Systematic and narrative review of treatment for older people with substance problems

PurposeSubstance misuse among older people is a growing concern. Treatment outcomes are perceived to be poor. The aim of the study was to examine the evidence for effective treatment for older substance misusers.MethodsPubMed, The Cochrane Library, Medline, Project CORK, and EMBASE were searched up to January 2007. Trials were included if participants were over the age of 50, sample size was sufficient, follow-up was undertaken, baseline and outcome measures were reported, the design was randomised controlled (RCT), controlled without randomisation or non-experimental descriptive, and pharmacological or psychological treatments for alcohol, nicotine, prescription medications or illicit drugs were investigated. Sixteen papers met inclusion criteria.ResultsMost studies were carried out in the USA. Sample sizes ranged from 24 to 3622 (mean = 704) with follow-up from 1 month to 5 years (mean = 18 months). Eight randomised controlled trials and eight descriptive studies, covering alcohol with or without drug misuse (n = 11); methadone maintenance (n = 1), prescription drugs (n = 1), smoking (n = 3) were examined systematically. All had baseline and outcome measures, which varied across studies. Outcome depended on self-report in 11 out of 16 studies: most did not utilise biological measures or other corroboration. A range of psychological treatment interventions was tested. Older people do respond to treatment, do not achieve worse outcomes than younger counterparts, and sometimes do even better.ConclusionsThis is the first systematic review on this topic. These preliminary results show an optimistic picture, which provides a foundation for further research to determine the most appropriate treatments for this group.