CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Reasons Identifying Alcohol Problems in Older Adults Is Difficult

Professionals may not recognize, assess, or respond to alcohol problems in older people for several reasons.

Biases and Beliefs

Attitudes are often one of the greatest barriers to identifying and addressing alcohol problems in older adults.

Lack of Knowledge

Some professionals may have limited education and understanding of substance abuse and the signs and symptoms. Therefore, they may not feel competent to assess or address the issue. A professional may not know what to do when he or she identifies an older person who is abusing alcohol or drugs. Some professionals may not know about the resources available to address addiction.

Lack of Third Parties Who Are Aware of the Drinking Problem

Changes in the older person’s life may make it more difficult to identify a drinking problem. People who could help may not be available or may not note a problem. For example:

• After retirement, there is no employer to note poor work performance.
• If a spouse or partner dies, there is no cohabitant to recognize the problem.
• Adult children may live elsewhere.
• Family and friends may inadvertently enable the client’s drinking by denying the problem.

Professional Perspectives and Expectations

Labeling and prioritizing symptoms according to one’s professional specialty, such as medical, mental health, or addiction, can be a problem. For example, physicians may treat symptoms of an alcohol problem, such as liver disease and malnutrition, without addressing the cause, alcohol abuse. Symptoms such as weight loss, unsteady gait, and memory lapses in an older person may be viewed as signs of chronic medical illness, dementia, or depression, rather than addiction.

In addition, people do not seek what they do not expect to find. For years, health professionals were taught that addictive problems were limited to youth and early to middle adulthood. Professionals learned that by age 50 affected persons were dead or had “matured out” of their addictive problems.

Denial

Denial has many elements, including:

• Conscious and unconscious distortion of the facts of an addiction
• Ignorance of information on alcohol and drug effects
• Forgetfulness and blackouts

However, denial is less of a barrier to treatment than many think. People may be quite willing to initiate treatment if they do not need to confess to big alcohol problems.

Family reports can be helpful or harmful. On the one hand, it may be the concerned caregiver who best knows and reports the relative’s alcohol-related problems. On the other hand, relatives or friends may be drinking partners or enablers. They may close ranks to protect the family system and their own drinking behavior.

Economics of the Health Care System

Insurers often will not pay for substance abuse treatment or they do not pay enough. Therefore, some professionals do not diagnose or refer. Many people with alcohol problems who are ages 55 to 64 and unemployed have no coverage. Medicare pays meager amounts for alcohol treatment and, typically, only for brief treatment.

Case Study

Check your understanding of barriers to identifying alcohol problems with a case study.