Evaluation of adding the Community Reinforcement Approach to Motivational Enhancement Therapy for Adults Aged 60 Years and Older with DSM‐5 Alcohol Use Disorder: A Randomised Controlled Trial

AIM: To examine whether adding the Community Reinforcement Approach for Seniors (CRA-S) to Motivational Enhancement Therapy (MET) increases the probability of treatment success in people aged >/= 60 years with alcohol use disorder (AUD). DESIGN: A single blind multi-centre multi-national randomized (1 : 1) controlled trial. SETTING: Out-patient settings (municipal alcohol treatment clinics in Denmark, specialized addiction care facilities in Germany and a primary care clinic in the United States). PARTICIPANTS: Between January 2014 and May 2016, 693 patients aged 60+ years and fulfilling DSM-5 criteria for AUD participated in comparing MET (n = 351) and MET + CRA-S (n = 342). INTERVENTION AND COMPARATOR: MET (comparator) included four manualized sessions aimed at increasing motivation to change and establishing a change plan. CRA-S (intervention) consisted of up to eight further optional, manualized sessions aimed at helping patients to implement their change plan. CRA-S included a specially designed module on coping with age and age-related problems. MEASUREMENTS: The primary outcome was either total alcohol abstinence or an expected blood alcohol concentration of 0.05% during the follow-up period (defined as failure). This was assessed by self-report using the Form 90 instrument. The main analysis involved complete cases. FINDINGS: The follow-up rate at 26 weeks was 76.2% (76.9% in the MET group and 76.0% in the MET + CRA-S group). The success rate in the MET group was 48.9% [95% confidence interval (CI) = 42.9-54.9%] versus 52.3% (95% CI = 46.2-58.3%) in the MET + CRA-S group. The odds of success in the two conditions did not differ (odds ratio = 1.22. 95% CI = 0.86-1.75, P = 0.26, Bayes factor = 0.10). Sensitivity analyses involving alternative approaches to missing values did not change the results. CONCLUSIONS: In older adults with an alcohol use disorder diagnosis, adding the 'community reinforcement approach for seniors' intervention to brief out-patient motivational enhancement therapy treatment did not improve drinking outcome.