BACKGROUND:Alcohol use and alcohol use disorder (AUD) among older women (defined as age 50 and over) have increased substantially in recent years. Compared to men and younger women, older women negotiate biopsychosocial transitions that put them at greater risk of alcohol-related health conditions as they age and are less reliably screened and treated for heavy alcohol use and AUD. OBJECTIVES:This scoping review represents a critical evaluation of research methodology and findings since 2004 on biopsychosocial correlates and consequences of alcohol misuse (i.e., heavy alcohol use, defined as four or more drinks on any day or eight or more drinks per week; and/or AUD) among older women. These findings, with a focus on their implications for treatment and prevention strategies among this at-risk population, are discussed. The goal of the review is to summarize current research as well as treatment and prevention options available for older women and to identify gaps in the literature and potential for future research. ELIGIBILITY CRITERIA:2,579 research articles were reviewed for inclusion in the paper. Inclusion criteria required that a study's findings were relevant to the review's objectives, with analyses and results that had clinically relevant findings for older women with heavy alcohol use and/or AUD. SOURCES OF EVIDENCE:Authors searched PubMed, Embase, and PsycInfo for articles published between January 1, 1994, and August 5, 2024. CHARTING METHODS:Two authors developed the template for data extraction, and four authors charted data. Weekly meetings were used to establish, monitor, and maintain calibration among authors. RESULTS:127 articles met inclusion/exclusion criteria and were included in the final extraction and results summary. Evidence-based information is presented on (1) clinical presentation of older women with alcohol misuse; (2) biological correlates of alcohol use in older age; (3) psychosocial correlates and consequences, such as mood disorders, social networks, and other substance use; (4) increased risk of health conditions, such as breast cancer and depression; and (5) current state of treatment and prevention needs and efforts. CONCLUSIONS:The research reviewed here indicates a need for further age- and sex-specific research in the field of alcohol use and AUD. After age 50, men and women continue to differ in important ways in relation to the correlates, consequences, and treatment of alcohol misuse. The current literature includes significant methodological limitations and inconsistencies. Research with samples of older women who drink at heavy levels may be particularly helpful in addressing these limitations. Existing prevention and treatment interventions may be good options for older women, but more research is needed.

Background: The opioid epidemic disproportionately affects individuals with co-occurring opioid use and mental health disorders (COD), who often have poor treatment engagement. Multicomponent treatment models are popular solutions to increase treatment access and engagement for those with COD. Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking (MISSION) is a hybrid multicomponent linkage and treatment approach that provides assertive community outreach combined with psychosocial treatment. This protocol paper describes a randomized controlled trial comparing MISSION and medication for opioid use disorder (MOUD), its multicomponent parts along with MOUD, and MOUD treatment as usual (TAU) to assess improvements in health and social outcomes. Methods: This study will use a half fractional factorial design and randomize 1000 patients with COD to one of five treatment conditions: (1) the full MISSION intervention plus MOUD; (2-4) a combination of two out of three MISSION components plus MOUD; or (5) TAU. Secondary aims include examination of mechanisms of action, economic evaluation of the implementation of MISSION and/or its components plus MOUD versus TAU, and exploratory predictive modeling to match optimal MISSION parts with patient needs. Discussion: This randomized controlled trial will help determine the effectiveness of MISSION (or its parts) and MOUD compared to TAU to improve engagement in treatment, substance use, and mental health symptoms. This trial is the first to compare MISSION and its parts with MOUD versus TAU in a real-world treatment scenario to determine which components are necessary and sufficient to drive treatment outcomes according to patient needs.

