Table 2.

Characteristics and findings of studies on age-specific treatment.

Study	Years data collected	Samplea	Mode of treatmentb	Characteristics of age Specific txb	Outcomes of interestc	Methodd	Findings
Dupree, Broskowski and Schonfeld66	NR [Estimated late 70s/early 80s]	N = 24 late onset PD; Age: 55+, M = 64, SD = NR % female: 39 % Cauc: NR % AfAm: NR	OP; Pilot day tx program; Focus: behaviorally oriented, enhancing social support networks, group therapy	4 modules: (1) Analysis of behavior (12 S); (2) Self management in high risk situations (45 S); (3) Education (9 S); (4) Problem solving (13 S)	Program success = abstinence or limited alcohol use; based on self report	Pre-to-post test. Gerontology Alcohol Project (GAP). Drop outs not followed. Time points: 7 Time span: 12 mo. post-discharge	At 12 mo., 74% of program graduates had program success. More females than males drank at home and sought professional help
Kofoed, Tolson, Atkinson, Toth and Turner75	1981–1982	N = 57 V; Controls: (n = 24)—Age: 54–66, M = 59, SD = 3.7, % female: 0; Experimental group: (n = 33)— Age: 55–76, M = 60, SD = 2.9 % female: 12; % Cauc: NR % AfAm: NR	OP; 50% first participated in mixed age IP; Only the OP was adapted	Flexible protocol emphasized socialization and support, slower pace and less confrontation	Retention (no. of mo. in tx, no. of visits, attendance rate), completed 1 year of tx (yes/no); no. of: irregular discharges, known relapses, relapses successfully treated, drinking at discharge	Quasi experimental study with an experimental group (E) and historical controls (C). All data from clinical charts. Time points: 2 Time span: 1 year	E: more mos. in tx, more tx visits, higher rates of completion, fewer irregular discharges than C. E had equal no. of relapses, but greater number of relapses treated successfully than C. Controlled for onset and severity of problem
Kashner, Rodell, Ogden, Guggenheim and Karson76	1987–1989	N = 166 V; Age: 45–70+, M = ~59, SD = NR % female: 0 % Cauc: 90 % AfAm: NR	OP; Discharged from IP, randomly assigned to OAR or traditional program. Both programs were 1 year OP aftercare. Group and individual therapy	Older Alcoholic Rehabilitation (OAR). Goals—building peer relationships, self-esteem. Used reminiscence therapy. Focus: past successes rather not future consequences. Peer lead training and less physical therapy. Non-age-specific program emphasized confrontation	Self and collateral reported abstinence in prior 6 mo	RCT. Time points: 3 Time span: 12 mo. post-discharge 82.5% follow up rate	OARS patients were 2.9 times at 6 mos. and 2.1 times at 12 mos. more likely to report abstinence than those in the traditional program. As age increased in either program, greater response. In OAR, patients had a greater response at older ages than in the traditional programs
Fleming, Manwell, Barry, Adams and Stauffacher56	1993–1995	N = 158 PDs from 24 PC clinics Age: 65+ M = NR, SD = NR % female: 34 % Cauc: NR % AfAm: NR	BI; Intervention group (IG) = 2, 10–15 min with physician; advice, education, contracting for reduced drinking. Controls (C): general health booklet	NR. Presumed feedback adjusted for OA	7 day alcohol use; binge drinking in last 30 days; frequency of excessive drinking in past 7 days;	RCT. Project GOAL. 30 min in-person interviews in PC clinics. Time points: 4 Time span: 12 mo. 92.4% follow up rate	At 12 mo. IG had significantly: fewer drinks in last 7 days (9.92 vs. 16.27); fewer binge episodes in last 30 days (1.83 vs. 5.36); smaller proportion binge drinking in last 30 days (30.8% vs. 49.3%); smaller proportion of excessive drinkers in last 7 days (15.4 vs. 34.3%) than C
Blow, Walton, Chermack and Mudd Brower72	1993–1995	N = 90 patients with AUD Age: 55–91, M = 71, SD = 6.8 % female: 41 % Cauc: 89 % AfAm: 8 % Latino: 3	IP and OP; case management services; identifying community resources	Adapted for physical and cognitive functioning. Less confrontation, CBT, interpersonal and supportive aspects. Emphasis on therapeutic alliance; grief, bereavement, loss, loneliness, boredom, isolation, developmental issues (integrity vs. despair); slower pace	BSI, Diagnostic Interview Schedule, TLFB	Pre-to-post test. Categorized at follow up: Abstainers (55.9%), Non binge drinkers (13.3%), binge drinkers (26.5%), and non-completers (9.4%). Time points: 2 Time span: 6 mo. 75.6% follow up rate	All groups showed improvements in perception of general health and were less limited by pain. Binge drinkers in greater distress than other groups
