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1 Graduate Center for Gerontology, University of Kentucky, Lexington.
Departments of 2 Psychiatry (Section of Geriatric Psychiatry)
3 Biostatistics, University of Pennsylvania, Philadelphia.
4 Philadelphia Veterans Affairs Medical Center (VAMC), VISN 4 Mental Illness, Research, Education and Clinical Center, Pennsylvania.
5 College of Medicine, Psychiatry, University of Illinois, Chicago.
6 Chicago VA Medical Center, Illinois.
7 William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
8 Department of Psychiatry, University of Wisconsin School of Medicine and Population Health, Madison.
9 Department of Psychiatry, University of Miami, Florida.
10 University of Arkansas for Medical Sciences, Little Rock.
11 Miami VAMC, Florida.
12 Office of Mental Health Services, U.S. Department of Veterans Affairs, Washington, DC.
13 Office of Geriatrics and Extended Care, U.S. Department of Veterans Affairs, West Palm Beach, Florida.
14 Philadelphia Center of Excellence for Substance Abuse Treatment and Evaluation (CESATE), Pennsylvania.
15 Department of Psychiatry, Center for Studies on Addiction, University of Pennsylvania, Philadelphia.
Address correspondence to Faika Zanjani, PhD, University of Kentucky–Gerontology, 306B Wethington Health Science Bldg., 900 South Limestone, Lexington, KY 41094. E-mail: f.zanjani{at}uky.edu
Background. This investigation aims to determine the 12-month drinking trajectory of older at-risk drinkers in treatment. Furthermore, the drinking trajectory between at-risk drinkers who had met the threshold suggestive of alcohol dependence (problem at-risk drinkers) and those who did not meet this threshold (nonproblematic at-risk drinkers) were compared.
Methods. This investigation is a component of the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) Study, a multisite randomized trial comparing service use, outcomes, and cost between Integrated (IC) versus Enhanced Specialty Referral (ESR) care models for older (65+ years) adults with depression, anxiety, and/or at-risk alcohol consumption. This investigation focuses only on at-risk drinkers, generally defined as exceeding recommended drinking limits, which in the case of older adults has been classified as consuming more than one drink per day. Two hundred fifty-eight randomized older at-risk drinkers were examined, of whom 56% were problem drinkers identified through the Short Michigan Alcohol Screening Test-Geriatric version.
Results. Over time, all at-risk drinkers showed a significant reduction in drinking. Problem drinkers showed reductions in average weekly consumption and number of occurrences of binge drinking at 3, 6, and 12 months, whereas nonproblematic drinkers showed significant reductions in average weekly consumption at 3, 6, and 12 months and number of occurrences of binge drinking at only 6 months. IC treatment assignment led to higher engagement in treatment, which led to better binge drinking outcomes for problem drinkers. Despite significant reductions in drinking, approximately 29% of participants displayed at-risk drinking at the end of the study.
Conclusions. Results suggest that older at-risk drinkers, both problem and nonproblematic, show a considerable decrease in drinking, with slightly greater improvement evidenced in problem drinkers and higher engagement in treatment seen in those assigned to IC.
Key Words: Alcohol • At-risk drinking • Problem drinkers
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