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)

Special Treatment Issues for Prescription Drug Abuse

Because so many problems with prescription drug abuse stem from unintentional misuse, approaches for responding to these clients differ in some important respects from treatment for alcohol abuse and dependence. Issues that need to be addressed as part of treatment include:

• Educating and assisting patients who misuse prescribed medications to comply consistently with dosing instructions
• Providing informal or brief counseling for patients who are abusing a prescribed substance with harmful consequences
• Engaging drug-dependent patients in the formal treatment system at the appropriate level of care

In addition, providers need to understand how practitioners’ prescribing behavior contributes to the problem. Then they can address the problem with clients and uninformed health care practitioners in the community.

Once the substance abuse treatment provider identifies a medication misuse problem, arrangements should be made for an initial but intensive monitoring of the patient’s use of the problematic drug. Monitoring may be undertaken by visiting or public health nurses or other designated medical staff. The objective is to determine whether misuse continues despite all attempts to correct underlying reasons for nonadherence. If the patient appears to be knowingly nonadherent, the behavior is characteristic of abuse.

The intervention for this behavior will depend on an accurate and indepth assessment of the social, medical, and psychological problems that may be driving the substance abuse. These include problems such as depression, bereavement, a medical condition, social isolation, physical pain, and insomnia. Assessment results then provide the basis for an individualized treatment plan that includes and ranks mechanisms for addressing each issue.

Unless the abuse has resulted in a serious crisis, it is usually appropriate to try psychosocial approaches first. These include grief therapy, sleep management training, relaxation techniques, socialization (e.g., day care) programs, psychotherapy, and acupuncture.

Once treatment begins to resolve the underlying issues, the provider must confer with the health care practitioner to determine the best of three options:

1. Remain on the problematic drug at a reduced dose.
2. Discontinue use altogether.
3. Switch to an alternative prescription with less addictive potential.

The choice will depend on the available options and the severity of the problems resulting from the substance abuse. An open discussion of these issues with the patient, substance abuse treatment provider, and health care practitioner is recommended.

In addition, treatment providers can help empower older adults to ask more questions and optimize the benefits of their contacts with medical professionals. Older patients with some cognitive or sensory impairment may not be able to adhere to complicated medication regimens. In these cases, treatment providers can identify and educate family members or other professional or volunteer advocates and caregivers about the need to assist the older adult with this task.