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Background Alcohol use disorder (AUD) is an increasingly common, under-recognized, and under-treated health concern in older adults. Its prevalence is expected to reach unprecedented levels as the Canadian population ages. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of AUD in older adults. Methods A systematic review of English language literature from 2008–2018 regarding AUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method by drawing on current literature. Recommendations were created and assessed using the GRADE method. Results Twenty-two recommendations were created. Prevention recommendations: Best advice for older adults who choose to drink is to limit intake to well below the national Low-Risk Alcohol Drinking Guidelines. Screening recommendations: Alcohol consumption should be reviewed and discussed on an annual basis by primary care providers. This type of discussion needs to be normalized and approached in a simple, neutral, straight-forward manner. Assessment recommendations: Positive screens for AUD should be followed by a comprehensive assessment. Once more details are obtained an individualized treatment plan can be recommended, negotiated, and implemented. Treatment recommendations: AUD falls on a spectrum of mild, moderate, and severe. It can also be complicated by concurrent mental health, physical, or social issues, especially in older adults. Naltrexone and Acamprosate pharmacotherapies can be used for the treatment of AUD in older adults, as individually indicated. Psychosocial treatment and support should be offered as part of a comprehensive treatment plan. Conclusion These guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of AUD in older adults within the Canadian context.

This article presents an application of Norma Lang’s nondeliberative theory in groupwork with clients of Community Outreach Programs in Addictions (COPA), a Toronto community-based organization that assists adults age 55 and older who struggle with addictions and mental health. The article illustrates how we challenged concepts of group work which are predominantly discussion-based problem solving or premeditated by hosting a group in a major art gallery with clients considered difficult to serve. What was done is juxtaposed with what might have been done with greater knowledge of nondeliberative theory.

Community Outreach Programs in Addictions (COPA) is a Canadian organization that assists older adults who live with substance misuse and mental health issues. COPA College, a psycho educational mutual aide support group consists of weekly group sessions. The program uses a Solution Focussed approach ( De Jong, Insoo Kimberg, 2008) which provides support to socially disadvantaged older adults with substance and mental health issues through a group format. This article sets out to evaluate participant reactions and determine if participants decrease substance use following completion of the group. One-on-one semi-structured interviews with ten participants were conducted. Participants were asked to rate the importance of different aspects of the program and discuss alcohol intake following involvement in the group. Aspects of the program rated highly by all the participants included learning new information, the breadth of topics discussed and the harm reduction approach taken by the program. Finally, the general atmosphere of the group was considered very important, especially being comfortable in the group and combining humour with learning, and an opportunity for refl ective, sharing peer support.

A typology of elderly alcohol abusers was developed on the basis of case studies conducted at an outreach addictions treatment program for the elderly. Three main types were defined: chronic alcohol abuser (abusive drinking primarily maintained by a life of habitual consumption and a lack of alternative activities), reactive problem drinker (alcohol abuse developed and maintained in response to a loss, such as ill health or death of a spouse), and problem drinkers whose drinking seemed to be interrelated with psychatric or connitive problems. Case descriptions are provided to illustrate each type and the treatment implications of typology are discussed.