How do family pressure, health and ambivalence factor into entering alcohol treatment? Experiences of people aged 60 and older with alcohol use disorder

Perceived advantages and disadvantages of substance use in a dual diagnosis population with severe mental disorders and severe substance use disorder. Considering the self-medication hypothesis

AIM

Based on a large cohort of dual diagnosis patients, the aim of this study was to quantify the patient-perceived problems and advantages of their substance use and relate the quantity of problems to the substance type and psychiatric diagnosis.

MATERIAL

Data comes from a naturalistic cohort admitted to an in-patient facility in Denmark specialized in integrated dual diagnosis treatment. We included 1076 patients at their first admission to the facility from 2010 to 2017. Participants completed 607 DrugCheck and 130 DUDIT-E questionnaires.

METHOD

we analyzed the questionnaires and included admission diagnosis by use of t-test and ANOVA to depict the patterns in substance use in relation to psychiatric diagnosis.

RESULTS

The three most common substance related problems according to the DrugCheck questionnaire were: feeling depressed, financial problems, and losing interest in daily activities. From DUDIT-E, the highest-ranking negative substance related effects were financial ruin, deterioration of health, and problems at work. Effects on social life relationships were also evident with more than 40% of participants. The top three positive substance related effects reported were relaxation, improved sleep, and control over negative emotions. The number of problems listed varied significantly with the type of preferred substance. Patients using pain medication, sedatives, central stimulants, and alcohol reported most problems. Diagnosis did not differentiate the problems experienced. Results partially support the broad self-medication hypothesis for patients with severe mental illness, but also points out that patients are well aware of negative effects.

'Ageing with an alcohol problem is not what I envision': reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems

BACKGROUND

Eliciting and understanding older persons' descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing.

METHODS

Eight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews.

RESULTS

Three themes were identified: "Tipping the balance", "Staying behind a veil" and "Lifting the vail". First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery.

CONCLUSIONS

Older persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons' desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.

Characteristics of people who have received treatment for late-onset problem drinking and alcohol use disorder: A systematic review and narrative synthesis

Aims: The current review investigated the psychosocial characteristics of late-onset problem drinkers, an under-researched area of alcohol harm that accounts for one-third of older problem drinkers. Method: Following the PRISMA model, the protocol and search strategy included a scoping search and main search of nine databases. A total of 1,595 papers were identified; after screening, 26 papers were considered eligible and were included in the review. The review used an investigative framework comprising three categories: standardising age of onset; gender differences; and psychosocial and mental health characteristics. The review also investigated how meaning and purpose in life, and treatment have been reported in relation to this cohort. Findings/Conclusions: The combined onset ages of the reviews’ 26 papers (mean age = 52.69 years) and the participants’ self-reported age at onset (mean age = 56.79 years), suggest that late-onset alcohol use disorder (AUD)/problem drinking is likely to emerge at the age of 55 years and older. Moreover, there is a high prevalence of co-morbid mental health disorders among elderly, late-onset drinkers. Retirement was reported as the most prevalent psychosocial risk factor for late-onset problematic drinking; other late-life events included bereavement, loneliness and social isolation, and boredom. In the context of gender, women are at greater risk of developing late-onset problem drinking than men. Furthermore, late-onset problem drinkers, particularly women, are more treatment compliant than their early-onset counterparts, highlighting the case for bespoke treatments/interventions for late-onset problem drinkers. Finally, the role that meaning and purpose in life plays in late-onset problem drinking has been under-reported and requires further investigation.

Why treatment is not an option: Treatment naïve individuals, suffering from alcohol use disorders’ narratives about alcohol use and treatment seeking

Aims: To investigate the narratives of in- and outpatients at mental health and somatic hospitals, who suffer from alcohol use disorders (AUD) but have never sought AUD treatment. More specifically, to understand how the individuals view their alcohol use and explore their reasons for not seeking treatment. Methods: Individuals suffering from AUD were recruited at somatic and mental health hospitals. The study was qualitative, based on semi-structured individual interviews. A narrative analysis was performed. A total of six patients participated: three recruited at a mental health hospital, three from a somatic hospital. Results: The individuals described how heavy alcohol use had always characterised their lives; it was part of their surroundings and it added to their quality of life. Two narrative forms within the individuals’ stories were identified, in which treatment was considered either as a positive option for others but not relevant for themselves, or as representing a threat to the individuals’ autonomy. The participants expressed that they did not believe treatment was relevant for them, and if necessary, they preferred to deal with their heavy drinking themselves. Conclusions: Our findings indicate that a broad focus is needed if relatively more individuals suffering from AUD should seek treatment, since they – in spite of clearly suffering from AUD – nevertheless see themselves as heavy drinkers and have not even thought of seeking treatment. Thus, it is not (only) a question about the attractiveness of the treatment offer or due to lack of knowledge about treatment options that patients suffering from AUD do not seek treatment.

