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 Screening

To conduct prevention and early intervention with older adults, it is necessary to screen for alcohol use (frequency and quantity), drinking consequences, alcohol-drug interactions, and drug misuse. It is important to ask about frequency and quantity of prescription drug use also. Screening Questions for Opioid or Benzodiazepine Use provides examples of questions to ask.

Screening can be done as part of routine mental and physical health care and updated annually, before the older adult begins taking any new medications, or in response to problems that may be related to alcohol or medications. Screening can help identify the signs and symptoms described earlier.

Screening questions should include estimated alcohol consumption in the past 6 to 12 months. The screener should check average standard drinks per week and the highest number of standard drinks on a single drinking occasion.

Clinicians can follow up the brief questions about consumption and consequences with a few more indepth questions about consequences, health risks, and social and family issues. In addition, information regarding medication and herbal use will assist in making any diagnoses and brief intervention or treatment plans.

It is probably best to embed questions about alcohol use in the context of activities of daily living and health habits. Questions about alcohol can be included in discussions about diet, nutrition, exercise, leisure time management, and use of tobacco products and over-the-counter medications. Asking about the recent past will yield a more accurate history.

In addition, nonverbal cues may suggest the patient is minimizing use (e.g., blushing, turning away, fidgeting). Especially noteworthy is irritation or a "chip on the shoulder" attitude when questions about drinking are asked. In patients with mild or moderate cognitive impairment, spouses, caregivers, or family members may be able to help.

To assess dependence, questions should be asked about alcohol or drug-related problems, a history of failed attempts to stop or cut back, and withdrawal symptoms such as tremors. Clinicians should refer any patient thought to be dependent for a diagnostic evaluation and possible specialized alcohol treatment with an emphasis on treatment targeted to older adults.

Medication assessments include questions about prescriptions, particularly antidepressants, benzodiazepines, codeine, over-the-counter medications, and herbal remedies. If there is evidence of prescription drug problems, the patient should also be referred to a specialist for a diagnostic assessment and possible specialized treatment.