INTRODUCTION:Older adults drinking above low-risk guidelines, including those with AUD, are uniquely susceptible to alcohol-related harm yet largely perceive their drinking as non-problematic and avoid formal treatment. Adaptive brief interventions available in non-specialist settings, either in-person or via telehealth, could provide crucial alternatives, yet they remain untested across age and/or modality. METHODS:A secondary data analysis used data from a sequential multiple assignment randomization trial of adaptive brief interventions to test moderators, age and modality (video-conferencing vs. in-person), on drinking at 12 (treatment end) and 24 weeks. After receiving brief advice (BA) at week 1, 160 participants were reassessed at week 4. Those drinking at high-risk levels (non-responders) were randomized to 2 sessions of Motivational Interviewing (MI) or 20 min more of BA (BA Plus). At week 8, MI non-responders were randomized to either a third session of MI or 4 sessions of brief self-control therapy (BSCT); BA Plus non-responders were randomized to either 2 sessions of MI or 1 session MI and 4 BSCT. Generalized estimating equations tested main and moderating effects of age and modality on intervention effects on longitudinal drinking outcomes, average weekly sum of standard drinks (SSD) and average weekly number of heavy drinking days (HDD). RESULTS:A significant main effect of age demonstrated OAs (57+) had the smallest reduction in SSD and HDD compared to middle-aged (48-56) and younger (< 48) adults; with middle-aged adults reducing the most. Modalities were equivalent by week 24, yet in-person reduced more rapidly than telehealth. Significant interaction terms (age x condition; modality x condition) revealed that 3 sessions of MI performed poorest among OA and that 3 MI in-person sessions outperformed its telehealth counterpart and other conditions. CONCLUSIONS:These findings suggest OA with AUD may need immediate, longer duration interventions compared to other age groups. Those ages 48-56 provide a unique window for substantial change in drinking among those with AUD. While in-person interventions yielded earlier changes than those implemented via telehealth, both modalities successfully reduced drinking, providing an important alternative way to access treatment. Future research on intervention components, such as dosage, timing and duration, across age groups and modality, would further inform their implementation across the life span.

INTRODUCTION:Cross-sectional evidence shows that alcohol use disorders (AUD) are under-treated. Knowledge is needed on longitudinal predictors of long-term receipt of AUD treatment among older adults. AIMS:To identify the: (i) long-term occurrence of AUD treatment receipt during follow-up; (ii) time to treatment; and (iii) predictors of long-term treatment receipt. METHODS:Longitudinal cohort study. To create a baseline, a subsample from the Danish National Health Survey 2017 with a positive CAGE-C (n = 13,489, aged 55-80 years) was enriched with Danish national register data. AUD treatment data covered a follow-up period of up to 2.9 years following this baseline and came from the National Alcohol Treatment Register. Longitudinal predictors of treatment receipt were investigated with Cox regression analysis; time-to-treatment with Kaplan Meier curves. All analyses were conducted in the whole sample, in a subsample scoring ≥ 2 on the original CAGE (n = 3748, 28.9%), and in a subsample endorsing the CAGE-'Eye-opener'-criterion (n = 707, 6.2%). RESULTS:In the whole sample, only 1.3% received AUD treatment in the follow-up period (3.9% in the CAGE- and 7.3% in the 'Eye-Opener'-criterion subsample). Across all samples, only about 40% of treatments were initiated by 12 months after baseline. Baseline contacts with health care providers and impaired well-being predicted a greater rate of treatment entry during follow-up (p < 0.05). DISCUSSION AND CONCLUSIONS:Among older adults, AUD treatment uptake in the 2.9 years after reporting recent problematic alcohol use is rare. Treatment occurs with delay, regardless of problem severity. Contacts with health care providers are opportunities to support subsequent treatment receipt.

