Referral paths, patient profiles and treatment adherence
of older alcoholic men
Roland M. Atkinson, M.D.
, Sahana Misra, M.D.
Stephen C. Ryan, M.D.
, John A. Turner, Ph.D.
Substance Abuse Treatment Program, Mental Health Division, Portland Veterans Affairs Medical Center, 3710 SW
U.S. Veterans Hospital Road, P.O. Box 1034, Portland, OR 97207, USA
Department of Psychiatry (OP02), School of Medicine, Oregon Health and Science University,
3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
Department of Medicine, Washington University School of Medicine, Barnes/Jewish Hospital, 660 Euclid Avenue,
P.O. Box 8121, St. Louis, MO 63110, USA
Received 24 December 2002; received in revised form 22 March 2003; accepted 22 March 2003
We sought factors affecting completion by older men of 1-year outpatient treatment for alcohol dependence. We retrospectively studied
clinical datasets of 110 men, age z 55 years, consecutively admitted over 4 years, examining the association of 18 referral, treatment and
patient variables with completion of treatment. We found that referral source was the most significant correlate of completion. Legal and self/
family referrals were far more likely to complete treatment than patients referred by health or social services. Referral groups had distinctive
profiles. Legal referrals were the healthiest. Self/family referrals were most likely to be married, to have had prior alcoholism treatment (a factor
also associated with treatment completion), and to suffer currently from depression. Health/social services referrals showed the highest levels
of psychosocial and physical dysfunction. Referral pathways deserve special consideration by programs treating older alcoholics. Special
strategies for engaging dysfunctional older patients in alcoholism treatment are discussed. D 2003 Elsevier Inc. All rights reserved.
Keywords: Alcoholism treatment; Aging; Adherence; Referral sources
Alcohol dependence is common among older adults, es-
pecially in clinical settings, where it is reported in 4% to
23% of older patients (Atkinson, 2000). For narrative ease
we will use interchangeably the DSM-IV term ‘‘alcohol
dependence’’ and ‘‘alcoholism,’’ and the corresponding
referents for patients, i.e., as ‘‘alcohol dependent’’ or ‘‘alco-
holic.’’ All other diagnostic terms will follow DSM-IV
(American Psychiatric Association, 1994). In alcoholism
treatment outcome studies stratified for age, older patients
fare as well as or better than their younger counterparts
(Atkinson, 1995, 1998). Several specialized treatment pro-
grams have been established for aging clienteles (Atkinson,
Turner, & Tolson, 1998; Blow, Walton, Chermack, Mudd,
Brower, & Comstock, 2000; Dupree, Broskowski, & Schon-
feld, 1984; Kashner, Rodell, Ogden, Guggenheim, & Karson,
1992), and best practice guidelines have been promulgated
recently for treatment of this age group (Barry, Oslin, &
Blow, 2001; Center for Substance Abuse Treatment, 1998;
Gurnack, Atkinson, & Osgood, 2002). But there has been
little published research on treatments matched to older age,
or on predictors of treatment adherence or outcome for al-
coholic older adults (Atkinson, 1995).
For the past 20 years, in a specialized outpatient treat-
ment program for older adult alcoholics at the Veterans
Affairs Medical Center in Portland, Oregon, our group has
sought to identify factors that affect treatment adherence
among this aging population. Our first study showed that
when older patients were placed with age peers in outpatient
group treatment, rather than mixed together with younger
patients, 1-year treatment retention and attendance rates
improved dramatically (Kofoed, Tolson, Atkinson, Toth,
& Turner, 1987). Later we demonstrated that among older
men treated in the age peer group program, referral source
0740-5472/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved.
* Corresponding author. Tel.: +1-503-494-6146; fax: +1-503-494-6578.
E-mail address: email@example.com (R.M. Atkinson).
Journal of Substance Abuse Treatment 25 (2003) 29 – 35