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)

Tobacco

Surveys show that cigarette smoking, although fairly widespread among older adults, declines sharply after age 65. In 1999, nearly 23 percent of adults ages 50 to 64 reported past month use of cigarettes. Among those age 65 and older, however, this figure was only about 11 percent.¹⁹

Older women have lower smoking rates than older men. In 1995, 11.5 percent of women age 65 and older reported smoking cigarettes, compared to 14.9 percent of men.²⁰ Although use declines with age, the problem remains significant, with nearly 4 million older adults smoking regularly.¹⁹

Smoking in older problem drinkers is far more prevalent than in the general older adult population. Some researchers estimate that 60 to 70 percent of older male alcohol users smoke a pack a day.¹¹ Some studies indicate that the prevalence of smoking among alcoholics generally is above 80 percent.²¹

Dangers of Smoking

Smoking is a major risk factor for many of the leading causes of death among individuals 60 years and older, including:

• Heart disease
• Cerebrovascular disease
• Chronic obstructive pulmonary disease
• Pneumonia and influenza
• Lung cancer
• Colorectal cancer²²

Current cigarette smoking is also associated with an increased risk of losing mobility.²³ In addition, older adult smokers have a 70 percent overall risk of dying prematurely,²⁴ and fewer smokers live to old age than nonsmokers and quitters.²² Smoking also may affect the performance of prescription drugs. For example, smokers tend to require higher doses of benzodiazepines to achieve efficacy than nonsmokers.²⁵

Benefits of Cessation

Although there have been few studies on interventions that are especially useful to older adults regarding smoking cessation, the advantages of quitting at any age are clear.^26-29 They include the following:

• Two years after stopping, the risk of stroke begins to decrease.
• Mortality rates for chronic obstructive pulmonary disease decline.
• Bronchitis, pneumonia, and other infections decrease.
• Respiratory symptoms such as cough, wheezing, and sputum production lessen.³⁰

As another example, a 60-year-old male smoker who quits can expect to reduce his risk of smoking-related illness by about 10 percent over the next 15 years.²²

As with alcohol and drug abuse, studies suggest that many clinicians fail to counsel patients about the health effects of smoking. This is true even with older smokers, who are more likely to quit than younger smokers.³¹ However, tailoring smoking cessation strategies to the unique concerns of older adults improves success rates.

Brief intervention can more than double 1-year quit rates for older adults.²⁹ In one study of older smokers using transdermal nicotine patches, 29 percent of the subjects quit smoking for 6 months.²⁸ In addition, there is little evidence that adults in recovery from alcohol problems relapse when they stop smoking. Therefore, efforts to reduce substance abuse among older adults should include tobacco smoking.³²