BACKGROUND:Alcohol use disorder (AUD) among older adults, particularly with respect to gender differences in treatment outcomes, remains underexplored. Our objective was to explore gender differences in AUD treatment outcomes among older adults, focusing on continuous measures (e.g., drinks per day) and binary measures (e.g., abstinence) across a 1-year period. METHODS:We analyzed data from a multinational randomized controlled trial involving 693 older adults (60+) diagnosed with DSM-5 AUD. Participants received motivational enhancement therapy and the community reinforcement approach, across sites in Denmark, Germany, and the United States. Participants were assessed at baseline and after 4, 12, 26, and 52 weeks. Multilevel mixed-effects linear and logistic regressions were used, adjusted for sociodemographic and baseline drinking characteristics. RESULTS:Both men and women showed significant improvements across all outcomes. At baseline, females reported 0.75 fewer drinks/day, 1.33 fewer drinks/drinking day, and 50% lower odds of low blood alcohol content (BAC) compared to males (OR = 0.50; p < 0.05). Gender-time interactions showed smaller reductions in females' drinks per day and drinks per drinking day (p < 0.05), resulting in similar drinking levels at follow-ups. No gender differences were found at any time points for percent days abstinent and percent heavy drinking days (p ≥ 0.05). A significant gender-time interaction was found for percent days abstinent (p = 0.04), but no consistent direction was observed across time points. For abstinence and no heavy drinking, no gender differences were found (p ≥ 0.05). No interactions between gender and time were found for any binary outcome (p ≥ 0.05). CONCLUSIONS:Among older adults with DSM-5 AUD diagnosis, treatment led to substantial and sustained improvements across genders. While women showed less favorable drinking reductions, adjusted estimates were broadly comparable. Given women's increased physiological vulnerability to alcohol, this may not imply equivalent clinical risk. Still, findings support the potential for meaningful treatment benefits regardless of gender.

PURPOSE:Alcohol use and alcohol use disorder (AUD) among adults age 50 and older are an expanding public health challenge, requiring effective alcohol prevention interventions. Empirical literature on prevention interventions among older adults is limited by design issues, lack of publication, and misconceptions of aging. To enhance scientific rigor, prior reviews of prevention interventions among older adults excluded pre-to-posttest studies and studies with subgroups, such as veterans, racial minorities, and individuals who seek out digital interventions. The current narrative review aims to understand with whom prevention interventions for older adults are tested; describe barriers and facilitators of successful interventions; and include perspectives of both older adults and intervention providers. Unlike prior reviews, it includes a range of study designs, including digital interventions, and examines decade of age, periods in which studies took place, and generational factors associated with prevention intervention success. SEARCH METHODS:In December 2024, Boolean search terms, such as "alcohol*," "older adults," and "intervention," were used across medical and social science databases, including PubMed, World of Science, PsycInfo, Social Sciences Citation Index, Cochrane Database, and other sources. The searches identified 983 articles published between 1999 and 2024, 582 of which were duplicates. Of the 401 abstracts reviewed, 231 did not mention older adults and/or alcohol. Thus, 170 full texts were reviewed. To be included, studies had to be peer-reviewed; have a mean participant age of 55 and older or a labeled subsample of individuals age 50 and older; focus on a nonpharmacological intervention; and reported alcohol or alcohol-related outcomes or older adult and/or provider perspectives of interventions. Studies set in a formal substance use treatment program were excluded. Overall, 84 records describing 51 interventions and 16 articles of consumer and provider perspectives were synthesized. SEARCH RESULTS:Studies were categorized into primary prevention, secondary prevention of AUD, and tertiary prevention of worsening AUD. Most interventions were delivered in person, in primary care, with individuals born from 1901 to 1923 (Greatest Generation) and 1924 to 1945 (The Silent Generation), and yielded significant reductions in alcohol use and related consequences. Only The Silent Generation consistently responded to interventions, demonstrating large effects. Additionally, two out of 18 randomized controlled trials found that individuals born from 1946 to 1964 (Baby Boomers) significantly responded to prevention interventions. Digital interventions were successful across generations. DISCUSSION AND CONCLUSIONS:Barriers to successful interventions occur at the organizational, provider, and older adult levels. Prevention intervention facilitators include drink tracking, agreement with another person, and aligning tone of the intervention to older adult perspectives of their drinking and perceived need to change. Adapting prevention interventions to older adults could include tailoring to an individual's identity, culture, and meaning behind their drinking, which is often defined by generation, rather than only by age.

