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)

Driving

BAC, expressed as a percentage, is the measurement used for legal reasons. For example, most States set a limit of .08 or .10 percent for a driver to be considered intoxicated. Low BACs produce increased sociability and euphoria, but they also produce some difficulty in motor coordination.

According to the National Highway Traffic Safety Administration, a driver's ability to divide attention between two or more sources of visual information can be impaired by BACs of .02 or lower. At BACs of .05 or more impairment occurs consistently in the following:

• Eye movements
• Glare resistance
• Visual perception
• Reaction time
• Certain types of steering tasks
• Information processing
• Other aspects of psychomotor performance¹

BACs of .08 to .10 are the legal limits for driving in most States because at those levels motor functions and reaction times are severely impaired. Compared with drivers who have not had any alcohol, the risk of a crash for drivers who have had alcohol follows:

• BACs between .02 and .04, 1.4 times higher
• BACs between .05 and .09, 11.1 times higher
• BACs between .10 and .14, 48 times higher
• BACs between .15 and .18, 380 times higher.¹

It is not known what the effects are for older adults, but they may be greater.

Although most rules of evidence specify that the proportion of alcohol in the whole blood be used to measure the level of intoxication, most hospitals routinely calculate the proportion of a drug in the plasma. Since the addition of red and white blood cells would add to the blood volume that dilutes the alcohol, using only the plasma fraction would result in a higher percentage of alcohol than would be found in whole blood. Although there is some variation from person to person, the average adjustment factor is 1.16.

To estimate the alcohol level in whole blood using the alcohol level in blood plasma, it would be necessary to divide by 1.16. Thus, a person with a BAL of .08 would show a BAC of .07 and would pass a Breathalyzer test. However, the person might still experience medical problems.²

The Alcohol Impairment Chart developed by the Pennsylvania Liquor Control Board provides estimated BACs for men and women of various weights. This chart is often used as a guide to prevent drunk driving.

In 2000, President Clinton signed a law imposing a stricter national standard for drunk driving by threatening States with a reduction in millions of Federal highway dollars. Under the law, States are required to adopt a .08 BAL as the legal threshold for drunken driving by 2007 at the latest.³

Older drivers today are less likely to have been drinking than is true for younger drivers, since they grew up at a time when alcohol use was not high compared to current consumption. However, among baby boomers, alcohol use by women has increased disproportionately. Because of the cohort changes occurring in these groups, these differences could have important implications for future older drivers.

Women and older persons generally have a higher BAC for the same amount of alcohol per body weight. In addition, older persons, as a group, use a disproportionate number of prescriptions. Although alcohol is the major drug of abuse among impaired drivers, the synergistic effects of alcohol and medications may take on more importance. There is growing evidence that alcohol potentiates injury; that is, a drinking driver is more likely to be seriously injured or killed than a driver who has not consumed alcohol.