Fresh Onward'. A study on group-based treatment programs for elderly with problematic alcohol use

Background: Although excessive alcohol use among the elderly is prevalent, available group-based treatment programs are not standardized. This paper describes a study on four group-based programs for elderly with alcohol problems, based on the Dutch program 'Fresh Onward'. The aim was to explore these programs, present characteristics and similarities/differences between the programs, explore possibilities for standardization, and compare current evidence-based elements from the literature with the four selected programs in this study.

Methods: A document analysis, interviews with implementers and practitioners, and evidence-based insights based on a scoping literature review, were generated.

Results: Prominent similarities between the programs showed that all strived for acceptable use of alcohol such as abstinence, were group-oriented and based on lifestyle training/cognitive behavioral therapy (CBT). All programs were provided within specialized mental health care, mainly by nurses. Programs all ranged between 8- 12 participants per group. Participants were referred mainly through primary care. Prominent differences between the programs were the group structure they used (open versus closed), the duration, and the theoretical premise of the programs. Additional to lifestyle training/CBT, the acceptance and commitment therapy (ACT) was also conducted. Examples of subjects covered include self-control, dealing with cravings, coping with social pressure, and setting goals. In addition, attention is paid to psycho-education, life-stage issues (loss, retirement), the meaning of life, shame and guilt, and lifestyle. Elements from the literature that match the programs, were not patronizing, providing attention to increasing individual skills, information transfer, influencing social norms and providing tailored feedback based on monitoring drinking behavior.

Conclusion: It is desirable to expand the program with an early intervention group. Also, the expansion and subsequent repositioning of 'Fresh Onward' to the general practice could increase accessibility and intake of participants. In future research, an evaluation should be conducted to assess effectiveness in advance of standardization on a national level.