What do elderly problem drinkers aim for? Choice of goal for treatment among elderly treatment-seeking alcohol-dependent patients

Abstract

Objective: The patient’s free choice of treatment goals for alcohol use disorder (AUD) is predictive for treatment outcome. Presently there is limited knowledge of whether the age at onset of AUD influences the choice of goal for treatment. The present study investigates whether there are differences in choice of treatment goal between patients with very late onset alcohol use disorder (VLO AUD ≥ 60 years) and those having early or mid-age onset of AUD (EMO AUD < 60 years). Method: Participants were 341 persons, voluntarily enrolled in the Elderly Study, who were seeking treatment for AUD in outpatient centres for alcohol treatment in Denmark. Data regarding thoughts about abstinence, alcohol use in the last 90 days, motivation for treatment and psychiatric diagnosis were collected via questionnaires. A logistics regression was used to analyse the data. Results: 32.1% of the participants with VLO AUD chose temporary abstinence goals, compared to 18.2% of the patients with earlier-onset AUD ( p = 0.024). Further, 10.7% of participants with VLO AUD chose total abstinence goals compared to 31.3% of participants with early or mid-age onset AUD ( p = 0.002). Conclusion: There are significant differences in choice of goal between participants with very late onset AUD and early or mid-age onset AUD. Individuals with very late onset alcohol use disorder tend to choose temporary abstinence over any other treatment goal whereas, in general, individuals with early onset alcohol use disorder choose permanent abstinence over other treatment goals.

Stability of Posttreatment Reductions in World Health Organization (WHO) Drinking Risk Levels and Posttreatment Functioning in Older Adults with DSM‐5 Alcohol Use Disorder: Secondary Data Analysis of the Elderly Study

“…Particularly, even when abstainers were excluded from the analysis, risk‐level reductions were maintained, and improvements in functioning could be measured, especially for the 2‐level risk reduction group. As noted by Witkiewitz and colleagues (2019), this is important as many treatment‐seeking individuals with AUD prefer nonabstinence goals (Haug et al, 2018; Haug et al, 2017), which may in particular be the case for those who are elderly (Emiliussen et al, 2019).…”

“…Over the last decades, the prevalence of AUD among older adults has increased (Geels et al, 2013; Han et al, 2019; Han et al, 2017; The Danish Health Authority, 2015), and consequently, there is also an increase in the number of older adults who seek treatment for AUD (Nielsen et al, 2010). Although knowledge about treatment of older adults (60+ years) suffering from AUD is rather limited (Kuerbis, 2020), this new patient group seems to aim for reduced alcohol intake rather than abstinence, in particular if the onset of the AUD has happened late in life (Emiliussen et al, 2019). From a health point of view, such a nonabstinent reduction in alcohol consumption is associated with being beneficial for both somatic and mental health (Knox et al, 2019a; Knox et al, 2018; Knox et al, 2019b).…”

“…R ESEARCHERS AND TREATMENT professionals have long considered complete abstinence the safest and, therefore, optimal outcome of treatment for alcohol use disorder (AUD), and especially so for ICD-10 and DSM-IV alcohol dependence (Mann et al, 2017). However, individuals seeking treatment for AUD are often interested in drinking reduction rather than completely giving up drinking (Emiliussen et al, 2019), and it is common that individuals treated for AUD are engaging in drinking following treatment, albeit often at a reduced level (Miller et al, 2001).…”

Treating patients with multiple substance use in accordance with their personal treatment goals: a new paradigm for addiction treatment

“…For example, in almost all applications of MI with smokers it is apparent that smoking cessation is set as an apparently self-evident goal and that the options "reduced smoking" and "harm reduction" (switching to e-cigarettes) are not at all considered and treated as legitimate goals (Bommelé et al, 2017;Lindson-Hawley et al, 2015) and this despite the fact that the majority of smokers prefer reduction treatment to abstinence treatment (Glasgow et al, 2006). The same is true for the use of MI in the treatment of alcohol use disorders (Emiliussen et al, 2019).…”

Can gambling-funded research be non-biased? The case of section 52

“…Tove Sohlberg surveys former smokers’ support of tobacco control policies in Sweden ( Sohlberg, 2019 ); Emiliussen, Andersen, Nielsen, Braun, and Bilberg have inquired into how goals are defined for elderly alcohol-dependent patients seeking help ( Emiliussen et al, 2019 ); Johansen, Kristiansen, Bjelland, and Tavakoli study the under-researched group of SUD therapists ( Johansen et al, 2019 ); help-seeking in drug-related emergency situations is examined with the help of online surveying in Sweden ( Soussan and Kjellgren, 2019 ); and gambling among homeless people in Poland is explored by Łukasz Wieczorek, Stokwiszewski, and Klingemann (2019) .…”