title: Longitudinal course of substance treatment benefits in older male veteran at-risk drinkers.
abstract: BACKGROUND
  This investigation aims to determine the 12-month drinking trajectory of older at-risk drinkers in treatment. Furthermore, the drinking trajectory between at-risk drinkers who had met the threshold suggestive of alcohol dependence (problem at-risk drinkers) and those who did not meet this threshold (nonproblematic at-risk drinkers) were compared.
  
  
  METHODS
  This investigation is a component of the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) Study, a multisite randomized trial comparing service use, outcomes, and cost between Integrated (IC) versus Enhanced Specialty Referral (ESR) care models for older (65+ years) adults with depression, anxiety, and/or at-risk alcohol consumption. This investigation focuses only on at-risk drinkers, generally defined as exceeding recommended drinking limits, which in the case of older adults has been classified as consuming more than one drink per day. Two hundred fifty-eight randomized older at-risk drinkers were examined, of whom 56% were problem drinkers identified through the Short Michigan Alcohol Screening Test-Geriatric version.
  
  
  RESULTS
  Over time, all at-risk drinkers showed a significant reduction in drinking. Problem drinkers showed reductions in average weekly consumption and number of occurrences of binge drinking at 3, 6, and 12 months, whereas nonproblematic drinkers showed significant reductions in average weekly consumption at 3, 6, and 12 months and number of occurrences of binge drinking at only 6 months. IC treatment assignment led to higher engagement in treatment, which led to better binge drinking outcomes for problem drinkers. Despite significant reductions in drinking, approximately 29% of participants displayed at-risk drinking at the end of the study.
  
  
  CONCLUSIONS
  Results suggest that older at-risk drinkers, both problem and nonproblematic, show a considerable decrease in drinking, with slightly greater improvement evidenced in problem drinkers and higher engagement in treatment seen in those assigned to IC.
authors.affiliation: Graduate Center for Gerontology, University of Kentucky, Lexington, KY 41094, USA. f.zanjani@uky.edu
authors.forename: Faika
authors.initials: F
authors.lastname: Zanjani
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Mavandadi
authors.forename: Tom
authors.initials: T
authors.lastname: TenHave
authors.forename: Ira
authors.initials: I
authors.lastname: Katz
authors.forename: Nalla B
authors.initials: NB
authors.lastname: Durai
authors.forename: Dean
authors.initials: D
authors.lastname: Krahn
authors.forename: Maria
authors.initials: M
authors.lastname: Llorente
authors.forename: JoAnn
authors.initials: J
authors.lastname: Kirchner
authors.forename: Edwin
authors.initials: E
authors.lastname: Olsen
authors.forename: William
authors.initials: W
authors.lastname: Van Stone
authors.forename: Susan
authors.initials: S
authors.lastname: Cooley
authors.forename: David W
authors.initials: DW
authors.lastname: Oslin
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000517:prevention & control*; D000437:Alcoholism / Q000628:therapy*; D001008:Anxiety Disorders / Q000628:therapy; D019033:Delivery of Health Care, Integrated; D003866:Depressive Disorder / Q000628:therapy; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010348:Patient Care Team; D012017:Referral and Consultation; D012307:Risk Factors; D016896:Treatment Outcome; D014728:Veterans