1
|
Kuerbis A, Behrendt S, Morgenstern J. Age as a moderator of motivational interviewing and nondirective client-centered psychotherapy for alcohol use disorder: An exploratory study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:527-539. [PMID: 36871206 PMCID: PMC10050112 DOI: 10.1111/acer.15015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/08/2022] [Accepted: 01/11/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Motivational interviewing (MI) is a widely used intervention applied to a host of health behaviors, including alcohol consumption among individuals with alcohol use disorder (AUD). Age is an underexplored moderator of MI for treating AUD, with the impact of comparing older individuals with their younger counterparts virtually unexplored. Also unexplored is whether age is associated with distinct mechanisms of change (e.g., motivation and self-efficacy) within treatment. METHODS This secondary data analysis utilizes combined data from two previous studies (total N = 228) that both aimed to test MI's mechanisms of action in the context of a goal for moderated drinking. Both studies had three conditions: MI, nondirective listening (NDL), and a self-change condition (SC). In the current analyses, the moderating impact of continuous age and age group, <51 (younger adults, YA) versus ≥51 (older adults, OA), on the impact of MI on alcohol use compared to NDL and SC were tested using generalized linear models. Age differences in confidence and commitment to reduce heavy drinking during treatment were also explored. RESULTS Age group by condition differences emerged, where NDL significantly reduced drinking among YA but not OA (mean -12 vs. -3 standard drinks, respectively). Among OA, MI outperformed NDL but not SC, though the effect was weak. Confidence and commitment during treatment were not significantly different across age-by-condition groups. CONCLUSION Findings underscore the importance of understanding the impact of age on treatment effectiveness, as providing a nondirective intervention for OA with AUD could provide suboptimal treatment. Further research is needed to explore these differential effects.
Collapse
Affiliation(s)
- Alexis Kuerbis
- Silberman School of Social Work, Hunter College, City University of New York, 2180 Third Avenue, New York, NY 10035
| | - Silke Behrendt
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 20, indg. 220 B, 5000 Odense C, Denmark, and OPEN Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; and Institute of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Jon Morgenstern
- Center for Addiction Services and Psychotherapy Research, Northwell Health, 1010 Northern Blvd. Suite 311, Great Neck, N.Y., 11021
| |
Collapse
|
2
|
Choi NG, DiNitto DM, Marti CN, Choi BY. U.S. older adults' heroin and psychostimulant use treatment admissions, 2012-2019: Sociodemographic and clinical characteristics. Drug Alcohol Depend 2022; 231:109256. [PMID: 34998248 PMCID: PMC8810593 DOI: 10.1016/j.drugalcdep.2021.109256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Increases in U.S. older adults' nonprescription opioid and psychostimulant use call for examining their treatment admissions for these substances. METHODS Using admissions age 55 + involving heroin (N = 299,073) from the 2012-2019 Treatment Episode Data Set-Admissions, we examined trends and sociodemographic and clinical characteristics of three groups: (1) heroin-only admissions (i.e., not involving cocaine or methamphetamine), (2) heroin-cocaine admissions, and (3) heroin-methamphetamine admissions. Bivariable and multivariable logistic regression analyses were conducted to examine the research questions. RESULTS Between 2012 and 2019, the numbers of both heroin-only and heroin-cocaine admissions increased 2.3-fold and heroin-methamphetamine admissions increased seven-fold. First time heroin-methamphetamine admissions increased 18-fold. Heroin-methamphetamine admissions were concentrated in the Western region and heroin-cocaine admissions in the Northeastern region. Multivariable analyses showed a nearly 6 times higher relative risk ratio (RRR; 95% CI=5.24-6.74) for heroin-methamphetamine vs. heroin-only admissions in 2019 compared to 2012. Being non-Hispanic Black, compared to non-Hispanic White, was associated with a RRR of 2.4 (95% CI=2.34-2.46) for heroin-cocaine admissions and a RRR of 0.14 (95% CI=0.12-0.15) for heroin-methamphetamine admissions. Late-onset heroin use, experience of homelessness and other psychiatric problems, and past 30-day arrest episodes were associated with a higher likelihood of heroin-cocaine and heroin-methamphetamine admissions, while injection drug use (IDU) was associated with a higher likelihood of heroin-methamphetamine admissions only. CONCLUSIONS Healthcare providers should assess and monitor psychostimulant, methamphetamine in particular, use among older adults. Those who use heroin and psychostimulants should receive substance use treatment and help to secure stable housing and meet other living needs.