Oslin, Thompson, Kallan and Ten Have, et al64	1995–1998	N = 2,637 V admitted to IP VA units; screened + for anxiety, depression, and/or at-risk drinking Age: 60+ M = 70, SD = 6.6 % female: 4 % Cauc: ~71 % AfAm: NR	CC; UPBEAT vs. usual care (UC); onsite training and supervision, but no certification of care coordinators; UC = referrals only	Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT): clinical assessment, treatment engagement, help in adhering to tx plan; case management/ care coordination. Specifically for elderly veterans	For at-risk drinkers (n = 1,709): Alcohol Use Disorders Identification Test scores (AUDIT). Mental health related disability: Mental Component Summary (MCS) score on SF-36	RCT. Randomized to UPBEAT or UC after hospitalization. Time points: 4 Time span: 12 mo. 40.1% follow up	Low participation. Outcomes did not differ by condition. AUDIT scores lowered over time for both conditions
Schonfeld, Dupree, Dickson-Fuhrmann, Royer, McDermott, Rosansky, Taylor and Jarvik66	1996–1999	N = 110 V Age: 53–82, M = 65, SD = 5.5 % female: 2 % Cauc: 51 % AfAm: 42 % Latino: 6 % Asian: 2	OP; Weekly support groups for V 60+, CBT (16 S), psycho-education (6 S). Groups were 75 min. Completers went to 13 out of 16 S.	Age specific support groups. CBT program—adapted from GAP (Dupree et al, 1984)—CBT and self management (SM) therapy. Included the SAPE (a structured interview that helps to facilitate CBT modules	Self reported abstinence. Used clinical measures and information from the charts for descriptors	Post-test only. Geriatric Evaluation Team: Substance Misuse/ Abuse Recognition and Treatment (GET SMART). Administrative and clinical records, telephone interviews at follow up Time points: 2 Time span: 6 mo. post-tx	44.5% completed the program. Of those, 55% remained abstinent, 26.5% primarily abstinent with some slips. Of the 55% non-completers— 16% remained abstinent, 31.1% returned to full time use. Completers significantly more likely to remain abstinent, and non-completers likely to return to full use
Slaymaker Owen70	2000	N = 67 Age: 55–88 M = 66, SD = 7.2 % female: 50 % Cauc: 99 % AfAm: NR	IP; Residential treatment. Group and individual S; lectures, homework assignments; self-help groups; 12-step with CBT and MI	Special unit for older adults. Physical accommodations (for vision, hearing, mild cognitive disabilities). Special group topics: grief, loss, life transitions, leisure, recreation	ASI subscale scores. SF-12 for health. Mental component summary (MCS)	Pre-to-post test. Consecutive admissions to IP unit. 33% refused to participate. Time points: 3 Time span: 12 mo. 64% and 58% follow up at 6, 12 mo.	77% completed the program. 71% and 60% were continuously abstinent at 6 and 12 mo. ASI psychiatric scores showed significant change at 6 mo. which remained at 12 mo. Significant improvement in MCS at 6 and 12 mo.
Oslin, Sayers, Ross, Kane, Ten Have, Conigliaro and Cornelius	2000–2002	N = 97 V in PC and specialty care. Presence of depression, suicidality, and/or at-risk drinking Age: 18+, M = 62, SD = 10.5 % female: 4 % Cauc: 50 % AfAm: NR	BI; Usual care (UC) vs. telephone disease management (TDM); TDM = 7 calls, occurred weeks 1–24 post intake. Booklet mailed post-call. 45 min. calls. UC = referral to specialty care	Used BI described in Barry, Oslin, and Blow, 2001. MI based BI for alcohol	At risk drinking = 14+ per week and greater than 3 binge episodes in 3 mo.	RCT. Randomly assigned physician to condition. Time points: 2 Time span: 4 mo. post intake 76.3% follow up rate	Only 31 were at-risk drinkers. Those in TDM had more than twice the rate of response than UC for either depression or at risk drinking. No significant differences in drinking outcomes by condition. Among at-risk drinkers: TDM (n = 16), UC (n = 15)
