Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program

Authors

  • Derek D. Satre,

    Corresponding author
    1. Department of Psychiatry, University of California, San Francisco, CA,
    2. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA and
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  • Jennifer R. Mertens,

    1. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA and
    2. Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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  • Patricia A. Areán,

    1. Department of Psychiatry, University of California, San Francisco, CA,
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  • Constance Weisner

    1. Department of Psychiatry, University of California, San Francisco, CA,
    2. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA and
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Derek D. Satre University of California San Francisco 401 Parnassus Avenue Box 0984-OVS San Francisco CA 94143 USA Tel: (415) 476 7382 Fax: (415) 476 7719 E-mail: dereks@lppi.ucsf.edu

ABSTRACT

Aims  This study compared 5-year treatment outcomes of older adults to those of middle-aged and younger adults in a large managed care chemical dependency program. We examined age group differences in individual, treatment and extra-treatment factors, which may influence long-term outcome.

Design  Seventy-seven per cent of original study participants completed a telephone interview 5 years after out-patient chemical dependency treatment at Kaiser Permanente. This sample (N = 925) included 65 patients aged 55–77, 296 patients aged 40–54 and 564 patients aged 18–39 (age at baseline).

Measurements  Measures at follow-up included alcohol and drug use, Addiction Severity Index (ASI), Alcoholics Anonymous Affiliation Scale, social resource and self-reported health questions. Mortality data were obtained from contact with family members of patients as well as automated health plan records.

Findings  Older adults were less likely to be drug-dependent at baseline than younger and middle-aged adults, and had longer retention in treatment than younger adults. At 5 years, older adults were less likely than younger adults to have close family or friends who encouraged alcohol or drug use. Fifty-two per cent of older adults reported total abstinence from alcohol and drugs in the previous 30 days versus 40% of younger adults. Older women had higher 30-day abstinence than older men or younger women. Among participants dependent only on alcohol, there were no significant age differences in 30-day abstinence. In logistic regression analysis, age group was not significant. Variables associated with greater age that independently predicted 30-day abstinence in the logistic regression model included longer retention in treatment and having no close family or friends who encouraged alcohol or drug use at 5 years; female gender was also significant.

Conclusions  Results indicate that older adults have favorable long-term outcome following treatment relative to younger adults, but these differences may be accounted for by variables associated with age such as type of substance dependence, treatment retention, social networks and gender. Age differences in these characteristics inform intervention strategies to support long-term recovery of older adults and provide direction for investigation of how age affects outcome.

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