Background: Knowledge on age-specific patient characteristics and treatment outcome predictors from routinecare is needed to understand the treatment needs of older adults (OA; age 60+) with alcohol use disorder (AUD). Aims: To explore age-specific patient characteristics and age-specific predictors of AUD-treatment outcomes. Methods: Routinecare data from n = 125 young adults (18-39 years), n = 216 middle-aged adults (40-59 years), and n = 80 OA who began outpatient AUD-treatment in a Danish municipality between 2019 and 2022. Patients underwent a clinical interview, including the Addiction Severity Index (ASI), at intake and three months after intake. Treatment outcome predictors were investigated with Generalized Linear Models with and without interactions with age group. Results: At intake, OA had greater health and financial problems than younger patients. OA more often had a higher secondary education and were not working. Being an OA (vs. young adults) predicted a lower ASI alcohol score at three months (p<0.001). In the whole sample, more days with health problems, greater financial problems, and previous AUD treatment predicted less favorable treatment outcomes (p<0.05). Most interactions with age were non-significant (p >= 0.05). Conclusions: No set of age-specific predictors of treatment outcomes among OA was identified. Predictors of negative treatment outcomes are very prevalent among OA (e. g., health problems) and deserve attention in AUD interventions with OA.

INTRODUCTION:Alcohol use disorders (AUD) are under-treated, particularly among older adults. Using data from national treatment registers can expand knowledge on the AUD treatment rate among older adults and on potential biases in treatment receipt. The aim of this paper was to determine the AUD treatment prevalence rate and to investigate sociodemographic, health-related and substance use-related correlates of AUD treatment receipt among older adults with different degrees of problematic alcohol use. METHODS:The study sample (n = 13,403; inclusion criteria: age 55-80 years, positive CAGE-C) is a subsample from the representative cross-sectional 2017 Danish National Health Survey. It was enriched with data from Danish National Registers, including the National Alcohol Treatment Database. Weighted 12-month AUD treatment prevalence rates were determined. Logistic regression analysis was applied to identify correlates of treatment receipt. All analyses were conducted among: (i) the study sample; (ii) the 28.9% with a positive original CAGE (n = 3725); and (iii) the 6.1% endorsing the CAGE's E-criterion (n = 692). RESULTS:The 12-month AUD treatment prevalence was 0.5% in the study sample, 1.6% in the CAGE-, and 3.8% in the E-criterion subsample. Not being married or partnered, loneliness and contacts with health care providers were positively associated with AUD treatment receipt in all three samples. DISCUSSION AND CONCLUSIONS:Even in the subsample with putative alcohol withdrawal, the AUD treatment rate did not reach 5%. This finding suggests that putative AUD is significantly undertreated in older adults. Contacts with other health care providers may facilitate AUD treatment entry in this age group.

