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

Supplements

Spectrum of Alcohol Use

Abstinence

This refers to drinking no alcohol in the previous year. A large percentage of older adults are abstinent; only about a third have reported past-month drinking.1 If an older person is abstinent, it is useful to ascertain why alcohol is not used.

Some individuals are abstinent because of a previous problem with alcohol. Some are abstinent because of recent illness, while others have lifelong patterns of low-risk use or abstinence. Patients who have a history of alcohol problems may require preventive monitoring to determine if any new stresses could exacerbate an old pattern.

Low-Risk Use

This is alcohol use that does not lead to problems. Older adults in this category drink within recommended guidelines (no more than 1 drink/day or 7 drinks/week, never more than 2 drinks on any one drinking day), can set reasonable limits on alcohol consumption, and do not drink when driving a motor vehicle or boat or when using contraindicated medications.

At-Risk Use

This increases the chances that a person will develop problems and complications. Among older persons, many of whom take multiple medications, even small amounts of alcohol can turn a formerly social drinker into an at-risk drinker.

Persons over 65 who drink more than 7 drinks/week—one per day—are in the at-risk category. Although they may not currently have a health, social, or emotional problem caused by alcohol, they may experience family and social problems. If this drinking pattern continues over time, health problems could worsen. Brief interventions are useful for older adults in this group (see Module 6).

Problem Use

This refers to alcohol consumption at a high enough level to result in adverse medical, psychological, and social consequences. Potential consequences include accidents and injuries, medication interaction problems, and family problems.

It is important to reiterate that some older adults who drink even small amounts of alcohol can experience alcohol-related problems. Quantity and frequency of alcohol use may not be the first determinant of the usefulness of intervening. The presence of consequences also affects the need to intervene.

The concept of heavy drinking used with younger people is not so relevant to older persons. People over 60 may experience pervasive consequences with less consumption due to their heightened sensitivity to alcohol or to the presence of such coexisting diseases as diabetes, hypertension, cirrhosis, and dementia. Therefore, the terms “at-risk use” and “problem use” are more appropriate. However, to gauge the level of alcohol problems among older persons, the National Household Survey on Drug Abuse measures heavy alcohol use, using a very specific definition.

Alcohol Dependence

Also known as alcoholism, this refers to a medical disorder characterized by

Also see FAQ’s on Alcohol Abuse and Alcoholism.

The definition provided by the American Society of Addiction Medicine and the National Council on Alcoholism and Drug Dependence notes that alcoholism is a primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal.

Formal specialized treatment is generally used with persons who meet criteria for alcohol abuse or dependence and who cannot discontinue drinking with a brief intervention protocol. Nonetheless, pretreatment strategies are also appropriate for this population. Brief interventions have been recommended by the Center for Substance Abuse Treatment Treatment Improvement Protocol on Brief Interventions and Brief Therapies for Substance Abuse.

Brief interventions can be used as a pretreatment strategy to assist individuals on waiting lists for formalized treatment programs, for some patients who meet abuse or dependence criteria with no physical dependence or withdrawal, or as an adjunct to specialized treatment to assist with specific issues (e.g., completing homework for treatment groups, attendance at work, adherence to the treatment plan). See Module 6 for more on brief interventions.

References

Office of Applied Studies. Summary of Findings from the 1999 National Household Survey on Drug Abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration, August 2000. << Previous Page