Collapse
Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin,Corresponding author: Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712.
| | - Diana M. DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine & Bay Health
| |
Collapse
|
3
|
Ghadigaonkar DS, Kandasamy A, Sivakumar PT. Forensic Aspects of Substance Use in Older Adults. Indian J Psychol Med 2021; 43:S128-S133. [PMID: 34732965 PMCID: PMC8543613 DOI: 10.1177/02537176211047957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Older adults are at high risk of developing more severe consequences of substance use. Due to aging, they may also have multiple medical and psychiatric comorbidities as well as cognitive impairment. This may lead to forensic issues both in terms of civil and criminal matters. This article will review the forensic issues of substance use and their relevance to the older population in particular.
Collapse
Affiliation(s)
| | - Arun Kandasamy
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | |
Collapse
|
4
|
Mejldal A, Andersen K, Bilberg R, Braun B, Bogenschutz M, Bühringer G, Nielsen AS, Silke B. The Alcohol Dependence Scale and DSM-5 alcohol use disorder: Severity ratings correspond insufficiently in older patients. Int J Methods Psychiatr Res 2020; 29:e1811. [PMID: 31808602 PMCID: PMC7051836 DOI: 10.1002/mpr.1811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/10/2019] [Accepted: 10/08/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To investigate the psychometric properties of the frequently used Alcohol Dependence Scale (ADS) in older adults and the associations between ADS scores and alcohol use and DSM-5 AUD symptom counts. METHODS Using baseline data from an international multicenter RCT on outpatient AUD treatment for adults aged 60+ with DSM-5 alcohol use disorder (AUD; n = 529), we computed Cronbach's alpha (α) and applied confirmatory (CFA) and exploratory factor analysis (EFA) to determine the underlying factor structure. A structural equation model (SEM) explored the interrelationship of latent ADS factors with alcohol use and number of DSM-5 criteria endorsed. RESULTS Internal consistency of the ADS (α = 0.81) was good. EFA revealed a three-factor structure. Factor 1 ("Severe withdrawal symptoms") consisted of severe psychoperceptual and psychophysical consequences of excessive drinking, Factor 2 ("Loss of control") consisted of acute physical reactions of intoxication, and Factor 3 ("Obsessive-compulsive drinking") described habitual drinking. The SEM suggested that only Factor 3 had large effects on DSM-5 symptom score and drinking behavior. CONCLUSION Lowering the ADS threshold or focusing on ADS items from Factor 3 may be more suitable measures of severity of alcohol dependence in treatment-seeking older adults as ADS scores are low and not closely related to DSM-5 AUD.
Collapse
Affiliation(s)
- Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Psychiatric Department, Region of Southern Denmark, Odense, Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Psychiatric Department, Region of Southern Denmark, Odense, Denmark
| | - Randi Bilberg
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Psychiatric Department, Region of Southern Denmark, Odense, Denmark
| | - Barbara Braun
- IFT, Institut für Therapieforschung, Munich, Germany
| | | | - Gerhard Bühringer
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,IFT, Institut für Therapieforschung, Munich, Germany.,Institute of Clinical Psychology and PsychotherapyTechnische Universität Dresden, Dresden, Germany
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Psychiatric Department, Region of Southern Denmark, Odense, Denmark
| | - Behrendt Silke
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern DenmarkOdense, Denmark.,BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Psychiatric Department, Region of Southern Denmark, Odense, Denmark
| |
Collapse
|
5
|
Kuerbis A. Substance Use among Older Adults: An Update on Prevalence, Etiology, Assessment, and Intervention. Gerontology 2019; 66:249-258. [DOI: 10.1159/000504363] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/26/2019] [Indexed: 11/19/2022] Open
|
6
|
Vafeas C, Graham R, de Jong G, Sharp J, Ngune I, Maes S. Alcohol consumption patterns of older adults: a study in a regional town in Western Australia. Contemp Nurse 2017; 53:647-657. [PMID: 29279033 DOI: 10.1080/10376178.2017.1421051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM This study aimed to demonstrate that opportunistic health screening at health expos can provide an overall impression of alcohol consumption patterns. DESIGN A repeated cross-sectional survey design, completed over a four-year period (2011-2014), was used to assess the risk of harmful alcohol consumption, within a community setting of older adults, in the South West region of Western Australia. METHODS An alcohol screening survey (AUDIT) was used to collect data on alcohol consumption patterns on those aged 65 years and over. A total of 411 surveys were completed. RESULTS There was a statistically significant difference in mean risk scores across the four years (p < .001). 6.3-22.2% of survey completers presented as 'risky', and a further 3.8-12.3% as 'high risk' in terms of alcohol consumption. CONCLUSIONS Opportunistic screening for alcohol consumption during health expos can aid the identification of at-risk individuals who may require further education or treatment.
