The COVID-19 global pandemic had a major impact on older people's mental health and resulted in changes in alcohol use, with more older adults increasing than decreasing consumption levels among the general population. So far, no studies have focused on older people who were already experiencing problem alcohol use. This qualitative research is the first to provide a nuanced understanding of changes to drinking patterns among older adults engaged in alcohol treatment during the COVID-19 pandemic, and the implications of these for practice. We conducted 30 semi-structured interviews with people in alcohol treatment aged 55+ living in urban and rural areas across the UK. Data were analysed using thematic analysis. We found that changes in alcohol use varied depending on the social, economic and health impacts of the pandemic on older adults. Boredom, lack of adequate medical or emotional support, and key life changes experienced during the pandemic (such as bereavement or retirement) increased the risk of increased drinking. Moreover, some people in longer-term alcohol treatment were struggling to maintain abstinence due to lack of face-to-face peer support. For others, decreased drinking levels were a side-effect of lockdown policies and restrictions, such as alcohol-related hospitalisations, closure of social spaces or inability to source alcohol; these also supported those who decided to cut down on drinking shortly before the pandemic. Generally, older adults who developed home-based interests and self-care practices managed lockdown best, maintaining abstinence or lower risk drinking levels. Based on these results, we argue that multilevel interventions aimed at strengthening resilience are required to reduce drinking or maintain abstinence among older adults. Such interventions should address three domains: individual (coping strategies and mindset), social (support networks), and structural (access to resources). In preparation for supporting older alcohol users through prospective future pandemics, building digital literacy and inclusion are essential.

Gamma-hydroxybutyrate (GHB) is a neurotransmitter found naturally in the human brain. Sodium oxybate (SO) is the sodium salt of GHB. In 2000 GHB was classified a Schedule I controlled substance, while SO became a Schedule III controlled substance for medicinal use under the Controlled Substances Act. SO and alcohol share a similar pharmacological profile. GHB acts on GABAB receptors and extrasynaptic GABAA receptors resulting in alcohol-mimetic effects in several CNS actions. It substitutes the discriminative stimulus effects of alcohol in rats, and has cross tolerance with alcohol. All together, this leads to think of SO as a substitution therapy for alcohol use disorders. SO was initially studied in the prevention of alcohol withdrawal, and it showed similar efficacy to benzodiacepines. The studies on relapse prevention were developed later and the results are mixed and more complex to understand. While open label studies show a positive effect, RCTs have not been able to show a significant effect for the whole sample. Nevertheless, post-hoc analysis show a robust effect in the subsample of patients with high risk drinking levels, that would be the preferred target for a substitution treatment. The potential for abuse of GHB is well documented, which should be no surprise for a substitution treatment. Nevertheless, when correctly prescribed the risk of abuse of SO remains very low, as shown both in clinical trials and in the pharmacovigilance database, with more than 260000 cases documented. SO can be considered a substitution treatment, effective in patients with high risk drinking levels.

Background: The exact link between the process engaged in during Motivational Interviewing based interventions, such as Motivational Enhancement Therapy (MET), and outcome is yet to be fully understood. Aims: This preliminary study examined Client Language during MET and outcome. Method: A modified Motivational Interviewing Skills Code Version 2.0 was used to code 106 audiotaped MET sessions from 28 participants who received 3–4 sessions of MET within the context of a randomized controlled trial for mild-moderate alcohol dependence. Client Language was analyzed within sessions (categorized into Early, Mid, or End Intervals) and across sessions, and in relation to six month drinking outcome (drinking within/over national drinking guidelines, i.e. Remitted/Unremitted Drinkers). Results: Unremitted Drinkers uttered a significantly higher frequency of Sustain Talk, lower Ability Language strength (over all MET and during End Intervals), and lower Commitment Language strength (during Session 2 and 4, and change over MET). Conclusions: Notwithstanding limitations, this exploratory study was unique in examining the strength of Client Language within and across sessions. It produced potentially valuable findings that warrant further investigation including supporting the clinical benefit of monitoring Client Language to predict outcome.