Outpatient treatment of alcohol use disorders among subjects 60+ years: design of a randomized clinical trial conducted in three countries (Elderly Study)

Abstract

BackgroundThe proportion of 60+ years with excessive alcohol intake varies in western countries between 6–16 % among men and 2–7 % among women. Specific events related to aging (e.g. loss of job, physical and mental capacity, or spouse) may contribute to onset or continuation of alcohol use disorders (AUD). We present the rationale and design of a multisite, multinational AUD treatment study for subjects aged 60+ years.Methods/Design1,000 subjects seeking treatment for AUD according to DSM-5 in outpatient clinics in Denmark, Germany, and New Mexico (USA) are invited to participate in a RCT. Participants are randomly assigned to four sessions of Motivational Enhancement Treatment (MET) or to MET plus an add-on with eight sessions based on the Community Reinforcement Approach (CRA), which include a new module targeting specific problems of older adults. A series of assessment instruments is applied, including the Form-90, Alcohol Dependence Scale, Penn Alcohol Craving Scale, Brief Symptom Inventory and WHO Quality of Life. Enrolment will be completed by April 2016 and data collection by April 2017.The primary outcome is the proportion in each group who are abstinent or have a controlled use of alcohol six months after treatment initiation. Controlled use is defined as maximum blood alcohol content not exceeding 0.05 % during the last month. Total abstinence is a secondary outcome, together with quality of life andcompliance with treatment.DiscussionThe study will provide new knowledge about brief treatment of AUD for older subjects. As the treatment is manualized and applied in routine treatment facilities, barriers for implementation in the health care system are relatively low. Finally, as the study is being conducted in three different countries it will also provide significant insight into the possible interaction of service system differences and related patient characteristics in predictionof treatment outcome.Trial registrationClinical Trials.gov NCT02084173, March 7, 2014.

Why do some older adults start drinking excessively late in life? Results from an Interpretative Phenomenological Study

“…The present study is a substudy under the Elderly Study (36). The Elderly Study is a clinical randomized trial comparing two different alcohol interventions for people over 60 years, across multiple sites in Denmark, Germany and the USA.…”

Identifying Risk Factors for Late-Onset (50+) Alcohol Use Disorder and Heavy Drinking: A Systematic Review

“…Furthermore, since the number of older adults is set to increase in the coming decades, it is most likely that the number of older adults with a problematic alcohol consumption will increase (Andersen et al, 2015;Bjork, Vinther-Larsen, & Thygesen, 2006;Blazer & Wu, 2009;Hvidtfeldt, Vinther-Larsen, Bjork, Thygesen, & Grønbaek, 2006a, 2006b). The increase in heavy alcohol users among older adults is evident in a Danish study from 2006.…”

Uživanje alkohola med starostniki v domačem okolju: rezultati presejalnega testa SMAST-G

“…od zgodnjega začetka v mladosti, do pretiranega uživanja v srednjih letih ali začetka v poznih letih (Stanojević-Jerković, et al, 2011;Andersen, et al, 2015;Burns, 2015;Barry & Blow, 2016). Tako med starostniki ločimo tri kategorije uživalcev, in sicer v prvo kategorijo sodijo tisti z zgodnjim začetkom in daljšo zgodovino problematičnega uživanja alkohola, pogosto z družinsko anamnezo in zgodovino zdravstvenih težav v odraslem obdobju, kot so ciroza, organski možganski sindrom ali psihiatrične motnje (Stanojević-Jerković, et al, 2011;Andersen, et al, 2015;Burns, 2015).…”

“…od zgodnjega začetka v mladosti, do pretiranega uživanja v srednjih letih ali začetka v poznih letih (Stanojević-Jerković, et al, 2011;Andersen, et al, 2015;Burns, 2015;Barry & Blow, 2016). Tako med starostniki ločimo tri kategorije uživalcev, in sicer v prvo kategorijo sodijo tisti z zgodnjim začetkom in daljšo zgodovino problematičnega uživanja alkohola, pogosto z družinsko anamnezo in zgodovino zdravstvenih težav v odraslem obdobju, kot so ciroza, organski možganski sindrom ali psihiatrične motnje (Stanojević-Jerković, et al, 2011;Andersen, et al, 2015;Burns, 2015). Druga kategorija uživalcev s poznim začetkom problematičnega uživanja alkohola okoli 50. leta ima običajno krajša in daljša obdobja abstinence in predstavlja tretjino problematičnih uživalcev, ki razvijejo uživanje alkohola kot odgovor na življenjske krize, kot so upokojitev, izguba drage osebe in občutki osamljenosti (Stanojević-Jerković, et al, 2011).…”

“…V tretji kategoriji so uživalci, za katere je značilno kompulzivno uživanje alkohola z menjavanjem epizod ekscesnega uživanja alkohola in občasnih epizod kontroliranega uživanja in abstinence (Christie, 2013). Izidi zdravljenja odvisnosti od alkohola s poznim začetkom kažejo zelo dobre rezultate (Stanojević-Jerković, et al, 2011;Christie, et al, 2013;Andersen, et al, 2015;Isted, et al, 2015).…”