Oslin, Slaymaker, Blow, Owen and Colleran71	2000–2002	N = 1,358 Age: 50+, M = NR, SD = NR (2 groups, middle-aged and elderly—not defined) % female: 44 % Cauc: 98 % AfAm: 0	IP; 2 rehabilitation facilities for AD; One mixed-age, one age-specific; most services were similar re: group and individual therapy	Age specific facility included handicapped access, slowed program pace, and groups with special topics (eg, life transitions, senior support)	Post-discharge tx engagement; clinical outcomes (abstinence, overall progress; quality of life)	Post hoc analysis. CYTA. Admin-istrative data. Telephone interviews at follow up. Time points: 2 Time span: 1 mo. post-discharge. 64.5% follow up rate	Elderly were less likely to engage in after care, contact a sponsor, or report improved quality of life. As likely to be abstinent as younger group
Oslin and Grantham et al58	2000–2002	N = 560 at-risk drinkers Age: 65+ M = 72, SD = 5.3 % female: 8 % Cauc: 70 % AfAm: NR	BT; Integrated Care (IC) vs. Enhanced Specialty Referral (ESR). IC = provided onsite, services within PC, M visits = 3; ESR = referral offsite, M visits = 1.9	BI (IC) adapted from Barry, Oslin, Blow, 2001	Average number of weekly drinks; no. of binge episodes in the last 3 mo.	Multisite RCT. PRISM-E study. Time points: 2 Time span: 6 mos.	Only 9% had recommended 3 visits of IC. 21% reduced their drinking to safe levels. Both groups demonstrated lower levels of average weekly drinking and binge drinking. No group differences
Zanjani et al61	2000–2001	N = 258 at-risk drinkers. Problematic (n = 111) vs. non-problem-atic (n = 147) Age: 65+, M = 72, SD = 4.7 % female: 0 % Cauc: 66 % AfAm: NR	BT; IC vs. ESR. See Oslin, Grantham et al, 2006 above	BI (IC) adapted from Barry, Oslin, Blow, 2001	At-risk drinking defined as beyond safe levels (eg, more than 7 drinks/ week); Problem drinkers = those w/a score of 3+ on the SMAST-G	Multisite RCT. PRISM-E study. 3 sites-Chicago, Madison, and Philadelphia VA centers; Time points: 4 Time span: 12 mo.	Both groups showed reduction in drinks/week. Only PDs showed reduction in binge drinking. Condition by PD interaction on drinking over time—IC led to fewer binges
Lee et al60	2001–2005	N = 153 drinkers; Normal drinkers (n = 119); at-risk drinkers (n = 34) Age: 65+, M = 75, SD = 8 % female: 61 % Cauc: 40 % AfAm: 45	BT; IC vs. ESR; Site specific differences (respectively): individual vs. group; harm reduction vs. abstinence; IC = 3 sessions of MI; ESR = 12 step oriented, 8 weeks, for individuals 55+	BI (IC) adapted from Barry, Oslin, Blow, 2001	At-risk alcohol use in this analysis: 14 drinks/week for men, 12 for women and 4 binge episodes (4+ drinks) within 3 mo.	Multisite RCT. PRISM-E Study. Single site analysis. Time points: 3 Time span: 6 mo.	Among at-risk drinkers, only 20 out of 34 received tx—92.9% in IC; 35% in ESR. No. of days between screening and engagement for IC was half that of ESR. No. of drinks in past week and no. of binge episodes were significantly different between groups—IC reduced more than ESR. No change in SMAST-G scores
Fink, Elliot, Tsai and Beck49	2000–2003	N = 665 PC patients, 1+ drink in last 3 mo. Ages: 65+, M = 77, SD = 6.2 % female: 53 % Cauc: 88 % AfAm: 1 % Latino: 4 % Asian: 7	BA; Written feedback. 2 interventions: Combined report (both MD and patient receive report); Patient report only; Physicians not trained to intervene	Personalized information provided specific to older adults	Maintenance of nonhazardous drinking (no known risks). Reduction in hazardous drinking (risk for problems); Reduction in harmful drinking (presence of problems)	RCT. 3 PC sites randomized to 1 of 2 interventions or to usual care (UC). Measured via Computerized Alcohol-related Problems Survey (CARPS) Time points : 2 Time span: 12 mo.	Both interventions were associated with greater odds of lowered-risk of drinking than UC. Combined report was no more effective than patient report alone. Only combined report had greater odds of predicting decrease in drinks/week than UC at follow up
