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)

Differential and Dual Diagnosis

Differential diagnosis is essential for adequate treatment of the older alcohol- or drug-dependent person. Because symptoms can be so similar for alcoholism, diseases in later life, adverse drug reactions, and mental disorders, it is important to develop a procedure for ruling out alcohol and drug misuse and abuse. Whenever screening and initial assessment suggest dual disorders, a specialized assessment should be conducted.

The symptoms of an alcohol or drug problem can resemble dementia, depression, or an anxiety disorder. A person with a dementing illness such as Alzheimer’s is often forgetful and impaired in other cognitive capacities. Forgetfulness and mild cognitive impairment are also common in older people who are depressed.

Anxiety symptoms are also common in persons with alcohol or drug problems. Sometimes an alcohol or drug problem is misdiagnosed as Alzheimer’s, dementia, depression, or an anxiety disorder.

Symptoms of alcohol or drug abuse may look like worsening of a chronic illness. If a person has hypertension and drinks alcohol or takes certain medications, hypertension increases. If a person is depressed and drinks alcohol or takes medications that depress the central nervous system, the depression deepens. In addition, signs of alcoholism or chemical dependency may look like side effects or adverse reactions to prescription or over-the-counter medications.