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)

Key Terms and Concepts

In order to diagnose alcohol problems in older adults, it helps to be familiar with categories of consumption.

Use: Appropriate consumption in a manner that is within recommended guidelines and minimizes the potential for dependence or abuse.

Heavy use: Use of a substance in greater quantities than the recommended guidelines but without obvious negative social, behavioral, or health consequences. Heavy alcohol users may be dependent on the substance.

Problem use: Use of a substance in a manner that induces negative social, behavioral, or health consequences. A problem user may or may not meet the criteria for dependence or abuse, although many do.

Abuse: A maladaptive pattern of substance use leading to clinically significant impairment or distress. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)¹ includes symptoms such as:

• Recurrent substance use resulting in a failure to fulfill major role obligations at work or home (e.g., poor work performance related to substance abuse)
• Recurrent substance use in situations in which it is physically hazardous (e.g., driving a car)
• Recurrent substance-related legal problems (e.g., arrests for disorderly conduct)
• Continued substance abuse despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse)

Dependence: Dependence on a substance is defined by explicit diagnostic criteria, such as those found in the DSM-IV or International Classification of Diseases, 10^th Revision (ICD-10).² Serious and persistent involvement in the heavy use of a substance is the rule. These approaches set aside the older distinction between physical dependence and psychological dependence, which are now viewed as different manifestations of similar disorders. The term "alcoholism" is usually used as a synonym for alcohol dependence.