Setting Has Little Effect On Treatment Outcome

Conducting alcohol counseling sessions with the elderly in primary care settings is as effective at reducing alcohol consumption for at-risk drinkers as referring them to a mental health or substance abuse specialist in the community.

This is what researchers found in the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study, though the authors noted a number of limitations to the study.

The goal of the study was to assess whether and to what extent two models of care improved access to services, cost of services, and mental health outcomes.

In the process, the study highlighted important problems with access to and provision of care, even when common barriers to mental health services were removed. The findings are reported in the July Psychiatric Services.

Researchers at nine primary care sites screened patients aged 65 and older for participation in the study between March 2000 and March 2002.

Patients were considered eligible if they exhibited at-risk drinking, which was defined as drinking more than 14 drinks per week for men, more than 12 drinks per week for women, or four or more drinks four or more times during the prior three months for either men or women.

Researchers assessed 560 subjects at baseline and at three and six months in face-to-face or telephone interviews.

They measured the amount and frequency of alcohol use seven days before each assessment and the number of binge-drinking episodes before each assessment.

Two groups of 280 subjects each were randomly assigned to receive treatment in an integrated-care model or an enhanced specialty referral model. Staff at each primary care site or mental health or substance abuse clinic were responsible for developing treatment plans and initiating care.

Clinicians working under the integrated-care condition received a half day of training on administering face-to-face alcohol intervention counseling sessions, which included discussions with patients on drinking cues, reasons for drinking, and reasons to cut down or quit, among other issues.

Those randomized to the integrated-care model were to receive three 20- to 30-minute counseling sessions.

In addition, participants with at-risk drinking and comorbid mental health disorders were treated for both simultaneously.

According to lead author David Oslin, M.D., an associate professor of psychiatry at the University of Pennsylvania, those randomized to receive specialty care referrals had no copays, transportation was provided to appointments, and when patients did not show up to an appointment, the specialist (usually a psychiatrist or psychologist) was instructed to call the patient to try to engage him or her in treatment. In this referral model, each clinician decided what treatment was most appropriate for each patient.