BackgroundAlcohol use disorder is among the most pervasive substance use disorders in the United States, with a lifetime prevalence of 30%. Recommended treatment options include evidence-based behavioral interventions; smartphone-based interventions confer a number of benefits such as portability, continuous access, and stigma avoidance; and research suggests that interventions involving couples may outperform those for patients only. In this context, a behavioral intervention delivered to couples through smartphones may serve as an effective adjunct to alcohol use disorder treatment. ObjectiveThis pilot study aimed to (1) evaluate the feasibility of comparing a patient-only (Addiction version of the Comprehensive Health Enhancement Support System; A-CHESS) versus a couple-focused (Partner version of the Comprehensive Health Enhancement Support System; Partner-CHESS) eHealth app for alcohol misuse delivered by smartphone, (2) assess perceptions about and use of the 2 apps, and (3) examine initial indications of differences in primary clinical outcomes between patient groups using the 2 apps. Broadly, these aims serve to assess the feasibility of the study protocol for a larger randomized controlled trial. MethodsA total of 33 romantic couples were randomized to 6 months of A-CHESS app use (active treatment control) or Partner-CHESS app use (experimental). Couples comprised a patient with current alcohol use disorder (25/33, 76% male) and a romantic partner (26/33, 79% female). Patients and partners in both arms completed outcome measure surveys at 0, 2, 4, and 6 months. Primary outcomes were patients’ percentage of days with heavy drinking and percentage of days with any drinking, measured by timeline follow back. Secondary outcomes included app use and perceptions, and multiple psychosocial variables. ResultsAt 6 months, 78% (14/18) of Partner-CHESS patients and 73% (11/15) of A-CHESS patients were still using the intervention. The apps were rated helpful on a 5-point scale (1=not at all helpful, 5=extremely helpful) by 89% (29/33) of both Partner-CHESS patients (mean 3.7, SD 1) and partners (mean 3.6, SD 0.9) and by 87% (13/15) of A-CHESS patients (mean 3.1, SD 0.9). At 6 months, Partner-CHESS patients had a nonsignificantly lower percentage of days with heavy drinking compared with A-CHESS patients (β=–17.4, 95% CI –36.1 to 1.4; P=.07; Hedges g=–0.53), while the percentage of drinking days was relatively equal between patient groups (β=–2.1, 95% CI –24.8 to 20.7; P=.85; Hedges g=–0.12). ConclusionsInitial results support the feasibility of evaluating patient-only and couple-focused, smartphone-based interventions for alcohol misuse. Results suggest that both interventions are perceived as helpful and indicate maintained engagement of most participants for 6 months. A future, fully powered trial is warranted to evaluate the relative effectiveness of both interventions. Trial RegistrationClinicalTrials.gov NCT04059549; https://clinicaltrials.gov/ct2/show/NCT04059549

Abstract Session 1 of the Client Workbook provides information for clients about gender differences in alcohol and drug use and the unique challenges that women face. Clients will receive personalized feedback about their alcohol and drug use pattern, amounts, and consequences of use and will learn facts about alcohol that will help them change your drinking or drug use. Clients will learn how to identify and monitor their cravings, triggers, and substance use every day. They will learn to identify high-risk situations likely to occur in the upcoming week and come up with strategies to cope with the situations without using alcohol or drugs. Informational handouts and practice worksheets are used in session and during the week. Homework for the week is assigned. The material in every session is customized to women and to each client’s particular pattern of substance use, consequences, motivation, and related problems.

Abstract Session 7 covers skills to manage depressed and anxious mood states, as well as stress. Thinking errors are identified and cognitive restructuring skills are taught and practiced. Emotion regulation skills are also covered. As in every session, abstinence plans and status are monitored and adjusted, daily drinking/craving/trigger logs are discussed, other routine interventions are delivered, and other skills learned in previous sessions are reinforced.

Abstract Session 2 includes introductions and agenda setting; check-in and review of self-monitoring and homework; update of graphs showing drinking or drug use and cravings; and planning for upcoming high-risk situations during the week. Clients learn about behavior chains, which are made up of triggers; thoughts and feelings; behavioral response (drinking or drug use); and positive and negative consequences of use. Examples are provided and the skill is practiced during session, first by using a worksheet to list each client’s triggers for drinking or drug use, and then by completing some behavior chains for particular triggers. Behavior chains set the stage for subsequent session interventions to “break the chain” and are a basic cognitive behavioral technique. Clients identify high-risk situations for the upcoming week and brainstorm strategies to cope with them. Handouts and practice worksheets are used and homework is assigned.

