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)

Affective Disorders

Affective disorders, common in older patients, also influence treatment choices. For example, a patient with an affective disorder who takes psychotropic drugs requires a treatment program with a staff familiar with these medications. Suicidal patients require intensive inpatient programs and an immediate intervention.

Significant depressive symptoms, which are a common reaction after detoxification, can be worse in older adults than in younger patients. Older patients may require prescribed medicines to alleviate the depression before the abuse or addiction therapy is resumed. As noted below, research in the area of mental health comorbidities supports these findings.

Comorbid depressive symptoms are not only common in late life, but are also an important factor in the course and prognosis of psychiatric disorders. Depressed alcoholics have been shown to have a more complicated clinical course of depression. They have an increased risk of suicide and more social dysfunction than nondepressed alcoholics.^69,70 Moreover, they were shown to seek more treatment.

Relapse rates for alcoholics do not appear to be influenced by the presence of depression. Alcohol use prior to late life has also been shown to influence treatment of late-life depression. Cook and colleagues found that a prior history of alcohol abuse predicted a more severe and chronic course for depression.⁶⁹

Screening instruments for depression can be extremely useful as methods of detecting significant affective illness and for monitoring changes in affective states. The Geriatric Depression Scale (GDS) Short Form⁷¹ and the Center for Epidemiological Studies-Depression Scale (CES-D)⁷² have been validated in older age groups although not specifically in older adults with addiction problems. The CES-D is useful in general outpatient settings as a screen for depression among older patients.