BACKGROUND Previous studies have yielded mixed results on the association between gender and alcohol use disorder (AUD) treatment outcomes. Thus, additional research is needed to determine the effect of gender on AUD treatment outcomes, including quality of life (QoL), particularly among older adults. AIMS In a clinical sample of older adults with DSM-5 AUD, we examined changes in QoL from the beginning of AUD treatment through 1 year of follow-ups. We also examined the effect of gender and explored interaction effects with gender on QoL. METHODS We utilized data from the "Elderly Study," a multi-national, single-blind, randomized, controlled trial of 693 adults aged 60+ with DSM-5 AUD. Alcohol use was assessed with the Form-90, and QoL with the brief version of the World Health Organization QoL measure. Information was collected at treatment initiation and at 4-, 12-, 26-, and 52-week follow-ups. Multilevel mixed-effects logistic and linear regression models were used to examine QoL changes and the effect of gender on changes in QoL. RESULTS Following treatment, small, but significant improvements were seen over time in overall perceived health (p < 0.05). Improvements that persisted over the 1-year follow-up period were seen in the QoL domains of physical health (β: 2.6, 95% CI: 1.4-3.9), psychological health (β: 3.5, 95% CI: 3.3-3.8), social relationships (β: 4.0, 95% CI: 2.5-5.6), and environmental health (β: 1.4, 95% CI: 0.4-2.4). No significant changes were seen over time in overall perceived QoL (p = 0.58). Gender was not associated with changes in any of the QoL outcome measures (all p ≥ 0.05). CONCLUSIONS Among 60+ year-old adults receiving treatment for DSM-5 AUD, improvements in QoL were achievable and maintained over time, but were not associated with gender.

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.

Given both a worldwide aging population and increasing rates of high-risk alcohol use, rates of adults 50 and older with high-risk alcohol use and associated problems are rapidly growing. Several barriers to prevention, intervention, and treatment persist among this group. Mobile interventions, specifically those who use text messaging (TM), can provide an opportunity for early intervention and prevention of problems. This study is a secondary analysis of data from a pilot study of a TM intervention among high-risk drinkers (N=151) with one third of the participants 50 to 65 years old. Feasibility, acceptability and preliminary effectiveness of the intervention for older adults (OA) were explored compared to their younger adult (YA, 21-49 years old) counterparts. Between age group differences at baseline and end of treatment (12 weeks) were explored. An age group by TM type (loss framed/gain framed, tailored, or assessment only) interaction was tested to determine whether there was a moderating effect of age group on TM type. Few baseline differences emerged between age groups, except that OA drank almost daily, while YA drank fewer days but more heavily on the days they drank. Only OA ranked boredom as one of the most challenging situations to not drink heavily. The TM intervention was effective at 12 weeks in reducing drinking among both age groups, though slightly more effective for YA than for OA and with tailored messaging outperforming the other two TM types on drinking outcomes. Among OA, loss and gain framed messages were effective on the additional health outcomes. All participants reported satisfaction with the intervention and two-thirds in both age groups elected to continue receiving TM after the study period concluded. There is preliminary evidence that TM is feasible, acceptable, and effective across age groups. Findings also suggest that further adaptation of TM across age group could enhance its effectiveness.

There is a lack of evidence for the consistency between self‐reported alcohol consumption (SRAC) and concentrations of ethyl glucuronide in hair (hEtG) among elderly patients treated exclusively for alcohol use disorder (AUD). Hence, this study assessed the consistency between these two measures in these patients. A total of 190 patients with AUD were assessed for SRAC using Form 90 and hEtG, 14 or 22 weeks after treatment conclusion. Patients were grouped according to SRAC (g/day) and corresponding hEtG concentrations (pg/mg): 0 and <5 (abstinence), 0.1–14.3 and 5.0–9.9 (low consumption), 14.4–21.4 and 10.0–15.9 (moderate consumption), 21.5–59.9 and 16.0–30 (high consumption) and ≥60 and >30 (excessive consumption). The extent of underreporting and overreporting was examined by crosstabulations, and inter‐rater reliability was reported by kappa correlations. Associations and effect modification were examined by conditional logistic regression. Due to multitesting, p ‐values ≤0.01 were considered significant. Underreporting was found in 96 patients (50.5%) and overreporting in 41 patients (21.6%). The kappa coefficients varied between 0.19 and 0.34. HEtG was more likely to detect low, moderate and high alcohol consumption compared with SRAC (ORs between 5.1 and 12.6, all p ‐values <0.01), but SRAC and hEtG did not differ significantly with respect to identification of abstinence (OR = 1.9, p = 0.05). Inconsistency between the outcome measures was found in a considerable number of the patients. More studies examining the consistency between SRAC and specific direct biomarkers of alcohol in this population seem warranted.

