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Reliance on informal caregivers without considering the caregiver's ability to provide care can create a stressful and potentially unsafe environment for the caregiver and the care recipient.

While numbers and proportions of older adults with behavioral health issues are expected to substantially increase, there is also a widening gap in available services for older adults. Mobile health interventions (mhealth) are a way to address existing barriers to treatment, provide frontline assessment and increase access to services for older adults. Due to perpetuated stereotypes, many assume that older adults do not utilize mobile technology nor will they accept a mHealth intervention. The purpose of this paper is to synthesize contemporary literature from information technology and healthcare regarding: (1) current mobile technology utilization by older adults, particularly in regards to health; (2) factors affecting older adult motivation to engage with mobile technology; and (3) older adult preferences for interacting with mobile technology. Findings reveal that significant proportions of older adults: already utilize mobile technology; are willing to engage in existing mobile interventions for health reasons; and have positive attitudes overall towards mobile technology. Finally, recommendations for optimizing mobile interventions to better suit older adults with behavioral health problems are reviewed.

Motivational Interviewing (MI) is an effective treatment for substance use disorders (SUD) that focuses on resolving ambivalence and increasing commitment to positive behavior change. While MI has a well developed clinical theory, research findings have been mixed in supporting its view of how change occurs. The primary aim of this pilot study was to test hypothesized MI active ingredients and mechanisms of change in reducing drinking during the initiation of a behavior change episode. Problem drinkers (N=89) seeking treatment were randomly assigned to MI, relational MI without directive elements (Spirit-Only MI, SOMI), or a self-change (SC) control condition. Participants were followed during an eight week treatment period. The first two of four treatment sessions were videotaped and coded for fidelity, discriminability, and change talk. Overall, conditions demonstrated high fidelity. As predicted, change talk significantly increased in MI relative to the SOMI condition. Drinking was significantly reduced at end treatment, but the reduction was equivalent across conditions. Post-hoc analyses found that MI reduced drinking more rapidly than SOMI and SC and that increased change talk mediated the effects of MI relative to SOMI during the week immediately following the first session. Findings are discussed in the context of the pilot nature of the study and the relative absence of experimental tests of mechanisms of behavior change in SUD treatment research.

IntroductionRecent evidence suggests that text messaging may help to reduce problem drinking as an extension to in-person services, but very little is known about the effectiveness of remote messaging on problem drinking as a stand-alone intervention, or how different types of messages may improve drinking outcomes in those seeking to moderate their alcohol consumption.MethodsWe conducted an exploratory, single-blind randomized controlled pilot study comparing four different types of alcohol reduction-themed text messages sent daily to weekly drink self-tracking texts in order to determine their impact on drinking outcomes over a 12-week period in 152 participants (≈ 30 per group) seeking to reduce their drinking on the internet. Messaging interventions included: weekly drink self-tracking mobile assessment texts (MA), loss-framed texts (LF), gain-framed texts (GF), static tailored texts (ST), and adaptive tailored texts (TA). Poisson and least squares regressions were used to compare differences between each active messaging group and the MA control.ResultsWhen adjusting for baseline drinking, participants in all messaging groups except GF significantly reduced the number of drinks consumed per week and the number of heavy drinking days compared to MA. Only the TA and GF groups were significantly different from MA in reducing the number of drinking days. While the TA group yielded the largest effect sizes on all outcome measures, there were no significant differences between active messaging groups on any outcome measure. 79.6% of individuals enrolled in the study wanted to continue receiving messages for an additional 12 weeks at the end of the study.DiscussionResults of this pilot study indicate that remote automated text messages delivered daily can help adult problem drinkers reduce drinking frequency and quantity significantly more than once-a-week self-tracking messages only, and that tailored adaptive texts yield the largest effect sizes across outcomes compared to MA. Larger samples are needed to understand differences between messaging interventions and to target their mechanisms of efficacy.

Objective This study tested the comparative effectiveness of Modified Behavioral Self-Control Therapy (MBSCT) and naltrexone (NTX), as well as the added benefit of combining the two, in problem drinking men who have sex with men (MSM) seeking to reduce, but not quit drinking. Method: Participants (N=200) were recruited and urn randomized to one of two medication conditions, NTX or placebo (PBO) and either MSBCT or no behavioral intervention, yielding four conditions: PBO, NTX, MSBCT, and NTX+MSBCT. In addition, all participants received a brief medication compliance intervention. Participants were treated for 12 weeks and assessed one week after treatment completion. Two primary outcomes - sum of standard drinks and number of heavy drinking days - and one secondary outcome - percentage of those drinking in a non-hazardous manner (NoH) - were selected a-priori. Results: There was a significant main effect for MBSCT (all ps < .01), but not NTX on all three outcomes. In addition, the combination of NTX and MBSCT was not more effective than either MSCBT or PBO. There was a significant interaction effect on NoH, such that NTX significantly increased the likelihood (OR = 3.3) of achieving a non-hazardous drinking outcome relative to PBO. In addition, NTX was significantly more effective than PBO on a descriptive outcome: negative consequences of drinking. Conclusions There was no advantage to adding NTX to MBSCT. In addition, MBSCT showed stronger evidence of efficacy than NTX. At the same time, NTX delivered in the context of a minimal medication compliance intervention was significantly more effective than PBO on an important clinical indicator. Results provide new information to guide the treatment of problem drinking, including in primary care settings.

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Background Helping alcohol dependent individuals to cope with, or regulate, cue-induced craving using cognitive strategies is a therapeutic goal of cognitive behavioral therapy (CBT) for alcohol dependence. An assumption that underlies this approach is that alcohol dependence is associated with deficits in such cognitive regulation abilities. To date, however, the ability to utilize such strategies for regulation of craving has never been tested in a laboratory setting. Methods Here we compared 19 non-treatment-seeking, alcohol dependent drinkers (AD) to 21 social drinkers (SD), using a laboratory task that measured the ability to reduce cue-induced alcohol craving by thinking about long-term negative consequences of drinking, which is a specific cognitive regulation strategy that is taught in CBT. The task also assessed the ability to reduce food craving elicited by high-calorie food cues using a similar strategy. Results The reduction in craving when using this cognitive regulation strategy was approximately double in SD, compared to AD, for both alcohol and food cues. Furthermore, in SD but not AD, the ability to regulate cue-induced alcohol craving was correlated with the ability to regulate food craving. There were no significant correlations found between the ability to regulate cue-induced alcohol craving and a number of self-report measures related to severity of alcohol dependence, baseline craving, impulsivity and general self-regulation ability, for either AD or SD. Conclusions The results suggest that alcohol dependence is associated with deficits in cognitive regulation of cue-induced craving, and that these deficits are not specific to the regulation of alcohol craving, but generalize to the regulation of other appetitive states, such as food craving. Future studies may use similar procedures to address the neural and cognitive processes that underlie such regulation deficits, as well as the effects of treatments such as CBT on these processes.