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

406 IV. SPECIAL POPULATIONSLocation of TreatmentThe group approach I have described has been generally very effective. Thiscan be provided wherever elderly alcoholics are found in psychiatric clinics,inpatient alcoholism programs, geriatric clinics, and senior citizen centers ornursing homes. The approach can also be provided individually in primary carephysicians’ or psychiatrists’ offices. I provide the aging-specific approach individuallyin my office, with generally high recovery rates.The essence of the aging-specific approach includes determining whetherthere is an alcohol problem, what stresses of aging are affecting the patient, thepresence of coexisting depression or other psychiatric conditions, and relationshipto families and friends. Many elderly patients look forward to the visit tothe doctor’s office, and this interest can be utilized to engage patients in treatingnot only the alcohol problem but also other problems that they may beexperiencing.ELDERLY ALCOHOLICS IN GENERAL HOSPITALSElderly alcoholics can be found in significant numbers in general hospitals(Adams et al., 1993 Gerke, Hapke, Rumpf, & John, 1997; Moore et al., 1989).They are usually more frequently found on medical–surgical services ratherthan in inpatient detoxification or psychiatric units.The presence of elderly alcoholics in relatively large numbers presents aparticular challenge to consultation–liaison psychiatrists and addiction psychiatristsworking in general hospitals. Diagnostic approaches indicated for elderlyalcoholics can be readily applied in a general hospital setting. A studythat compared readiness to deal with alcohol problems in alcohol-dependentpatients in the general hospital and such patients in the general populationfound that the general hospital patients seemed more willing to engage in treatment(Rumpf, Hapke, Meyer, & John, 1999). However, my experience withidentifying and referring elderly alcoholics for treatment after discharge, byusing alcohol nurse coordinators, resulted in very few successful referrals. Thisfailure resulted in part because of the lack of an aging-specific program at thishospital’s alcoholism clinic and the fact that the patients were referred to a clinicianat the alcoholism clinic who was anonymous as far as the patients wereconcerned. They also resisted going to an alcoholism clinic. In contrast, in myexperience, patients seen at the general hospital by me and referred to myselffor outpatient care accepted the referral and followed up treatment.To be able to engage elderly alcoholics in the general hospital, treatmentprograms must be available to meet their needs. First, there should be a highindex of suspicion of alcohol problems among elderly persons admitted to generalhospitals. Administering the CAGE and reviewing blood studies should be