Aims To investigate among older adults with DSM-5 alcohol use disorder (AUD) the relevance of (1) baseline DSM-5 AUD severity, (2) age of DSM-5 AUD onset, and (3) the interactions of DSM-5 AUD severity*treatment condition and age of DSM-5 AUD onset*treatment condition for the prediction of AUD treatment outcomes. Methods The international multicenter RCT “ELDERLY-Study” compared outpatient motivational enhancement therapy (4 sessions) with outpatient motivational enhancement therapy followed by community reinforcement approach for seniors (8 sessions) in adults aged 60+ with DSM-5 AUD. Baseline and 1-, 3-, and 6-month follow-up data from the German and Danish ELDERLY-sites (n = 544) were used (6-month participation rate: 75.9%). DSM-5 AUD diagnoses were obtained using the Mini International Neuropsychiatric Interview and alcohol use using Form 90. Associations between DSM-5 AUD severity and age of onset and AUD treatment outcomes were investigated using multiple logistic regression and generalized linear models. Results The sample was diverse in AUD severity (severe: 54.9%, moderate: 28.2%, mild: 16.9%) and age of onset (median: 50 years; 12–78 years). Overall, with few exceptions, neither AUD severity, nor age of onset, nor their respective interactions with treatment condition significantly predicted drinking outcomes at the different follow-ups (P ≥ 0.05). Conclusions No indication was found for the need to tailor treatment content according to DSM-5 AUD severity and earlier onset in older adults.

Background A major challenge to psychological treatment for alcohol use disorder (AUD) is patient non-compliance. A promising new treatment approach that is hypothesized to increase patient compliance is blended treatment, consisting of face-to-face contact with a therapist combined with modules delivered over the internet within the same protocol. While this treatment concept has been developed and proven effective for a variety of mental disorders, it has not yet been examined for AUD. Aims The study described in this protocol aims to examine and evaluate patient compliance with blended AUD treatment as well as the clinical and cost effectiveness of such treatment compared to face-to-face treatment only. Methods The study design is a pragmatic, stepped-wedge cluster randomized controlled trial. The included outpatient institutions (planned number of patients: n = 1800) will be randomized in clusters to implement either blended AUD treatment or face-to-face treatment only, i.e. treatment as usual (TAU). Both treatment approaches consist of motivational interviewing and cognitive behavioral therapy. Data on sociodemographics, treatment (e.g. intensity, duration), type of treatment conclusion (compliance vs. dropout), alcohol consumption, addiction severity, consequences of drinking, and quality of life, will be collected at treatment entry, at treatment conclusion, and 6 months after treatment conclusion. The primary outcome is compliance at treatment conclusion, and the secondary outcomes include alcohol consumption and quality of life at six-months follow-up. Data will be analyzed with an Intention-to-treat approach by means of generalized linear mixed models with a random effect for cluster and fixed effect for each step. Also, analyses evaluating cost-effectiveness will be conducted. Discussion Blended treatment may increase treatment compliance and thus improve treatment outcomes due to increased flexibility of the treatment course. Since this study is conducted within an implementation framework it can easily be scaled up, and when successful, blended treatment has the potential to become an alternative offer in many outpatient clinics nationwide and internationally. Trial registration Clinicaltrials.gov .: NCT04535258 , retrospectively registered 01.09.20.

