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

404 IV. SPECIAL POPULATIONSStaffing of the group program should include a group leader who is knowledgeableabout alcoholism and geriatrics, ideally a psychiatrist, a nurse, or socialworker, or an alcoholism counselor helping patients with practical problems,such as economic and housing needs, and relationships to friends, relatives, andneighbors. Helping a patient make doctor appointments and attend to otherneeds should be continued until the patient is able to accomplish theses activitieson his or her own (Zimberg, 1995).The most important goal of the aging-specific approach to treatment ofalcoholism is not necessarily producing abstinence. This fact creates resistanceamong the clinicians used to the alcohol-specific approach, where abstinence isthe goal of treatment. The aging-specific approach is not designed as a harmreduction technique either. The paradox of the aging-specific approach directedmainly at the psychosocial stresses of aging is that it often results inabstinence achieved early in treatment and is more easily maintained, with few,if any, relapses to drinking. Abstinence is encouraged and occurs in the contextof reduction of the maladaptations to aging, the treatment of coexistingdepression, and improved self-esteem, with more opportunities to feel worthwhile.Current experiences support the findings of the early clinicians workingwith elderly alcoholics in the 1960s and 1970s that psychosocial treatments arebetter for alcohol problems that are caused or exacerbated by the psychosocialstresses of aging. This observation can be applied equally well to both earlyonsetand late-onset elderly alcoholics. Both groups respond to the agingspecificapproach (Zimberg, 1974).Pharmacological TreatmentPharmacological treatment of alcohol withdrawal in elderly persons involvesuse of tapering doses of long-acting benzodiazepines, as indicated earlier. I havefound that the use of benzodiazepines can be safe and effective. Ambulatorydetoxification can be carried out in those elderly alcoholics who do not haveserious cardiovascular disease, or other serious medical or neurological problems.A physical examination is necessary prior to starting an outpatient detoxification.Patients should not be maintained on benzodiazepines because of thedrug’s dependence liability, adverse cognitive effects, and the availability ofother, safer drugs to treat anxiety.Depression is a common problem among elderly alcoholics. The use ofselective serotonin reuptake inhibitor drugs, such as sertraline, or tricyclics,such as nortriptyline, has been found effective in treating depression in theelderly (Kennedy, 2000). The elderly alcoholic patient should not be activelydrinking and should be alcohol-free for 2–3 weeks to determine whether theobserved depression is alcohol induced. If alcohol is not a cause, starting onantidepressant medication can be very effective in helping patients maintain