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Ask the Mental Health Expert Archives 2001-2004

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Old Among the Young

Q. I am interested in getting an older adult into a treatment program for alcohol abuse at her HMO. However, I am concerned that she will feel out of place in a treatment setting where there are lots of younger adults. Do you think she would benefit from such a program? Is there any research that would address this issue?

A. It's always possible that your patient may feel out of place among younger adults--but I'm not aware of any research literature that would predict poor compliance/participation in a 12-step program, solely on the basis of age differences.

A couple of studies bear indirectly on your question. Green et al (J Subst Abuse Treat. 2002 Dec;23(4):285-95) studied gender differences in treatment outcome among 293 HMO members recommended for substance abuse treatment. Treatment initiation, completion, and time spent in treatment did not differ by gender, but other factors did predict these outcomes. Initiation was predicted in women by alcohol diagnoses; in men, by being employed or married. Failure to initiate treatment was predicted in women by mental health diagnoses; in men, by less education.

Treatment completion was predicted in women by higher income and legal/agency referral; in men, by older age. Failure to complete was predicted in women by more dependence diagnoses and higher Addiction Severity Index Employment scores; in men, by worse psychiatric status, receiving Medicaid, and motivation for entering treatment. More time spent in treatment was predicted, in women, by alcohol or opiate diagnoses and legal/agency referral; in men, by fewer mental health diagnoses, higher education, domestic violence victim status, and prior 12-step attendance.

Another study by Lemke & Moos (J Subst Abuse Treat. 2003 Jan;24(1):43-50) is more directly relevant to your question. These authors studied older patients with alcohol use disorders who had gone through residential treatment; and matched groups of young and middle-aged patients (N = 432 in each age group).

The study examined 1- and 5-year outcomes, use of continuing care services, and outcome predictors. Older patients had better outcomes than did young and middle-aged patients but had comparable levels of continuing substance abuse care and 12-step self-help group involvement. Similar factors predicted outcomes regardless of the age group.

The authors concluded that, "...older patients with alcohol use disorders respond to age-integrated substance abuse treatment programs at least as well as do younger patients, and are equally involved in formal and informal continuing substance abuse care." In short--the above research provides no reason to assume your patient won't do well in the treatment program, even if most of the other patients are younger.

January 2004

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