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      What do elderly problem drinkers aim for? Choice of goal for treatment among elderly treatment-seeking alcohol-dependent patients

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          Abstract

          Objective:

          The patient’s free choice of treatment goals for alcohol use disorder (AUD) is predictive for treatment outcome. Presently there is limited knowledge of whether the age at onset of AUD influences the choice of goal for treatment. The present study investigates whether there are differences in choice of treatment goal between patients with very late onset alcohol use disorder (VLO AUD ≥ 60 years) and those having early or mid-age onset of AUD (EMO AUD < 60 years).

          Method:

          Participants were 341 persons, voluntarily enrolled in the Elderly Study, who were seeking treatment for AUD in outpatient centres for alcohol treatment in Denmark. Data regarding thoughts about abstinence, alcohol use in the last 90 days, motivation for treatment and psychiatric diagnosis were collected via questionnaires. A logistics regression was used to analyse the data.

          Results:

          32.1% of the participants with VLO AUD chose temporary abstinence goals, compared to 18.2% of the patients with earlier-onset AUD ( p = 0.024). Further, 10.7% of participants with VLO AUD chose total abstinence goals compared to 31.3% of participants with early or mid-age onset AUD ( p = 0.002).

          Conclusion:

          There are significant differences in choice of goal between participants with very late onset AUD and early or mid-age onset AUD. Individuals with very late onset alcohol use disorder tend to choose temporary abstinence over any other treatment goal whereas, in general, individuals with early onset alcohol use disorder choose permanent abstinence over other treatment goals.

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          Most cited references33

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          Do increases in patient activation result in improved self-management behaviors?

          The purpose of this study is to determine whether patient activation is a changing or changeable characteristic and to assess whether changes in activation also are accompanied by changes in health behavior. To obtain variability in activation and self-management behavior, a controlled trial with chronic disease patients randomized into either intervention or control conditions was employed. In addition, changes in activation that occurred in the total sample were also examined for the study period. Using Mplus growth models, activation latent growth classes were identified and used in the analysis to predict changes in health behaviors and health outcomes. Survey data from the 479 participants were collected at baseline, 6 weeks, and 6 months. Positive change in activation is related to positive change in a variety of self-management behaviors. This is true even when the behavior in question is not being performed at baseline. When the behavior is already being performed at baseline, an increase in activation is related to maintaining a relatively high level of the behavior over time. The impact of the intervention, however, was less clear, as the increase in activation in the intervention group was matched by nearly equal increases in the control group. Results suggest that if activation is increased, a variety of improved behaviors will follow. The question still remains, however, as to what interventions will improve activation.
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            Helping smokers make decisions: the enhancement of brief intervention for general medical practice.

            Primary care clinicians are often encouraged by government agencies to intervene systematically with all smokers. Pressure of time and pessimism about their own efficacy and patients' capacity to change are some of the reasons why clinicians do not feel it is appropriate to always advise every patient about unhealthy behaviours. Developments in patient centred approaches to the consultation and progress in the addictions field suggest that new consulting methods could be constructed which are more satisfying than giving brief advice to change. The aim of this study was to develop a structured, teachable and acceptable intervention for clinicians to help patients consider their smoking during general medical consultations. Patient centred strategies derived from the stages of change model and motivational interviewing and its adaptations were explored in experimental consultations with 20 volunteer smokers. Feedback from them and from general practice registrars trained in the use of the method informed its development. Acceptability to clinicians was assessed by semi structured telephone interviews with 24 general practice registrars who participated in a randomised controlled trial assessing the effectiveness of the method. Anonymous, written questionnaires were also completed by 20 of the registrars who recruited ten or more patients into the trial. The method is described. Key components are: establishing rapport, assessing motivation and confidence, and then depending on the response, asking standard scaling questions, asking about pros and cons of smoking, non-judgmental information sharing, brainstorming solutions and negotiating attainable goals and follow-up. The clinicians used the method with a total of 270 smokers, taking an average of 9.69 min with each patient. Evaluation reveals that it is acceptable to the group of general practice registrars. Longer consultation time was seen as the main drawback. We conclude that acceptable methods for opportunistic health promotion can be developed by taking into account patient centred approaches to the consultation, developments from the addictions field and the practical problems faced by clinicians. The process can be further enhanced by considering feedback from those who are likely to receive and use the interventions.
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              The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of structured diagnostic psychiatric interview for DSM-IV and ICD-10

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                Author and article information

                Contributors
                Journal
                Nordisk Alkohol Nark
                Nordisk Alkohol Nark
                NAD
                spnad
                Nordisk alkohol- & narkotikatidskrift : NAT
                SAGE Publications (Sage UK: London, England )
                1455-0725
                1458-6126
                4 July 2019
                December 2019
                : 36
                : 6
                : 511-521
                Affiliations
                [1-1455072519852852]Faculty of Health, Department of Clinical Research, Unit for Clinical Alcohol Research and Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
                [2-1455072519852852]Department of Psychiatry, Region of Southern Denmark, Odense, Denmark
                [3-1455072519852852]OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
                [4-1455072519852852]Faculty of Health, Department of Clinical Research, Unit for Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark
                [5-1455072519852852]IFT Institut für Therapieforschung, Munich, Germany
                [6-1455072519852852]Faculty of Health, Department of Clinical Research, Unit for Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark
                Author notes
                [*]Jakob Emiliussen, The Unit for Clinical Alcohol Research, J.B. Winsløws Vej 18, Entrance 220B, 5000 Odense, Denmark. Email: jemiliussen@ 123456health.sdu.dk
                Author information
                https://orcid.org/0000-0003-4840-3223
                Article
                10.1177_1455072519852852
                10.1177/1455072519852852
                7434199
                32934584
                6364d4cc-8684-4008-8a2b-2e5932f1dae4
                © The Author(s) 2019

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 22 October 2018
                : 4 April 2019
                Funding
                Funded by: Region Syddanmark, FundRef https://doi.org/10.13039/501100003554;
                Award ID: Unconditional Grant
                Categories
                Research Report

                alcohol use disorder,older adults,randomised controlled trial,treatment goals,very late onset

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