BACKGROUND:Only a minority of individuals with problematic alcohol use ever seek alcohol treatment. Knowledge of general help-seeking behavior in the healthcare system can identify possibilities for prevention and intervention.METHOD:The current study describes healthcare use, burden of disease, and prior morbidities over a 15-year period by current alcohol use behavior among Danish adults aged 60-70. The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2014-2016) were linked to Danish national registers to collect annual information on healthcare use and morbidity for the 15 years prior to inclusion. Participants from the 3 largest Danish municipalities were divided into 4 groups with varying drinking patterns and no recent treatment [12-month abstinent (n = 691), low-risk drinkers (n = 1978), moderate-risk drinkers (n = 602), and high-risk drinkers (n = 467)], and a group of treatment-seeking individuals with a 12-month DSM-5 alcohol use disorder (AUD; n=262). Negative binomial regression models were utilized to compare rates of healthcare use and logistic regressions were used to compare odds of diagnoses.RESULTS:Low-, moderate-, and high-risk drinkers had similar rates of past healthcare utilization (low-risk mean yearly number of contacts for primary care 7.50 (yearly range 6.25-8.45), outpatient care 0.80 (0.41-1.32) and inpatient care 0.13 (0.10-0.21)). Higher rates were observed for both the 12-month abstinent group (adjusted RR = 1.16-1.26) and the group with AUD (ARR = 1.40-1.60) compared to the group with low-risk alcohol consumption. Individuals with AUD had higher odds of previous liver disease (adjusted OR = 6.30), ulcer disease (AOR = 2.83), and peripheral vascular disease (AOR 2.71). Twelve-month abstinence was associated with higher odds of diabetes (AOR = 1.97) and ulcer disease (AOR = 2.10).CONCLUSIONS:Looking back in time, we found that older adults had regular healthcare contacts, with those who received treatment for AUD having had the highest contact frequency and prevalence of alcohol-related diseases. Thus, healthcare settings are suitable locations for efforts at AUD prevention and intervention.

BackgroundStudies have found that reductions in World Health Organization (WHO) drinking risk levels may be a stable outcome of treatment for alcohol use disorder (AUD) and associated with functional improvements. The aim of this study was to investigate whether posttreatment reductions in WHO drinking risk levels are stable over time among older adults and associated with a decrease in consequences of drinking and AUD symptoms and improved quality of life.MethodsParticipants. Individuals 60+ years old, suffering from DSM‐5 AUD (n = 693), and seeking outpatient treatment.Measurements. WHO drinking risk levels, prior to treatment and at all follow‐up points up to 1 year after treatment start, were assessed with Form 90. Outcomes at follow‐up included consequences of drinking (Drinker Inventory of Consequences), quality of life (WHOQOL‐BREF), and DSM‐5 AUD symptoms (Mini International Neuropsychiatric Interview). Logistic regression and linear mixed models were used to examine the probability of maintaining risk‐level reductions at follow‐up and the association between risk‐level reductions and outcomes, respectively.ResultsReductions in risk levels were maintained over time (at least 1 level: OR 5.39, 95% CI 3.43, 8.47; at least 2 levels: OR 9.30, 95% CI 6.14, 14.07). Reductions were associated with reduced consequences of drinking and number of AUD symptoms, and minor, but statistically significant, improvements in quality of life.ConclusionsMaintaining reductions in WHO risk levels appears achievable for older adults seeking treatment for AUD. The small reduction of AUD symptoms and improvement of quality of life indicates that these reductions may not be adequate as the only treatment goal.

BACKGROUND:Knowledge is lacking on distinct health-related risk profiles among the substantial group of middle-aged and older adults with risky alcohol use (AU). Such profiles could inform the planning of interventions and prevention.AIMS:To 1) identify distinct health-related profiles based on different types of health-related functioning limitations and distress and 2) assess associations between these profiles and age, sex, and health-relevant behaviors (e.g., smoking).METHODS:Cross-sectional nation-wide Danish health survey with n = 6630 adults aged 55-64 and n = 7605 aged 65-74 with at least risky AU (>84 g ethanol/week in women, >168 in men). Health-related risk profiles were identified with Latent Class Analysis (LCA). Multinomial regression was applied for the association between risk profiles and auxiliary variables.RESULTS:A six-class LCA solution was found among 55-64 year-olds (classes: 'Normative' [61%], 'Distress' [6%], 'Mental health limitations [5%]', 'Pain-related distress [10%]', 'Broad limitations and pain distress [7%]', 'High overall burden' [11%]) and a five-class solution among 65-74 year-olds. Most classes were comparable across age groups. The 'Distress'-class characterized by pain-distress, tiredness-distress, and sleep-related distress (6%) only showed in the younger group. In both age groups, auxiliary covariates (high-risk AU, possible alcohol use disorder, weekly smoking) were positively associated with problematic profile membership (vs. normative class membership).CONCLUSION:Middle-aged and older adults with risky AU have distinct health-related profiles relevant for the form and content of prevention and interventions. Despite their distinct features, almost all problematic health profiles warrant careful attention regarding high-risk AU and probable alcohol use disorder.

