literature (70 refs.).
        Hosp Community Psychiatry. 1992; 43: 975-984
        • Davies B
        • Bowen C
        Total body water and peak alcohol concentration: a comparative study of young, middle-aged, and older females.
        Alcohol Clin Exp Res. 1999; 23: 969-975
        • Curtis J
        • et al.
        Characteristics, diagnosis, and treatment of alcoholism in elderly patients.
        J Am Geriatr Soc. 1989; 37: 310-316
        • Joe G
        • Simpson D
        • Broome K
        Retention and patient engagement models for different treatment modalities in DATOS.
        Drug Alcohol Depend. 1999; 57: 113-125
        • Janik S
        • Dunham R
        A nationwide examination of the need for specific alcoholism treatment programs for the elderly.
        J Stud Alcohol. 1983; 44: 307-317
        • Kofoed LL
        • et al.
        Treatment compliance of older alcoholics: an elder-specific approach is superior to “mainstreaming”.
        J Stud Alcohol. 1987; 48: 47-51
        • Atkinson R
        • Tolson R
        • Turner J
        Factors affecting outpatient treatment compliance of older male problem drinkers.
        J Stud Alcohol. 1993; 54: 102-106
        • Schuckit M
        • Pastor P
        The elderly as a unique population: alcoholism.
        Alcohol Clin Exp Res. 1978; 2: 31-38
        • Wiens AN
        • et al.
        Medical-behavioral treatment for the older alcoholic patient.
        Am J Drug Alcohol Abuse. 1982–1983; 9: 461-475
        • Dupree L
        • Broskowski H
        • Schonfeld L
        The Gerontology Alcohol Project: a behavioral treatment program for elderly alcohol abusers.
        Gerontologist. 1984; 24: 510-516
        • Schonfeld L
        • Dupree LW
        • Dickson-Euhrmann E
        • et al.
        Cognitive-behavioral treatment of older veterans with substance abuse problems.
        J Geriatr Psychiatry Neurol. 2000; 13: 124-129
        • Kashner TM
        • et al.
        Outcomes and costs of two VA inpatient treatment programs for older alcoholic patients.
        Hosp Community Psychiatry. 1992; 43: 985-989
        • Rice C
        • et al.
        Age-group differences in response to treatment for problematic alcohol use.
        Addiction. 1993; 88: 1369-1375
        • Pettinati H
        • et al.
        Improving naltrexone response: an intervention for medical practitioners to enhance medication compliance in alcohol-dependent patients.
        J Addict Dis. 2000; 19: 71-83
        • Volpicelli J
        • et al.
        Combining Medication and Psychosocial Treatments for Addictions: The BRENDA Approach. Guilford, New York2001
        • Oslin D
        • et al.
        Alcohol-related dementia: proposed clinical criteria (62 refs).
        Int J Geriatr Psychiatry. 1998; 13: 203-212
        • Oslin D
        • et al.
        Naltrexone as an adjunctive treatment for older patients with alcohol.
        Am J Geriatr Psychiatry. 1997; 5: 324-332
        • O'Malley SS
        • et al.
        Naltrexone and coping-skills therapy for alcohol dependence: a controlled study.
        Arch Gen Psychiatry. 1992; 49: 881-887
        • Volpicelli JR
        • et al.
        Naltrexone in the treatment of alcohol dependence.
        Arch Gen Psychiatry. 1992; 49: 876-880
        • Chick J
        • et al.
        A multicentre, randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of alcohol dependence or abuse.
        Alcohol Alcohol. 2000; 35: 587-593
        • Sobell L
        • et al.
        Reliability of a timeline method: assessing normal drinkers' reports of recent drinking and a comparative evaluation across several populations.
        Br J Addiction. 1988; 83: 393-402
        • Sobell LC
        • Sobell MB
        Timeline follow-back: a technique for assessing self-reported alcohol consumption.
        in: Litten R Allen J Measuring Alcohol Consumption. Humana Press, Inc., Totowa, NJ1992: 41-65
        • Miller W
        • et al.
        Long-term follow-up of behavioral self-control training.
        J Stud Alcohol. 1992; 53: 249-261
        • McLellan AT
        • Lubrosky L
        • O'Brien CP
        An improved evaluation instrument for substance abuse patients: the Addiction Severity Index.
        J Nerv Ment Dis. 1980; 168: 26-33
        • McLellan AT
        • et al.
        The fifth edition of the Addiction Severity Index.
        J Subst Abuse Treat. 1992; 9: 199-213
        • McHorney CA
        • et al.
        The MOS 36-item Short-Form Health Survey (SF-36), III: tests of data quality, scaling assumptions, and reliability across diverse patient groups.
        Med Care. 1994; 32: 40-66
        • McLellan AT
        • et al.
        New data from the Addiction Severity Index: reliability and validity in three centers.
        J Nerv Ment Dis. 1985; 173: 412-423
        • Anton RF
        New methodologies for pharmacological treatment trials for alcohol dependence.
        Alcohol Clin Exp Res. 1996; 20: 3A-9A
        • Kranzler H
        Efficacy of naltrexone and acamprosate for alcoholism treatment: a meta-analysis.
        Alcohol Clin Exp Res. 2001; 25: 1335-1341
      1. Miller WR, et al: Motivational Enhancement Therapy Manual. NIAAA Project MATCH Monograph Series, Vol 2. Washington, DC, NIH Publication No. 94-3723. 1995, U.S. Government Printing Office, 1995

        • Amodeo M
        Treating the late-life alcoholic: guidelines for working through denial, integrating individual, family, and group approaches.
        J Geriatr Psychiatry. 1990; 23: 91-105
        • Oslin DW
        • Liberto JG
        Substance abuse in the elderly.
        in: Wilner P Psychiatry. JB Lippincott, Philadelphia, PA1995
        • Fleming M
        • et al.
        Brief physician advice for alcohol problems in older adults: a randomized, community-based trial.
        J Fam Pract. 1999; 48: 378-384
        • Barry KL
        • et al.
        Elder-specific brief alcohol intervention: 3-month outcomes (abstract).
        Alcohol Clin Exp Res. 1998; 22: 32A