Cognitive-behavioral treatment of older veterans with substance abuse problems.

The authors describe the initial cohort of participants in the GET SMART program, an age-specific, outpatient program for older veterans with substance abuse problems. Chief among the program's services is a relapse-prevention intervention consisting of 16 weekly group sessions using cognitive-behavioral (CB) and self-management approaches. Group sessions begin with analysis of substance use behavior to determine high-risk situations for alcohol or drug use, followed by a series of modules to teach coping skills for coping with social pressure, being at home and alone, feelings of depression and loneliness, anxiety and tension, anger and frustration, cues for substance use, urges (self-statements), and slips or relapses. Of the first 110 admissions, more than one-third were homeless, which is indicative of the severity of psychosocial distress of the patients, and more than one-third used illicit drugs. A total of 49 patients completed CB treatment groups and 61 dropped out of treatment. At 6-month follow-up, program completers demonstrated much higher rates of abstinence compared to noncompleters. The results suggest that CB approaches work well with older veterans with significant medical, social, and drug use problems.

Treatment approaches for older problem drinkers.

Recent research suggests that older adults with alcohol problems often drink in response to loneliness, depression, and poor social support networks. Although a variety of approaches such as psychodynamic, Twelve Step, social support, behavioral, and cognitive-behavioral, have been suggested, only those studies involving behavioral and cognitive-behavioral interventions have provided empirical support for treatment effectiveness. Some research also suggests that age-specific group treatment produces better outcomes than when older adults are placed in treatment with younger alcoholics.

Antecedents of drinking for early- and late-onset elderly alcohol abusers.

The present study compared antecedents to recent drinking for two groups of elderly alcohol abusers admitted for treatment. Twenty-three early-onset alcohol abusers were matched with 23 late-onset alcohol abusers according to age and sex. Depression, loneliness and lack of social support were the most frequently reported antecedents to preadmission drinking behavior for both groups. However, early-onset subjects were more likely to have changed residence, were intoxicated more often and experienced more severe levels of depression and anxiety. Late-onset subjects had greater life satisfaction and motivation for treatment, but were rated by collaterals as having more severe alcohol problems. Early-onset subjects were more likely to drop out of treatment. Treatment implications for age-related commonalities are discussed.

Older adult users of outpatient mental health services.

Descriptive demographic, clinical and interview data from clients of an outpatient mental health clinic for older adults are presented. These clients are better educated and have a more frequent history of marital difficulties than older adults in general. Although a significant minority received V code and Adjustment Disorder diagnoses, the majority were depressed and had histories of prior mental health services. Economic factors are a major issue in seeking services.

Comparison of three case-finding strategies relative to elderly alcohol abusers.

The effectiveness of three case-finding strategies for locating elderly alcohol abusers and linking them with an alcohol treatment program was explored. The three approaches emphasized the formal caregiver (CARN), the general public (PAC), and community health clinics (CBO). The CARN and PAC approaches appeared to be most cost-effective. I discuss implications of the findings.

Antecedents of relapse and recent substance use.

The present study investigated determinants of relapse and antecedents of recent use for 30 substance abusers re-entering inpatient treatment. A structured interview assessment revealed that the patients relapsed within two months following previous treatment, yet waited 2.7 years before re-entering treatment. Alcohol was often the initial and subsequently the most frequently used substance. Determinants of relapse were a variety of interpersonal and intrapersonal events. However, antecedents to recent use were almost exclusively negative emotional states such as depression and loneliness. Implications for treatment are presented.

The Democratic Republic of Afghanistan, 1979.

PIP: 4 struggles currently dominate Afghan politics: 1) the war being fought by regionally and religously oriented guerrillas to overthrow the Soviet-leaning Amin regime; 2) the competition between conservative and religious leaders in the Pushtun area to monopolize funds from friendly Arabs; 3) the attempts by guerrilla forces to establish localized bases of power, so that any new regime in Kabul must grant the various ethno-linguistic groups some type of regional autonomy; and 4) the internal struggle for power within the Khalq leadership. 2 factions of Khalquis are involved: the liberal nationalists, led by Panjsheri and most military members of the Cabinet and Revolutionary Council; and the pro-Soviet opportunists led by Amin. The author lists these points after recounting the events leading to the coup d'etat against the Daoud regime on April 17, 1978 and the subsequent, but not markedly successful, attempts by leaders of the newly proclaimed Democratic Republic of Afghanistan to gain stability and implement land reform. More often, the struggle for security and legitimacy has led to rhetoric and repression--and growing opposition. The Soviet Union, which is currently facing an Islamic revival within its own borders, will only intervene physically against its better judgment, in the opinion of the author; the United States is terminating all aid, including the Peace Corps.^ieng

Ghar-i-Mordeh Gusfand (Cave of the Dead Sheep): A New Mousterian Locality in North Afghanistan.

The Middle Paleolithic of Central Asia is little known and less understood. Several sites have been excavated in Soviet Central Asia, but few have been adequately presented. Recent excavations in north Afghanistan may throw new light on the problem because of the size of the rock shelter involved and its relative geologic dating.