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)

Overview of Psychiatric Comorbidities

Epidemiologic studies have clearly demonstrated that comorbidity between alcohol use and other psychiatric symptoms is common in younger age groups. Less is known about comorbidity between alcohol use and psychiatric illness in late life. A few studies do indicate that dual diagnosis with alcoholism is important among older adults.

Data from the Epidemiologic Catchment Area (ECA) study have strengthened support for a possible link between alcohol use and abuse and the development of other psychiatric illnesses.⁴⁹ Adults with a lifetime diagnosis of alcohol abuse or dependence had nearly three times the risk of being diagnosed with another mental disorder.

Comorbid disorders associated with alcohol use include:

• Anxiety disorders
• Affective illness
• Cognitive impairment
• Schizophrenia
• Antisocial personality disorder^50-54

According to one study, older alcohol abusers are more likely to have triple diagnoses—alcohol, depression, and personality disorders—whereas younger substance abusers are more likely to have diagnoses of schizophrenia.⁵⁵ In addition, alcohol use triples the risk of depression.^56,57

One problem that arises in older persons is concurrent use of alcohol and benzodiazepines. Benzodiazepines are commonly used for anxiety disorders. They are often inappropriately used to treat depression, psychosis, and chronic insomnia.

It is advisable to consider reducing benzodiazepine use in all older patients regardless of drinking status. However, particular concerns regarding the combination of alcohol and benzodiazepines need to be addressed.

Chronic benzodiazepine use, defined as use of a benzodiazepine for more than 3 months nearly every day, is a major health hazard in individuals who have significant alcohol consumption. Although there are few protocols for managing patients who have been chronically taking benzodiazepines and need to be taken off these medications, there are some steps that can be taken.