Review of: Andersen K et al, Addiction 2020;115(1):69–81

During the COVID-19 pandemic, when every personal contact requires risk-reward deliberations, understanding the impact of relationships on health is crucial. This timely study, conducted from 2014 through 2016, investigated whether social networks reduce drinking among older adults with alcohol use disorder (AUD). The authors hypothesized that a community reinforcement approach tailored to seniors (CRA-S) could mitigate alcohol use patterns such as drinking more when lonely or grieving. CRA has long been used effectively for patients with a range of substance use disorders. In this approach, practitioners encourage clients to become involved in non-substance-related pleasant social activities, and to work on enhancing the enjoyment they receive within the community.

In the study, CRA-S was paired with motivational enhancement therapy (MET), a mainstay of addiction therapy. 693 seniors with AUD in the US, Denmark, and Germany—predominantly men in their 60s—were randomized to MET alone or MET followed by CRA-S. All participants received MET weekly for 1 month, and then patients in the treatment arm were able to select up to 8 further 1-hour manualized CRA-S sessions from a menu of choices. Examples of modules included “building a sober network,” “coping with craving,” and “coping with aging.” The primary endpoint was self-reported alcohol use 26 weeks after the study start.

CRA-S turned out to make no significant difference. At follow-up, about 50% of participants in both groups either abstained entirely from drinking or had a calculated blood-alcohol level of ≤ 0.05%. In fact, the only significant predictors of abstinence were older age and male sex. The study was underpowered and most patients did not receive all CRA-S sessions, but the authors note that their results are consistent with other studies showing that more treatment doesn’t necessarily lead to better outcomes for patients with AUD.

CATR’s TAKE
Although addressing social and psychological factors is a cornerstone of addiction medicine, CRA-S did not lead to abstinence from alcohol in this study among seniors with AUD. However, future sufficiently powered and controlled studies may have more to say about CRA-S.