Moore and Blow et al63 Lin and Karno et al62	2004–2007	N = 631 PC patients from 3 sites; Age: 55+ M = 69, SD = 6.8 % female: 29 % Cauc: 87 % AfAm: NR % Latino: 9	BI; 2 conditions: Control (C): general health booklet; Intervention (I): feedback, advice from physician, 3 health educator calls (1 40 min S, w/2 20 min S); MI based	Booklet specific to aging and alcohol in intervention condition	Comorbidity Alcohol Risk Evaluation Tool (CARET); Drinks/week; daily use of alcohol; no. of risks; Being an at-risk drinker; risk scores; no. of days drinking; heavy drinking; no. of drinks in last 7 days	RCT. Healthy Living as You Age (HLAYA) study. Time points: 3 Time span: 12 mo.	I: 19.7% did not receive calls; 30% completed 1–2; 50.3% completed all 3. Completing all 3 calls increased odds of being no longer at-risk at 3 mo. follow up compared to no calls. All drinking outcomes improved over time. At 12 mo.: I had lowest number of drinks in last 7 days. I did not reduce at-risk drinking compared to C
Schonfeld, King-Kallimanis, Duchene, Etheridge, Herrera and Barry Lynn50	2004–2007	N = 3,497 Age: NR M = 75, SD = 9.2 % female: 70 % Cauc: 76 % AfAm: 17 % Latino: 16	BI/BT; BI = 1–5 S, often delivered in home, w/health promotion workbook. BT = 16 S of relapse prevention	BI adapted from TIPs 26 and 34. Workbook on quality of life, healthy habits, education, reducing consequences of substance use; used MI techniques. BT = taken from GAP, CBT/SM treatment for older adults.	Short Michigan Alcohol Screening Test-Geriatric Version (SMAST-G); Self-report yes/no questions re: using/ abusing prescription and over-the-counter (OTC) medications and illicit drugs.	Pre-to-post test. Evaluation of pilot program modeled after SBIRT. Discharged individuals could be rescreened. Time points: 2 Time span: 30 days post-discharge	Alcohol (n = 339): SMAST-G scores differed significantly between intake and discharge— from 80% to 18.9%. At discharge: Prescription meds (n = 187): 32.1% improved. Illicit drugs (n = 12): 75% improved. OTC (n = 24): 95.8% improved
Outlaw, Marquart, Roy, Luellen, Moran, Willis and Doub69	2005–2007	N = 199 Age: 50–89 M = 59, SD = 7.4 % female: 33 % Cauc: 54 % AfAm: 34	OP; Weekly groups. Supplemented by individual therapy, case management services, and medication management Substance abuse treatment for the elderly	Utilized tx honed in Schonfeld et al, 2000, and published in CSAT, 2005; 18 S w/CBT rientation	Any alcohol; 5+ drinks; drug use; depression; anxiety; trouble concentrating or understanding as a result of drug or alcohol; stressfulness, emotional problems or reduced activities as a result of drug or alcohol use. Physical health, mental health, and social functioning	Pre-to-post test. Completers vs. non-completers. Completers attended 75% of modules. Time points: 2 Time span: 6 mo. post-baseline	42% completed the program. Completers: Over time, (a) more likely to reduce nonmedical prescription drug use; (b) greater reduction in trouble understanding, concentrating, or remembering; (c) more likely to report less stress, emotional problems and reduced daily activities. Main effects of time on all drinking outcomes. No main effect group differences on other outcomes

Abbreviations:

^aM, mean; SD, standard deviation; Cauc, Caucasian; AfAm, African American; NR, not reported; V, veterans; PC, primary care; AD, alcohol dependence; YA, young adults; MA, middle-ages adults; OA, older adults; PD, problem drinkers; AUD, alcohol use disorders; SA, substance abuse.

^bBA, brief advice; BI, brief intervention; OP, outpatient treatment; IP, inpatient treatment; M, mean; S, session(s); tx, treatment; VA, Veterans Affairs; CBT, cognitive behavioral therapy; NTX, naltrexone; MI, Motivational Interviewing;

^cTLFB, Timeline follow back; BSI, Brief Symptom Inventory; ASI, Addiction Severity Index; BAC, blood alcohol concentration; no., number;

^dCTYA, comparison to young adults; RCT, randomized controlled trial, randomized comparison trial; mo., month(s);

^eLOS, length of stay; tx, treatment; S, session(s); no., number; mo., month(s); ASI, Addiction Severity Index.