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)

Dual Diagnosis

Alcohol problems are often found to coexist with and compound other mental disorders, primarily affective disorders, anxiety disorders, and schizophrenia. Alcoholism also accelerates and mimics the dementing process, can produce confusion and memory loss, and can precipitate suicide. People with anxiety disorders and depressive disorders abuse alcohol at higher rates than the general population.

Substance use can precipitate a variety of mental conditions, including:

• Cognitive disorders
• Depressive disorders (major depression, bipolar disorder, etc.)
• Anxiety disorders
• Schizophrenic disorders and other psychoses
• Personality disorders (e.g., borderline, histrionic, narcissistic)

Reducing substance use could resolve or reduce the severity of psychiatric problems.

Co-occurrence of alcohol abuse with a psychiatric disorder complicates treatment in a number of ways:

• It creates interpersonal difficulties.
• The psychiatric problem contributes to continued alcohol abuse.
• Substance abuse interferes with engagement in mental health treatment.

The person with a dual diagnosis is at increased risk of social problems such as homelessness, poverty, incarceration, and legal problems.

There are three general linkages between substance abuse and mental health that apply to older adults:

• Substance abuse and mental health problems are correlated. There is a definite relationship, but it is not clear whether one causes the other.
• Mental health issues are often risk factors for substance abuse, such as low self-esteem, loneliness, stress, tension, personality factors, and depression.
• Many external factors are similar for both substance abuse and mental health problems. These include sociocultural factors, familial and genetic factors, and environmental factors.

Dual diagnosis in older adults differs from that in younger people in the following ways:

• The aging process affects the course of the condition.
• Older adults rarely use illegal drugs.
• Antisocial behaviors, such as car theft, and schizophrenia are less prevalent in older adults than in the younger population.
• Asocial, or isolating, behavior is more commonly seen with older adults.
• Older adults in general tend to experience higher rates of multiple chronic illnesses, cognitive impairments, and losses than younger adults.
• Lifestyle goals change.

Several factors place the mental health of older adults at risk:

• Societal stigma toward alcoholism and mental illness
• Code of silence (shame and embarrassment)
• Increased confusion and other cognitive impairments
• Denial
• Powerlessness
• Marginalization or having financial problems
• Minimizing or discounting the danger signs (seen as fear, anxiety, and decreased health)

These risk factors are common for both substance use and mental health problems. In many cases, it is almost impossible to determine which came first. It is more important to recognize coexisting conditions than to determine which came first. With chronic long-term use of alcohol there may be significant irreversible cognitive damage as well as a preexisting mental health condition.⁷⁸