Larry W. Dupree

Cognitive-behavioral treatment of older veterans with substance abuse problems.

The authors describe the initial cohort of participants in the GET SMART program, an age-specific, outpatient program for older veterans with substance abuse problems. Chief among the programs services is a relapse-prevention intervention consisting of 16 weekly group sessions using cognitive-behavioral (CB) and self-management approaches. Group sessions begin with analysis of substance use behavior to determine high-risk situations for alcohol or drug use, followed by a series of modules to teach coping skills for coping with social pressure, being at home and alone, feelings of depression and loneliness, anxiety and tension, anger and frustration, cues for substance use, urges (self-statements), and slips or relapses. Of the first 110 admissions, more than one-third were homeless, which is indicative of the severity of psychosocial distress of the patients, and more than one-third used illicit drugs. A total of 49 patients completed CB treatment groups and 61 dropped out of treatment. At 6-month follow-up, program completers demonstrated much higher rates of abstinence compared to noncompleters. The results suggest that CB approaches work well with older veterans with significant medical, social, and drug use problems.

Treatment Approaches for Older Problem Drinkers

Recent research suggests that older adults with alcohol problems often drink in response to loneliness, depression, and poor social support networks. Although a variety of approaches such as psychodynamic, Twelve Step, social support, behavioral, and cognitive-behavioral, have been suggested, only those studies involving behavioral and cognitive-behavioral interventions have provided empirical support for treatment effectiveness. Some research also suggests that age-specific group treatment produces better outcomes than when older adults are placed in treatment with younger alcoholics.

Preferences for Mental Health Care: A Comparison of Older African Americans and Older Caucasians

Research on mental health service utilization patterns has shown that older adults underutilize outpatient services, particularly in minority populations. Greater reliance on inpatient services may result when a mental health problem can no longer be ignored. The goal of this study was to compare the attitudes and beliefs of African American and Caucasian older adults about mental health care and preferred providers. A 47-item survey was administered to a convenience sample of 1,598 primarily African Americans, recruited at 40 sites, including the study sample of 726 people older than age 50. Results showed that respondents of both races preferred advice from their family doctor, clergy, or a family member. African Americans preferred services in their doctor’s or clergy’s office, whereas Caucasians preferred a professional service provider’s office. Findings suggest that providers and policy makers consider the impact of age, culture, and ethnicity on mental health services provision.

Older adult users of outpatient mental health services

Descriptive demographic, clinical and interview data from clients of an outpatient mental health clinic for older adults are presented. These clients are better educated and have a more frequents history of marital difficulties than older adults in general. Although a significant minority received V code and Adjustment Disorder diagnoses, the majority were depressed and had histories of prior mental health services. Economic factors are a major issue in seeking services.

Antecedents of relapse and recent substance use

The present study investigated determinants of release and antecedents of recent use for 30 substance abusers re-entering inpatient treatment. A structured interview assessment revealed that the patients relapsed within two months following previous treatment, yet waited 2.7 years before re-entering treatment. Alcohol was often the initial and subsequently the most frequently used substance. Determinants of relapse were a variety of interpersonal and intrapersonal events. However, antecedents to recent use were almost exclusively negative emotional states such as depression and loneliness. Implications for treatment are presented.

Comparison of Three Case-Finding Strategies Relative to Elderly Alcohol Abusers

The effectiveness of three case-finding strategies for locating elderly alcohol abusers and linking them with an alcohol treatment program was explored. The three approaches emphasized the formal caregiver (CARN), the general public (PAC), and community health clinics (CBO). The CARN and PAC approaches appeared to be most cost-effective. I discuss implications of the findings.

Alcohol use and misuse in older adults

Alcohol misuse among older people has now been investigated for over 30 years. Schonfeld and Dupree previously described studies of alcohol use and abuse in the USA and UK, categories of older problem drinkers, age-inappropriate assessments, and examples of age-specific treatment. This review addresses more recent studies on drinking behaviour across several countries, screening assessment for older adults, alcohol problems in primary care medical settings, current age-specific treatment programmes, and treatment recommendations by expert panels, as well as in-home detoxification and use of the medication naltrexone as adjuncts to treatment.

The Value of Behavioral Perspectives in Treating Older Adults

Behavioral approaches used in the treatment of older adults have now been implemented and evaluated over about a 25-year period. The field of behavioral gerontology, as it is known, is noted by Wisocki (1991) to be “best defined as the application of behavioral principles and procedures to the problems of the elderly and the issues of aging” (p. 3). Interventions based on these principles have proven to be among the most effective treatments for a wide variety of behavior problems for all age groups.

Geropsychology post-doctoral training in public sector service delivery: the USF/Tampa VA fellowship model.

Abstract There is a growing need for geropsychologists who are specialists in practice, research, education, and advocacy for older adults. The combined USF/Tampa VA geropsychology fellowship program focuses on the training of three post-doctoral Fellows each year in public sector service delivery across diverse long term care (LTC) and primary care settings. Addressing the bio-psycho-social needs of frail, poor, and minority older adults within an interdisciplinary framework exposes geropsychology Fellows to the complex nature of mental health problems of older adults and the need for collaborative efforts across professional lines. The program builds on prior geropsychology training at the graduate and internship levels by providing an integrated framework to achieve clinical, didactic, program evaluation, and advocacy goals: (1) delivery of state-of-the-art evidence-based psychological services to disadvantaged older adults in geriatric public sector primary care sites; (2) mastery of the knowledge base on diversity and interdisciplinary teamwork as they relate to providing services to older adults, including those residing in rural areas; (3) gaining competence in the evaluation of services to disadvantaged older adults; and (4) experience in public health advocacy for improvement of the LTC system.

Age and mental health status differences in medical service utilization in an integrated primary care setting

Abstract This study explored age and mental health referral status effects on a variety of patient, medical, and medical service utilization variables among adults seen in a rural integrated (mental health) primary care practice. The study cohort consisted of the first 150 consecutive patients referred for brief MH service, and a comparison group of 150 general medical patients not referred for MH service, as well as 34 matched older MH patients and controls. Results showed that older medical patients had significantly more medical problems and used more prescribed medications than younger medical patients (p > .05). Older patients referred for mental health services had experienced significantly more deaths among significant others, more adverse life events, and more family caregiver responsibilities than their younger counterparts (p > .05). In contrast to medical patients, younger and older patients referred for mental health care did not differ on medical variables or service utilizations variables, except for prescribed medication. Referred elders also had more medical problems than matched older medical patients. The presence of integrated mental health services appeared to markedly reduce age and mental health status differences on most medical service variables.