BACKGROUND:Substance-induced psychosis has previously been linked to increased incidence of schizophrenia and bipolar disorder. We aimed to investigate if substance-induced psychosis is associated with increased risk of depression or anxiety.METHODS:We conducted a nationwide prospective register-based cohort study from 1994 to 2017, including all individuals with substance-induced psychosis, and age-and-sex matched controls without substance-induced psychosis. We investigated time to either depression or anxiety, as well as time to depression and time to anxiety, in stratified Cox regression models.RESULTS:We included 5,557 individuals with substance-induced psychosis and 55,562 controls. Substance-induced psychosis was associated with increased risk of either depression or anxiety (HR=7.05, 95% CI 6.71-7.41), depression (HR=5.40, 95% CI 4.77-6.11), or anxiety (HR=7.05, 95% CI 5.99-8.31). Analyses of individual types of substance-induced psychosis revealed similar hazard ratios across substances. Associations between substance-induced psychosis and depression or anxiety were stronger in people without preceding alcohol or substance use disorders. While strongest shortly after incident substance-induced psychosis, the increased incidence of depression and anxiety remained more than double over the full period of follow-up.LIMITATIONS:Only psychiatric disorders treated either in psychiatric inpatient or outpatient units, supplemented with information on psychiatric medication, was available. Exact times of onset were similarly unknown, and only dates of first treatment were available.CONCLUSIONS:Substance-induced psychosis is a strong predictor of later onset of depression or anxiety. Regardless of whether this association is causal, this highlights the need for increased monitoring and possibly improved treatment of patients with substance-induced psychosis.

BACKGROUND:Risk of relapse within the first months after alcohol use disorder (AUD) interventions is substantial among older adults. For this vulnerable group, little information exists on how this risk is associated with residual DSM-5 AUD symptoms after treatment.AIMS:To investigate among older adults who received short-term treatment for DSM-5 AUD (1) the prediction of drinking behaviors and quality of life 12 months after treatment initiation by 6-month DSM-5 AUD symptoms, AUD severity, and AUD remission, and (2) whether these DSM-5 AUD indicators provide prognostic information beyond that gained from 6-month alcohol use (AU) status.METHODS:The international multicenter RCT "ELDERLY-Study" enrolled adults aged 60+ with DSM-5 AUD. We used data from the subsample of 323 German and Danish participants with complete DSM-5 AUD criterion information 6 months after treatment initiation (61% male; mean age = 65.5 years). AU was assessed with Form 90, DSM-5 AUD with the M.I.N.I., and quality of life with the WHOQOL-BREF. Generalized linear models were applied to investigate the associations between 6-month AUD indicators and 12-month AU and quality of life.RESULTS:Independent of AU at 6 months, having 1 (vs. no) residual AUD symptom at 6 months predicted a 12-month "slip," defined as exceeding a blood alcohol concentration of 0.05% at least once during that time (OR: 3.7, 95% CI: 1.5 to 9.0), heavy episodic drinking, and hazardous use (p < 0.05). AUD remission was associated with a lower risk of a "slip" at 12 months (p < 0.05). Failed reduction/cessation was associated with poorer physical health (Coef.: -0.4, 95% CI -0.7 to -0.1).CONCLUSION:For older adults, residual AUD symptoms in the first months after short-term treatment predict problematic AU outcomes during the first 12 months after treatment entry. Thus, residual symptoms should be addressed in this patient population during posttreatment screenings.