Collapse
Affiliation(s)
- Caroline Vafeas
- a School of Nursing & Midwifery , Edith Cowan University , Joondalup , Australia
| | - Renee Graham
- a School of Nursing & Midwifery , Edith Cowan University , Joondalup , Australia
| | - Gideon de Jong
- a School of Nursing & Midwifery , Edith Cowan University , Joondalup , Australia
| | - Jennie Sharp
- b School of Nursing & Midwifery , Edith Cowan University , Bunbury , Australia
| | - Irene Ngune
- c School of Nursing, Midwifery & Paramedicine , Curtin University , Bentley , Australia
| | - Saskia Maes
- d Edith Cowan College, Edith Cowan University , Joondalup , Australia
| |
Collapse
|
7
|
Abstract
Although the myth that older adults do not use mood-altering substances persists, evidence suggests that substance use among older adults has been underidentified for decades. The baby boom generation is unique in its exposure to, attitudes toward, and prevalence of substance use-causing projected rates of substance use to increase over the next twenty years. Given their unique biological vulnerabilities and life stage, older adults who misuse substances require special attention. Prevalence rates of substance use and misuse among older adults, methods of screening and assessment unique to older adults, and treatment options for older adults are reviewed.
Collapse
Affiliation(s)
- Alexis Kuerbis
- Department of Mental Health Services and Policy Research, Research Foundation for Mental Hygiene, Inc, Columbia University Medical Center, 3 Columbus Circle, Suite 1404, New York, NY 10019, USA.
| | - Paul Sacco
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA
| | - Dan G Blazer
- Department of Psychiatry and Behavioral Sciences, Academic Development, Duke University, DUMC 3003, Durham, NC 27710, USA
| | - Alison A Moore
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA
| |
Collapse
|
8
|
|
9
|
Hoge MA, Morris JA, Daniels AS, Huey LY, Stuart GW, Adams N, Paris M, Goplerud E, Horgan CM, Kaplan L, Storti SA, Dodge JM. Report of Recommendations: The Annapolis Coalition Conference on Behavioral Health Work Force Competencies. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2005; 32:651-63. [PMID: 16082800 DOI: 10.1007/s10488-005-3267-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In May 2004, the Annapolis Coalition on Behavioral Health Workforce Education convened a national meeting on the identification and assessment of competencies. The Conference on Behavioral Health Workforce Competencies brought leading consumer and family advocates together with other experts on competencies from diverse disciplines and specialties in the fields of both mental health care and substance use disorders treatment. Aided by experts on competency development in business and medicine, conference participants have generated 10 consensus recommendations to guide the future development of workforce competencies in behavioral health. This article outlines those recommendations. A collaborative effort to identify a set of core or common competencies is envisioned as a key strategy for advancing behavioral health education, training, and other workforce development initiatives.
Collapse
Affiliation(s)
- Michael A Hoge
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Naegle M. A world view of nurses and midwives responding to alcohol, tobacco and other drug issues. DRUGS AND ALCOHOL TODAY 2003. [DOI: 10.1108/17459265200300037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|