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)

Psychiatric Effects

Other biomedical changes of aging are cognitive impairments, which are both confused with and exacerbated by alcohol use. Chronic alcoholism can cause serious, irreversible changes in brain function. However, this is more likely to be seen in older adults who have a long history of alcoholism.

Alcohol use may have direct neurotoxic effects leading to a characteristic syndrome called alcohol-related dementia (ARD). It also may be associated with the development of other brain-damaging illnesses such as Alzheimer's disease and Wernicke-Korsakoff syndrome, an illness characterized by anterograde memory deficits, gait ataxia, and nystagmus.¹¹

Personality and psychiatric effects of alcohol abuse include:

• Depressed mood
• Irrational anger and jealousy
• Anxiety symptoms
• Increased suicide risk. Alcoholism is a major precipitating factor in late-life suicide. Approximately one-third of all suicides are alcoholics.¹²
• Loss of inhibition of risk-taking behavior
• Self-destructive or impulsive urges such as personal neglect, violent behavior, and self-imposed social isolation
• Denial of problems or distorting reality, especially regarding drinking
• With severe withdrawal, psychotic symptoms of delusions and/or hallucinations

Psychiatric comorbidity is often present. Depression and other affective disorders may contribute to alcohol abuse. Similarly, alcohol abuse can lead to depression. Alcoholism and other psychiatric disorders may coexist. Therefore, it is important to evaluate each individual carefully. Diagnosis is discussed further in Module 4, Diagnosing Alcohol Problems in Older Adults.