AIMS:The objective of this paper was to examine 20-year trends of the socioeconomic status (SES) measures income and employment and their association with current alcohol use behaviors in Danish adults aged 60-70.METHODS:Data from The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2013-2016) were combined to form four groups from the general population with various drinking patterns, but with no recent treatment for alcohol use disorder (AUD), and one group seeking treatment: Abstinent (n = 691), low- (n = 1978), moderate- (n = 602), and high-risk (HR) drinkers (n = 467), and DSM-5 AUD seeking treatment (n = 262). For all groups, Danish national register data were linked at the individual level obtain find annual information on income and employment during the 20 years prior to interview. Mixed effects models were utilized to model trajectories of income and employment for the five groups.RESULTS:Lower income and employment status was observed from middle-aged adulthood when comparing 12-month abstinence or AUD to individuals with low or moderate alcohol consumption. At the end of the study period, moderate-risk drinkers experienced an increase, and HR drinkers a decrease, in income and rate of employment relative to the low-risk drinkers.CONCLUSIONS:Alcohol use behaviors observed in older adults are related to distinct long-term trajectories regarding income and employment status, which are observable already in middle-aged adulthood.

Zusammenfassung Einleitung Methamphetaminkonsum hat sich im Südosten Deutschlands zu einer flächendeckenden Problematik ausgeweitet. Gleichzeitig fehlen deutschsprachige, standardisierte Therapiemanuale in der Versorgungslandschaft. Methodik Evaluation von Prozessvariablen eines neuen Manuals für die qualifizierte Entgiftungs- und Motivationsbehandlung der Methamphetaminabhängigkeit. Hierzu wurden 31 Patienten1 (Durchschnittsalter 29 Jahre, 11 weiblich) über 3 Monate regelmäßig untersucht. Ergebnisse Akzeptanz sowie Durchführbarkeit im stationären Alltag wurden positiv bewertet. Häufung von Abbrüchen bei Übergang in ambulantes Setting. Schlussfolgerung Das Manual wirkt der Versorgungslücke entgegen. Durchführbarkeit im klinischen Setting ließe sich durch Straffung der Module und höhere Therapiefrequenz verbessern.

BACKGROUND:Relatively little is known about the prognostic value of comorbid mental disorders in alcohol use disorder (AUD) treatment for older adults (OA). AIMS:This article aimed to investigate 1) the impact of current unipolar mood and anxiety disorders in AUD treatment success in OA, 2) the timing of this putative comorbidity impact over six months, and 3) the role of treatment length in comorbidity effects. METHODS:We analyzed baseline and one-, three-, and six-month follow-up data from the international multicenter RCT "ELDERLY-Study" (baseline n = 693, median age: 64.0 years) using mixed effects regression models. In adults aged 60+ with DSM-5 AUD "ELDERLY" compared outpatient motivational enhancement therapy (MET, four sessions) with outpatient MET plus community reinforcement approach for seniors (MET & CRA-S; up to 12 sessions). Aiming for abstinence or minimal alcohol use (AU), both conditions included CBT-elements. We assessed AU with Form 90, and mental disorders with the Mini International Neuropsychiatric Interview (M.I.N.I.). RESULTS:Mood-related disorders were associated with more drinks per day at baseline and greater reductions in drinks per day at one and six months (main effect mood disorder: Coef. 2.1, 95% CI 0.6-3.6; one month interaction effect: Coef. -1.9, 95% CI -3.3- -0.5; six months interaction effect: Coef. -2.1, 95% CI -3.5 - -0.6). These results were replicated within MET & CRA-S but not within MET. CONCLUSION:Comorbid mental disorders had modest effects on short-term outpatient treatment outcomes. OA with AUD and unipolar mood-related disorders may profit from short interventions based on motivational interviewing and CBT-elements. ClinicalTrials.gov:NCT02084173.