Motivating Older Alcohol Abusers to Enter Treatment

Motivating Older Alcohol Abusers to Enter Treatment- Once they are identified, motivating elders to consider treatment can  be difficult. Strategies based both on the transtheoretical model or  stages of change model and on the motivational interviewing approach  are recommended. These approaches recognize that some people are unaware of their problem and react poorly to direct attempts to  convince them of treatment needs (precontemplators). Those in later  stages of readiness to change (e.g., contemplation and preparation  stages)  may be thinking about, or  already taking first steps toward, change. Through motivational  interviewing approaches, counselors recognize how to judge each client's readiness and learn how to help their clients move toward  changing drinking behaviors and accepting professional help. 

Treatment Recommendations

The TIP panel recommended that older adults be treated in  elder-specific group treatment programs; that is, those that admit  only older adults. Programs should employ individuals trained to work with older adults, provide treatment at a slower pace, attend to negative affect and social support, and avoid confrontation.  Programs must attend to medical conditions and recognize elders' greater sensitivity to alcohol's effects.

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Elder-specific treatment approaches recommended by the TIP panel  included brief intervention (BI) and brief therapies using  cognitive–behavioral interventions. Because many older adults are  resistant to visiting outpatient treatment centers, BI is a viable  alternative. It can be delivered in a physician's office, an older  adult's home, a senior center, or other nontraditional sites where  substance abuse treatment is less likely to be offered. BI ranges from one to five sessions, with the counselor guiding the client  through the contents of a health promotion workbook.


The workbook  provides general education about older adults' health, information  on the use of alcohol and medications, feedback about the client's personal risk, identification of triggers for drinking and  suggestions for coping strategies relative to those triggers, and behavioral “prescriptions” to help the client define and decide on an immediate goal. Early studies of BI with older adults involved  primary care physicians and their patients. Subsequent applications  have extended BI for use by nonmedical service providers such as  psychologists, social workers, and aging services providers trained  to use the workbook. 

Brief therapies may consist of more sessions and aim for greater change in drinking behavior. Cognitive–behavioral therapy (CBT)  along with self-management approaches focuses on teaching skills  necessary for rebuilding the social support network, self-management approaches for managing negative affect (e.g., depression, grief,  loneliness, anxiety), and general problem solving. 

Older adults  identify their personal drinking behavior chain and high-risk  situations for drinking, and counselors teach clients the skills  necessary to prevent lapses or relapses from occurring.

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Larry W. Dupree& Lawrence Schonfeld