Exploring life-course patterns of substance abuse: a qualitative study

OBJECTIVES

This research sought to examine how older adults with substance abuse issues understand the pattern of their use. Qualitative interviews explored: (1) Whether self-reported age of onset of substance abuse in fact aligned with the age when use became problematic; (2) Patterns of substance use over the life-course; (3) Precipitants of substance use throughout the lifespan; (4) Factors that prevented identification of problem use; (5) How participants came to recognize that their substance use was problematic.

METHOD

Participants were 11 men and 9 women aged 62-78 years (M = 69.80, SD = 3.86) who were clients of an older adult substance abuse treatment program. Semi-structured interviews were conducted and transcribed for thematic analysis.

RESULTS

Interview data revealed discrepancies between self-identified age of substance abuse onset and reported problematic use throughout the lifetime. Thematic analysis revealed factors that contributed to participants not recognizing problem use earlier in life, such as normalizing and minimizing the impact of use and lack of severe consequences earlier in life. Additionally, factors that led to increased use (i.e. retirement, grief), and to recognition of problem use and treatment-seeking were identified (i.e. social, financial, legal, and health problems).

CONCLUSION

In general, self-reported age of substance abuse onset and patterns of substance abuse were highly variable across participants. These results have implications for assessment of substance use among older adults, as well as preventative efforts to decrease risk of substance abuse.

Choice, coercion, and/or muddling through: Older adults' experiences in seeking psychological treatment

Help-seeking related to mental health concerns has been found to decrease as age increases . Despite extensive literature devoted to barriers to accessing mental health services, the reasons why older adults are especially unlikely to seek treatment are not well understood. The present study had two objectives concerning the experiences of older adults accessing outpatient psychological treatment: 1) classifying pathways into treatment using the Network Episode Model (NEM; Pescosolido et al., 1998), and 2) critically examining whether these pathways effectively captured the process of seeking treatment for older adults. Utilizing secondary qualitative data from three studies (N = 35), we met our first objective of classifying pathways according to the NEM with directed content analysis. The majority (n = 21, 60%) of older adults willingly accessed treatment (choice) and 42.9% of those involved 'others' in their help-seeking by way of referrals or support. The remaining participants' (n = 14, 40%) pathways into treatment reflected a process of muddling through (being unsure of their need for mental health services and where to access support, or bouncing around the treatment system). No participants' pathways were categorized as coercive. To meet our second objective, we used conventional content analysis to explore how best to categorize pathways to treatment. Findings demonstrated that a minority of participants (n = 10, 28.6%) had a help-seeking journey that represented only one of the three pathways. Instead, most participants described a lengthy period of muddling through, eventually followed by a willingness to seek help. These findings highlight the complex process of seeking treatment, and suggest a need to implement more direct mental health literacy interventions to reduce the amount of time spent muddling through, while improving the experience of mental health help-seeking for older adults.

Alcohol use and generational masculinity: An interdisciplinary approach

INTRODUCTION

Alcohol ranks as a major risk factor for health-related harm and mortality. Older males who encounter alcohol problems late in life are an under-studied part of the affected population. This article seeks to broaden our understanding of this group by combining empirical data with humanistic cultural analysis. Specifically, it seeks to show how the desire to cope alone can be linked to generationally specific constructions of hegemonic masculinity.

METHOD

Clinical empirical methods are fused here with those of literary analysis. The subjects which the clinical researcher chooses for scrutiny are different from those most natural to literary study, yet the interpretive approaches of qualitative phenomenological investigation and literary close reading are in fact quite similar, and we argue that new knowledge can be generated by evaluating cultural texts alongside the testimony of phenomenological research subjects.

FINDINGS AND DISCUSSION

Our findings illustrate a thematic connection between subject testimony and literary texts from the relevant historical period. In the sources we compared - a qualitative study conducted in Denmark and a British novel, Kingsley Amis's 1954 Lucky Jim - we found a strong link between the values of masculinity and the values of independence. Older men's resistance of institutional treatment for alcohol problems has motivations which go beyond the desire not to rely on outside aid, a desire which may apply to any illness. As Lucky Jim helps us show, alcohol use functions for men of a certain generation as a symbol of rebellion against institutions, and having institutions play a dominant role in their alcohol cessation may create resistance in these men.