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Research Summary

Community-based Screening and Brief Intervention Is Effective at Identifying and Treating Older Adults with Depression and Substance Misuse

The Florida Brief Intervention and Treatment for Elders (BRITE) project recruited adults age 60 and older through community outreach or referrals from primary care and social, aging, or other services to assess the need for substance-abuse treatment. Most referrals were due to concerns about depression (64%), followed by medication misuse (26%), alcohol misuse (10%), and illicit drug use (1%). Subjects were assessed with the Short Geriatric Depression Scale (SGDS) and the Short Michigan Alcoholism Screening Test, Geriatric Version (SMAST-G). Illicit drug use was assessed by a single-question screen, and prescription drug misuse was assessed with a 17-item questionnaire developed by the researchers. Of 3497 subjects screened, 1999 had evidence of depression or substance misuse, 731 of whom received 1–5 brief intervention sessions conducted by trained counselors at the subjects’ home or other location of choice. Three hundred twenty-three subjects completed follow-up assessments at 30 days post-intervention. A planned 90-day follow-up assessment was not done due to attrition.

  • Although only 10% of initial referrals were for alcohol misuse, 26% of subjects had evidence of an alcohol use disorder. There was a positive correlation between depression scores and alcohol screening scores.
  • Among those who completed follow-up assessments, there was a significant decline in SGDS and SMAST-G scores.
  • Of the 187 subjects who screened positive for prescription drug misuse at entry, 60 (32%) showed no evidence at discharge; however, an additional 86 subjects screened positive at discharge who had not screened positive at entry.

Comments:

This study suggests that community-based screening and brief intervention can be effective—at least in the short term—for identifying and treating older adults with depression and substance misuse, although the low rate of follow-up precludes definitive interpretation. The results also highlight the prevalence of alcohol and medication misuse among older adults. Darius A. Rastegar, MD

Reference:

Schonfeld L, King-Kallimanis BL, Duchene DM, et al. Screening and brief intervention for substance misuse among older adults: the Florida BRITE project. Am J Public Health. 2010;100(1):108–14.

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