Cognitive and motivational therapy for problematic alcohol use and alcohol use disorder in older adults: a systematic review

INTRODUCTION: Cognitive and motivational therapies for alcohol use disorder (AUD) and problematic alcohol use have demonstrated effectiveness in youth and general adults, yet evidence specific to older adults has not been synthesized. This systematic review summarizes cognitive and motivational interventions in older adults. METHODS: PubMed, PsycINFO, Embase, and Web of Science were searched. Eligible studies included participants aged ≥55 years with AUD or problematic alcohol use and evaluated cognitive or motivational therapies. Studies without alcohol-related outcomes were excluded. The Effective Public Health Practice Project Quality Assessment Tool was used. RESULTS: Seven studies involving 1121 participants were identified. Motivational approaches were most common (4/7 studies; 813 participants, 72.5%), whereas combined cognitive-motivational approaches (1/7 studies; 158 participants, 14.1%), CBT-like approaches (1/7 studies; 60 participants, 5.4%), and other non-motivational cognitive interventions (1/7 studies; 90 participants, 8.0%) were represented by single studies. Treatments generally improved alcohol-consumption-related outcomes, although comparative efficacy was less clear. Although cognitive and motivational therapy for AUD and problematic alcohol use in older adults appear promising, definitive conclusions cannot be drawn as evidence is limited by methodological concerns including limited and heterogeneous evidence from randomized controlled trials, small sample sizes, limited long-term follow-up, and insufficient reporting of intervention components.