Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

402 IV. SPECIAL POPULATIONSAlcohol-Specific Approach to TreatmentThe treatment approach commonly used to treat alcohol-dependent individualsinvolves confronting them with the diagnosis and suggesting treatmentleading to abstinence. Detoxification is used, if indicated, and the treatmentcontract is established with the patient. This treatment is directed at the alcoholproblem, with cognitive therapy that involves relapse prevention and supportivetherapy to establish a positive relationship with the patient. Referral toAlcoholics Anonymous (AA) is often made to encourage peer support and rolemodels of recovery (Zimberg, 1999b).Pharmacological treatment, such as disulfiram, can be used with very resistantpatients, particularly if taking the disulfiram is observed (Kranzler, 2000).The use of naltrexone to reduce craving for alcohol has been found useful(Weinrieb & O’Brien, 1997). Clearly, the emphasis of this alcohol-specificapproach is centered on the use of alcohol and developing more effective waysto function without alcohol.With elderly people, such an approach has not been successful in my experience,except for the subgroup of elderly alcoholics treated for their alcoholproblem in an alcohol-specific way during their younger years. The reason forthis lack of success, and therefore for the very few elderly patients in treatmentat traditional alcohol programs, is that the stresses of aging are the major factorsleading to alcohol problems in older people. The inability to adapt the alcoholspecificapproach to the needs of the elderly has perpetuated the gap betweenthe awareness of the problem and the availability of effective treatment (Graham,1986; Schonfeld & Dupree, 1991).Aging-Specific Approach to TreatmentThe aging-specific approach involves identifying an alcohol problem amongother problems associated with aging: loneliness, retirement, deterioratinghealth, loss of loved ones, cognitive impairments, and depression. Depression isalso a condition in the elderly that is often underdiagnosed (Zimberg, 1996).Some early clinical literature on treating elderly alcoholics emphasized thestresses of aging, pointing the way toward a more effective treatment approach.An article by Droller (1964) reported on seven elderly alcoholic patients. Thisfamily physician visited elderly alcoholics at home. He found that in additionto medical and supportive treatment, primarily social treatment was most beneficialand reduced or eliminated the alcohol problem.Rosin and Glatt (1971), who treated 103 elderly alcoholics, found thatenvironmental manipulation, medical services, day hospital treatment, andhome visiting by staff or good neighbors were the most beneficial services. Hereagain, the therapeutic efforts that were directed at the stresses of aging provedthe most effective.