Abstract Session 8 helps clients evaluate their social network to determine if they have enough network members who support their recovery and treat them well, and if not, to brainstorm ways to enhance their social network connections going forward. The session focuses on the notion that each woman deserves to associate with people who respect her, treat her well, and are supportive and nurturing. Psychoeducation to identify healthy and unhealthy components of relationships is provided. Cognitive restructuring for alcohol- and drug-related thoughts is another skill taught and practiced in this session. As in every session, prior skills are carried forward, abstinence plans are monitored, routine interventions are delivered, and group support is encouraged.

Abstract The chapter introduces the decisional matrix to help clients evaluate the pros and cons of stopping or continuing drinking or drug use and to understand the natural ambivalence people have about stopping. Clients will learn how to pay attention to the positive consequences of abstinence and keep in mind the negative consequences of use. They also will identify and plan into their weekly schedule pleasant activities to take the place of the time they used to spend using alcohol or drugs in order to make abstinence more pleasant and rewarding. Clients also will identify the functions that alcohol or drugs may have served so they will be able to replace those with healthier ways to achieve similar results. At the end of the session clients will identify upcoming high-risk situations and develop plans to cope without using alcohol or drugs. The therapist also will review homework for the upcoming week.

Subject Clinical Psychology Series Treatments That Work Collection: Oxford Clinical Psychology

Abstract Session 7 expands on material from Session 6 and teaches clients about the relationship between their “automatic thoughts” and feelings. It lists different types of thoughts that are not usually helpful because they tend to aggravate bad moods; sometimes these types of thoughts are called “thinking errors.” Clients will learn to identify unhelpful thoughts and how these thoughts make them feel, and to cope with these thoughts by challenging and replacing them with more helpful thoughts, or by stepping back and letting them go using acceptance and mindfulness strategies. Clients will recognize and track unhelpful automatic thoughts going forward. They will also learn additional strategies to de-stress and to regulate strong negative emotions. At the end of the session clients will identify upcoming high-risk situations and develop plans to cope without using alcohol or drugs. the therapist also will review homework for the upcoming week.

Abstract Women’s Group Treatment for Substance Use Disorder: Evidence-Based Cognitive Behavioral Therapy—Client Workbook is a session-by-session guide to treat the unique challenges and needs of women with alcohol and/or drug use problems. This step-by-step program is designed to help women achieve and maintain abstinence from alcohol and drugs, learn skills to prevent relapse, and achieve improvements in quality of life, self-care, coping skills, self-compassion, relationships with others, and wellness. The program also teaches skills to alleviate depression, anxiety, and trauma symptoms. Written to be used in a therapeutic setting and in conjunction with the companion Therapist Guide, the program includes easy instructions and materials to help clients identify their drinking patterns and triggers, take control of their behavior, seek social network support, understand and experience the rewards of sobriety, and find positive alternatives to drinking and drug use. Clients also will learn useful techniques for managing strong negative emotions and negative thoughts. Overcoming alcohol or drug problems is an attainable goal with this effective and comprehensive program.

Abstract This chapter introduces the basics of the Women’s Group Treatment for Substance Use Disorder program. It provides information about how this treatment can help, how to decide if someone has an alcohol or drug problem, how to define risky drinking, and why a treatment program specifically for women is important. Details are given on the program, including the types of coping skills that are taught, the structure of each session, and what participants can expect in the treatment. The goal of abstinence is also discussed. The chapter covers options and coping skills to get to abstinence, the level of care a participant may need based on the pre-treatment assessment, and how women can use this workbook.

Abstract This chapter covers clinical and group management issues that are important for therapists to understand. Specific issues discussed in this chapter include handling clients’ ambivalence about change, enhancing clients’ motivation to change, setting goals, and dealing with clients who continue to drink or use drugs. Information is provided about how therapists should deal with comorbid psychological and psychiatric issues such as depression, anxiety, trauma, and suicidality. Other topics covered are physiological symptoms of withdrawal from drugs or alcohol, intimate partner violence, parenting concerns, and how to handle clients who arrive to treatment intoxicated or high. Suggestions are given for managing the group (managing time, managing group members, hybrid coping skills, and supportive group process).

