Evaluation of adding the community reinforcement approach to motivational enhancement therapy for adults aged 60 years and older with DSM‐5 alcohol use disorder: a randomized controlled trial

Abstract

Aim To examine whether adding the Community Reinforcement Approach for Seniors (CRA‐S) to Motivational Enhancement Therapy (MET) increases the probability of treatment success in people aged ≥ 60 years with alcohol use disorder (AUD). Design A single blind multi‐centre multi‐national randomized (1 : 1) controlled trial. Setting Out‐patient settings (municipal alcohol treatment clinics in Denmark, specialized addiction care facilities in Germany and a primary care clinic in the United States). Participants Between January 2014 and May 2016, 693 patients aged 60+ years and fulfilling DSM‐5 criteria for AUD participated in comparing MET (n = 351) and MET + CRA‐S (n = 342). Intervention and comparator MET (comparator) included four manualized sessions aimed at increasing motivation to change and establishing a change plan. CRA‐S (intervention) consisted of up to eight further optional, manualized sessions aimed at helping patients to implement their change plan. CRA‐S included a specially designed module on coping with age and age‐related problems. Measurements The primary outcome was either total alcohol abstinence or an expected blood alcohol concentration of ≤ 0.05% during the 30 days preceding the 26 weeks follow‐up (defined as success) or blood alcohol concentration of > 0.05% during the follow‐up period (defined as failure). This was assessed by self‐report using the Form 90 instrument. The main analysis involved complete cases. Findings The follow‐up rate at 26 weeks was 76.2% (76.9% in the MET group and 76.0% in the MET + CRA‐S group). The success rate in the MET group was 48.9% [95% confidence interval (CI) = 42.9–54.9%] versus 52.3% (95% CI = 46.2–58.3%) in the MET + CRA‐S group. The odds of success in the two conditions did not differ (odds ratio = 1.22. 95% CI = 0.86–1.75, P = 0.26, Bayes factor = 0.10). Sensitivity analyses involving alternative approaches to missing values did not change the results. Conclusions In older adults with an alcohol use disorder diagnosis, adding the ‘community reinforcement approach for seniors’ intervention to brief out‐patient motivational enhancement therapy treatment did not improve drinking outcome.

History of healthcare use and disease burden in older adults with different levels of alcohol use. A register‐based cohort study

“…The study was conducted by research centers in 3 countries (Denmark, United States, and Germany) between 2014 and 2016. In the current paper, only baseline data from the Danish sites were used (Andersen et al, 2020). Details and results of the Elderly Study can be found in Andersen et al (Andersen et al, 2020).…”

“…Thus, in this retrospective study among adults aged 60–70, with different alcohol use behavior, we aimed to: (1) describe and analyze use of health care over the past 15 years, grouped by current alcohol use behavior, and (2) identify the most common prior morbidities as causes for hospital contacts, and the burden of disease over 15 years in this age group, grouped by current alcohol use behavior. We combined data from 2 studies: the Danish part of the international randomized trial, the Elderly Study (Andersen et al, 2020) (inclusion 2014–2016), and a sub‐sample of the participants in the Danish National Health Survey 2013 (DNHS 2013). The rationale for combining data from the trial with survey data was to include individuals suffering from AUD and seeking treatment, a group typically much under‐represented in surveys (Christensen et al, 2015; McMinn et al, 2020).…”

Substance Use among Older Adults: An Update on Prevalence, Etiology, Assessment, and Intervention

“…Until recently, no studies on MET for substance use included OA ≥62 years. This multinational study compared MET (4 sessions) and MET plus a community reinforcement approach (up to 8 additional sessions) to reduce alcohol use among just under 700 adults ≥60 years [66]. At the 26-week follow-up, half of the participants in both groups (48.9 and 52.3%, respectively) were abstinent or maintained low blood alcohol concentration.…”

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

“…This study is a secondary analysis of data from the Elderly Study; a multisite, randomized controlled clinical trial that examined and compared 2 psychosocial interventions aimed at treating AUD among 60+‐year‐old individuals (Andersen et al, 2020; Andersen et al, 2015). There was no control group that did not receive treatment.…”