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)

Special Assessments of Comorbid Disorders

The relationship between alcohol use and a coexisting physical or mental disorder can take many different forms. At one extreme, medical and psychiatric problems can coexist with alcohol use with no specific relationship to drinking. Alternatively, those problems may be precipitating or maintenance factors for drinking.

The use of alcohol to anesthetize pain is an example of a maintenance factor. Alcohol use can then become its own problem or cause drug interaction problems with prescribed pain medications.

Medical or psychiatric problems such as alcoholic cirrhosis or cognitive deficits are other possible consequences of drinking. Even when the link is not so direct, alcohol use can worsen other conditions such as hypertension or congestive heart failure.

The existence of comorbid medical and psychiatric disorders will influence treatment choice and priorities and can affect treatment outcome. Frail or medically compromised alcohol abusers, for example, may require more intensive monitoring during the detoxification period of treatment than their more robust peers.

When disorders such as uncontrolled hypertension and depression are detected, reducing alcohol consumption becomes a priority. Until drinking is curbed, medication prescribed for those conditions will not work effectively. In contrast, for older adults suffering from chronic pain, the priority would be to identify an effective painkiller, then taper the amount of alcohol consumed.

Physical health assessment should document all chronic and more acute problems, and care arrangements for these should be ensured. Assessment should also include reviewing the older person’s medications, prescribed and over-the-counter. In addition, clinicians should be alert for psychiatric or mental health problems and other substance use problems, especially tobacco and sedative-hypnotic drug use (see Module 5).