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The authors describe the initial cohort of participants in the GET SMART program, an age-specific, outpatient program for older veterans with substance abuse problems. Chief among the program's services is a relapse-prevention intervention consisting of 16 weekly group sessions using cognitive-behavioral (CB) and self-management approaches. Group sessions begin with analysis of substance use behavior to determine high-risk situations for alcohol or drug use, followed by a series of modules to teach coping skills for coping with social pressure, being at home and alone, feelings of depression and loneliness, anxiety and tension, anger and frustration, cues for substance use, urges (self-statements), and slips or relapses. Of the first 110 admissions, more than one-third were homeless, which is indicative of the severity of psychosocial distress of the patients, and more than one-third used illicit drugs. A total of 49 patients completed CB treatment groups and 61 dropped out of treatment. At 6-month follow-up, program completers demonstrated much higher rates of abstinence compared to noncompleters. The results suggest that CB approaches work well with older veterans with significant medical, social, and drug use problems.

Recent research suggests that older adults with alcohol problems often drink in response to loneliness, depression, and poor social support networks. Although a variety of approaches such as psychodynamic, Twelve Step, social support, behavioral, and cognitive-behavioral, have been suggested, only those studies involving behavioral and cognitive-behavioral interventions have provided empirical support for treatment effectiveness. Some research also suggests that age-specific group treatment produces better outcomes than when older adults are placed in treatment with younger alcoholics.

Research on mental health service utilization patterns has shown that older adults underutilize outpatient services, particularly in minority populations. Greater reliance on inpatient services may result when a mental health problem can no longer be ignored. The goal of this study was to compare the attitudes and beliefs of African American and Caucasian older adults about mental health care and preferred providers. A 47-item survey was administered to a convenience sample of 1,598 primarily African Americans, recruited at 40 sites, including the study sample of 726 people older than age 50. Results showed that respondents of both races preferred advice from their family doctor, clergy, or a family member. African Americans preferred services in their doctor's or clergy's office, whereas Caucasians preferred a professional service provider's office. Findings suggest that providers and policy makers consider the impact of age, culture, and ethnicity on mental health services provision.By the year 2010, it is projected that 15% of Americans will be age 65 or older, and this proportion will rise to approximately 20% by the first quarter of the 21st century. Frequently overlooked is that a growing share of the increase will consist of ethnic minority elders, projected to comprise 40% of the population older than age 65 by