Introduction: Older adults drinking above low-risk guidelines, including those with AUD, are uniquely susceptible to alcohol-related harm yet largely perceive their drinking as non-problematic and avoid formal treatment. Adaptive brief interventions available in non-specialist settings, either in-person or via telehealth, could provide crucial alternatives, yet they remain untested across age and/or modality.
Methods: A secondary data analysis used data from a sequential multiple assignment randomization trial of adaptive brief interventions to test moderators, age and modality (video-conferencing vs. in-person), on drinking at 12 (treatment end) and 24 weeks. After receiving brief advice (BA) at week 1, 160 participants were reassessed at week 4. Those drinking at high-risk levels (non-responders) were randomized to 2 sessions of Motivational Interviewing (MI) or 20 min more of BA (BA Plus). At week 8, MI non-responders were randomized to either a third session of MI or 4 sessions of brief self-control therapy (BSCT); BA Plus non-responders were randomized to either 2 sessions of MI or 1 session MI and 4 BSCT. Generalized estimating equations tested main and moderating effects of age and modality on intervention effects on longitudinal drinking outcomes, average weekly sum of standard drinks (SSD) and average weekly number of heavy drinking days (HDD).
Results: A significant main effect of age demonstrated OAs (57+) had the smallest reduction in SSD and HDD compared to middle-aged (48-56) and younger (< 48) adults; with middle-aged adults reducing the most. Modalities were equivalent by week 24, yet in-person reduced more rapidly than telehealth. Significant interaction terms (age x condition; modality x condition) revealed that 3 sessions of MI performed poorest among OA and that 3 MI in-person sessions outperformed its telehealth counterpart and other conditions.
Conclusions: These findings suggest OA with AUD may need immediate, longer duration interventions compared to other age groups. Those ages 48-56 provide a unique window for substantial change in drinking among those with AUD. While in-person interventions yielded earlier changes than those implemented via telehealth, both modalities successfully reduced drinking, providing an important alternative way to access treatment. Future research on intervention components, such as dosage, timing and duration, across age groups and modality, would further inform their implementation across the life span.
Keywords: Age; Alcohol; Alcohol use disorder; Brief interventions; Moderators; Older adults; Telehealth.
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