title: Contrasting outcomes of older versus middle-aged and younger adult chemical dependency patients in a managed care program.
abstract: OBJECTIVE
  This study examined how well older chemical dependency patients succeed in treatment relative to middle-aged and younger patients in a mixed-age private HMO outpatient program. To predict successful outcome, we tested a model incorporating age group differences in individual, treatment and extratreatment factors.
  
  
  METHODS
  The sample included 89 patients aged 55 and over, 379 patients aged 40 to 54, and 736 patients aged 18-39 (N = 1,204). Baseline measures included DSM-IV substance misuse diagnoses, Addiction Severity Index (ASI), psychiatric symptom checklist, sources of suggestion to enter treatment, treatment history and motivation. Outcome measures were abstinence rates and ASI score 6 months posttreatment.
  
  
  RESULTS
  At baseline, older adults showed higher levels of alcohol dependence, lower rates of drug dependence and lower psychiatric symptoms relative to younger individuals. Source of suggestions to enter treatment differed by age. Older and middle-aged patients were more likely to have an abstinence goal and to stay in treatment longer than younger adults. At 6 months posttreatment, 55% of older adults reported abstinence in the preceding 30 days, versus 59% of middle-aged adults and 50% of younger adults (p = .035).
  
  
  CONCLUSIONS
  Lower rates of dependence and hostility, and greater abstinence motivation and length of stay in treatment--all of which were associated with greater age--positively affect prognosis of older adults in treatment.
authors.affiliation: University of California, San Francisco, 401 Parnassus Avenue, Box 0984-OVS, San Francisco, California 94143, USA. dereks@lppi.ucsf.edu
authors.forename: Derek D
authors.initials: DD
authors.lastname: Satre
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mertens
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Areán
authors.forename: Constance
authors.initials: C
authors.lastname: Weisner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome