Canadian Guidelines on Alcohol Use Disorder Among Older Adults

Open Access article:

Abstract

Background

Alcohol use disorder (AUD) is an increasingly common, under-recognized, and under-treated health concern in older adults. Its prevalence is expected to reach unprecedented levels as the Canadian population ages. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of AUD in older adults.

Methods

A systematic review of English language literature from 2008–2018 regarding AUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method by drawing on current literature. Recommendations were created and assessed using the GRADE method.

Results

Twenty-two recommendations were created. Prevention recommendations: Best advice for older adults who choose to drink is to limit intake to well below the national Low-Risk Alcohol Drinking Guidelines. Screening recommendations: Alcohol consumption should be reviewed and discussed on an annual basis by primary care providers. This type of discussion needs to be normalized and approached in a simple, neutral, straight-forward manner. Assessment recommendations: Positive screens for AUD should be followed by a comprehensive assessment. Once more details are obtained an individualized treatment plan can be recommended, negotiated, and implemented. Treatment recommendations: AUD falls on a spectrum of mild, moderate, and severe. It can also be complicated by concurrent mental health, physical, or social issues, especially in older adults. Naltrexone and Acamprosate pharmacotherapies can be used for the treatment of AUD in older adults, as individually indicated. Psychosocial treatment and support should be offered as part of a comprehensive treatment plan.

Conclusion

These guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of AUD in older adults within the Canadian context.

Jose Luis Vazquez Martinez

In ISAM-NIG's new monthly talk series "In-Love with Addicted Brains”, addiction neuroscientists from across the world share their personal stories/experiences on the beauty of addiction neuroscience and how/why they have decided to invest their scientific life in this field.

In-Love with Addiction Neuroscience

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February 11, starting at 10:30 AM (Washington, DC time), the Neuroscience Interest Group at the International Society of Addiction Medicine (ISAM NIG) invites you to the free virtual talk "In-Love with Addiction Neuroscience," presented by Dr. Silvia Cruz and hosted by Prof. Alexander Baldacchino.

In this talk series, addiction neuroscientists worldwide share their personal stories/experiences on the beauty of addiction neuroscience and how/why they have decided to invest their scientific life in this field.

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Jose Luis Vazquez Martinez

3rd ISAM Neuroscience Interest Group (ISAM-NIG) Webinar in Collaboration with ENIGMA Addiction Working Group

 

Biomarkers for Addiction Treatment Development: fMRI Drug Cue Reactivity as an Example

 

Motivations for Treatment Engagement in a Residential Substance Use Disorder Treatment Program: A Qualitative Study

Abstract

 

Aims:

The aim of this study was to explore perspectives on motivations for treatment engagement from substance use disorder (SUD) clients in a long-term residential rehabilitation program.

 

Design and Methods:

A convenience sample of 30 clients who were enrolled in a year-long SUD treatment program at a residential rehabilitation facility took part in in-depth interviews. Interview transcripts were analyzed using the directed content analysis approach.

 

Results:

Participant accounts indicated that their treatment engagement was motivated by factors that aligned with the six primary constructs of the Health Belief Model: (i) perceived susceptibility (eg, believing that their substance use required intervention and that they were prone to relapse), (ii) perceived severity (eg, substance use negatively impacted their health and harmed their close relationships), (iii) perceived benefits (eg, opportunities for a better life, reconnecting with family members and close friends, & avoiding legal consequences), (iv) perceived barriers (eg, the length of the treatment program), (v) cues to actions (eg, decisive moments, elements of the treatment program, & faith and spirituality), and (vi) self-efficacy in remaining abstinent (eg, treatment program provided them with skills and experiences to maintain long-term sobriety).

 

Discussion:

Our analysis indicates that participants’ treatment engagement was linked to their beliefs regarding the severity of their substance use disorder, their treatment program’s ability to help them avoid future relapse, and their own capability to act upon the strategies and resources provided by the treatment program. A theoretical understanding of these aspects can contribute to the future planning of precision interventions.

Jose Luis Vazquez Martinez

National Council for Behavioral Health

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Published by:
Kevin Alderson, PhD, R. Psych.
Counselling and Clinical Psychologist
Professor Emeritus, Counselling Psychology, University of Calgary