Relapse Prevention and Maintaining Abstinence in Older Adults with Alcohol-Use Disorders

Abstract

Although older adults are sometimes believed to have the lowest rates of alcohol abuse as an age cohort, the prevalence of alcohol use and abuse in this group is clearly underestimated. The under-diagnosis of alcohol abuse is due, in part, to the facts that the effects of alcohol use among older adults tend to be less clearly visible than among other age groups and that older adults are less likely to seek treatment than younger age groups. An additional challenge to diagnosis may be a lack of previous alcohol abuse by the patient, as approximately one-third of older adults with alcohol-use problems first develop their drinking problem after the age of 60 years. With a demographic shift that is expected to increase the number of older adults with alcohol problems, the awareness and understanding of this problem becomes increasingly important. Under-diagnosis of problem drinking in older adults is particularly unfortunate because the risks associated with alcohol abuse and relapse for the elderly are significant. Relapse, or the return to drinking following abstinence, may follow situations that are of particularly high risk for older adults. These include situations related to anxiety, interpersonal conflict, depression, loneliness, loss or social isolation. By helping patients to monitor these high-risk situations, to identify strategies that have been successful in promoting abstinence in the past, and to become engaged in treatment, relapse may be avoided and abstinence maintained. Treatments such as cognitive-behavioural therapy, group and family therapies and self-help groups are just as effective for older adults as they are for other age groups. In fact, group and family therapies and self-help groups may be of particular benefit to older adults because of the emphasis on social support. Medicinal adjuncts are also equally effective in the elderly, but strict compliance and careful monitoring of adverse effects are especially important in patients who take multiple medications. Because of their benign adverse effect profiles, naltrexone and acamprosate are particularly good pharmacological agents for relapse prevention in older adults.

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

“…There have been concerns about the increased risk of serious adverse effects in older adults prescribed disulfiram due to physical comorbidities and polypharmacy and the risks of precipitating a confusional state (Dufour and Fuller, 1995;Dunne, 1994;Schonfeld and Dupree, 1995 (IV)) and cardiovascular concerns if there was a drug-alcohol interaction (Barrick and Connors, 2002) (IV). However, Zimberg (2005) (IV) reports that disulfiram is safe and effective in a dose of 125 mg per day in elderly patients who are not suffering from significant cardiovascular or liver disease and who do not have significant cognitive impairment.…”

Characterization of the ethanol-deprivation effect in substrains of C57BL/6 mice

“…Relapse drinking behavior is a ubiquitous problem for individuals recovering from alcoholism, since at least 60-80% of abstinent alcoholics will relapse during their lifetime (Barrick and Connors, 2002;Chiauzzi, 1991;Jaffe, 2002;Weiss et al, 2001). Relapse and ethanol craving are an important focus of therapeutic approaches towards treatment of alcoholism.…”

The Role of Neuropeptide Y (NPY) In Uncontrolled Alcohol Drinking and Relapse Behavior Resulting From Exposure to Stressful Events

“…This paper is currently under review for the journal Psychopharmacology. of abstinent alcoholics will relapse at one point in their lifetime (Barrick and Connors 2002;Chiauzzi 1991). Thus, understanding the neurobiology of relapse and associated behaviors is a critical step towards the development of drugs aimed at treating alcoholism.…”