Abstract This session will help clients understand the factors supporting their drinking or drug use. They will learn about triggers, thoughts and feelings, behaviors (drinking or drug use), and consequences of use. Examples are provided and the skill is practiced during session, first by using a worksheet to list their own triggers for drinking/drug use and then by completing some behavior chains for particular triggers. Behavior chains set the stage for skills to “break the chain” and are a basic cognitive behavioral technique for behavior change. At the end of the session clients will identify upcoming high-risk situations and develop plans to cope without using alcohol or drugs. The therapist also will review homework for the upcoming week.

Abstract This chapter describes the structure of the treatment sessions, how to use the Client Workbook, how to teach and practice new skills in the therapy format, how to tailor the treatment to client needs, and how to use the treatment curriculum flexibly for specific settings (inpatient, outpatient, aftercare) and populations. The chapter discusses how to interface with adjunct therapies and self-help, and how to learn to deliver the program. The chapter also covers how to address clinical issues such as non-abstinence goals, specific substances of use (e.g., alcohol, opioids, marijuana), and how to adapt the program for open rolling-admissions groups versus closed groups. It describes the pre-treatment assessment (described in detail in Chapter 5) and orientation for clients before they join a rolling-admissions group. It also describes how to use an optional intervention to graph drinking/drug behavior each week to track progress.

Abstract Session 6 is the first of two sessions to help clients learn about, identify, and cope with symptoms of anxiety, depression, and trauma, because these are common mental health issues among women. Clients will also learn about the relationship between mood and alcohol/drug use and how they affect each other. Even clients who do not suffer from a full-blown disorder related to depression, anxiety, or trauma can benefit from identifying and understanding types of negative or distressing feelings. Clients will also learn more about what cravings to drink/use drugs are, what they mean, and how to identify them, and will develop strategies to handle cravings without drinking or using drugs. At the end of the session clients will identify upcoming high-risk situations and develop plans to cope without using alcohol or drugs. The therapist also will review homework for the upcoming week.

Abstract Session 1 of the Therapist Guide explains how to deliver the treatment as a closed or open group, and introduces optional graphing to monitor client progress. At the start of the session, the therapist facilitates introductions, distributes client workbooks, reviews treatment requirements, and presents an overview and rationale for the treatment. Psychoeducation is provided about women and substance use and about alcohol and drugs. The therapist presents personalized feedback to each client about her pre-treatment substance use pattern, amounts, normative data, and consequences of use. Daily self-monitoring to identify cravings, triggers, and substance use is introduced. An abstinence plan is developed with each client. In every session, clients learn how to identify high-risk situations likely to occur in the upcoming week and brainstorm strategies to cope without using alcohol or drugs. Informational handouts and practice worksheets are used. Homework is assigned.

Abstract Session 5 introduces the notions of psychological components (thoughts, thinking habits) and behavioral habits) components of health and well-being. For psychological self-care, exercises focus on identifying and replacing self-critical or shame-based thoughts with self-compassion thoughts. For behavioral self-care habits, clients learn to identify and track healthy behaviors they want to increase, and work to develop a more satisfying life by examining the balance between “wants” and “shoulds.” These changes are designed to support abstinence by enhancing the quality of recovery in ways that are often important to women. As in every session, the therapist is guided to deliver the material step by step, work through the handouts and practice worksheets, complete the routine interventions as well as the new skills, carry forward skills learned in previous sessions, and encourage supportive communication among group members to support positive change.

Abstract Session 4 provides an overview of some motivational interviewing techniques for the therapist. In this session the clients will use a decisional matrix to evaluate the pros and cons of continuing or stopping their drinking or drug use. This is done in a personalized way for each client, with identification of clients’ values as a guide to their own pros and cons. Coping skills are introduced to increase the salience of positive consequences of abstinence and negative consequences of use. The group brainstorms positive alternatives that can replace alcohol/drug use to help make abstinence and recovery rewarding, thus reducing the risk of relapse. As in every session, new skills are taught in a client-centered way and the therapist encourages supportive and constructive interaction and shared wisdom among the group members.