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Alcoholism Treatment Adherence

Older Age Predicts Better Adherence and Drinking Outcomes

Received November 21, 2001; revised February 5, April 2, 2002; accepted April 11, 2002. From the Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA (DWO), the Center for the Study of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA (DWO,HP,JRV), and the Philadelphia VA Medical Center (DWO). Address correspondence to Dr. Oslin, University of Pennsylvania, 3535 Market Street, Room 3002, Philadelphia, PA 19104. e-mail: oslin{at}mail.med.upenn.edu

OBJECTIVE: Adherence to treatment has been demonstrated to be an important factor for remission from alcohol dependence. The authors compared therapy and medication adherence for treatment of alcohol dependence in older adults with adherence in younger adults. METHODS: All subjects were participants in a randomized, double-blind, placebo-controlled efficacy trial of naltrexone for the treatment of alcohol dependence. All subjects received a medically-based psychosocial intervention focused on motivating patients to change and on adherence to treatment. The therapy is nonconfrontational and is delivered by a nurse-practitioner. RESULTS: Compared with younger adults, older adults had greater attendance at therapy sessions and greater adherence to the medication. Age-group was the only pretreatment factor associated with adherence. The greater adherence in older adults translated to less relapse than in younger adults. CONCLUSION: Treatment for alcohol dependence can be effective for older adults. Older adults appear to respond well to a medically-oriented program that is supportive and individualized. In fact, findings from this study suggest that older adults can be treated in mixed-age treatment settings when psychotherapeutic strategies are used that are age-appropriate and delivered on an individual basis.

Key Words: Alcoholism • Cognitive Therapy • Naltrexone

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