title: Harm reduction among at-risk elderly drinkers: a site-specific analysis from the multi-site Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study.
abstract: OBJECTIVE
  To assess the efficacy of a harm-reduction based intervention to enhance access to treatment and clinical outcomes among elderly at-risk drinkers.
  
  
  METHODS
  A site-specific secondary data analysis of Primary Care Research in Substance Abuse and Mental Health for Elders study (PRISM-E).
  
  
  METHODS
  Thirty-four at-risk drinkers age 65 or older who were randomized into one of two treatment conditions: an integrated care condition which incorporated a harm-reduction based approach to treatment and an enhanced referral condition.
  
  
  METHODS
  Access to subsequent services and clinical outcomes were examined 6 months post index-interview date. Clinical outcomes included changes in the number of drinks in the week prior to assessment, changes in the number of binges in the past 3 months prior to assessment, and changes in scores on the Short Michigan Alcoholism Screening Test-Geriatric Version (SMAST-G).
  
  
  RESULTS
  At-risk drinkers in the integrated care condition were more likely to access treatment than at-risk drinkers assigned to the enhanced referral condition (93% vs 35%; chi(2) = 11.38, df = 1, p = 0.001). Among those who received treatment, there were no differences in the total amount of treatment visits or in the number of brief alcohol interventions received among at-risk drinkers in the two conditions. However, those in integrated care condition received services sooner than those in the referral condition. Those in the integrated care condition showed a significant decrease in the number of drinks in the past week and in the number of binge drinking episodes in the past 3 months while there were no significant changes in these outcomes among the at-risk drinkers in the enhanced referral condition.
  
  
  CONCLUSIONS
  At-risk drinkers in the integrated care condition were more likely to access treatment and decrease harmful drinking behaviors than those in the enhanced referral condition. Implications for future research and treatment are discussed.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA, USA. hlee@lppi.ucsf.edu
authors.forename: Heather Sophia
authors.initials: HS
authors.lastname: Lee
authors.forename: Amy A
authors.initials: AA
authors.lastname: Mericle
authors.forename: Liat
authors.initials: L
authors.lastname: Ayalon
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Areán
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000523:psychology*; D019033:Delivery of Health Care, Integrated; D005260:Female; D040261:Harm Reduction; D006299:Health Services for the Aged; D006306:Health Surveys; D006801:Humans; D008297:Male; D011320:Primary Health Care; D012017:Referral and Consultation; D018709:Statistics, Nonparametric; D016896:Treatment Outcome