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)

Holistic Treatment Based on Age-Specific Problems

Treatment programs need to take a broad, holistic approach. Staff should focus on more than just the drinking or substance abuse problem when dealing with older clients. As people age, multiple conditions contribute to problem behavior. The individual’s psychological and health problems tend to become more complex, are caused by many factors, and interact with each other.

A number of interrelated emotional, social, medical, spiritual, and practical problems or changes characterize many older adults’ experiences. Some of these can lead to abuse of alcohol or other drugs. Those that initiate, sustain, or interact with the substance abuse problem provide the focus of a holistic treatment approach tailored to individual needs.

Recent research suggests that older adults with alcohol problems often drink in response to loneliness, depression, and poor social support networks.¹ Researchers have also noted chronic pain as a high-risk condition for substance abuse. Life changes associated with substance abuse include:

• Loss of friends, family members, social status, occupation and sense of professional identity, hopes for the future, ability to function
• Reduced self-regard or self-esteem
• Family conflict and estrangement
• Problems in managing leisure time/boredom
• Loss of physical attractiveness (especially important for women)
• Physical distress
• Physical disabilities and handicapping conditions
• Insomnia
• Sensory deficits
• Reduced mobility
• Cognitive impairment and change
• Impaired self-care
• Reduced coping skills
• Decreased economic security or new poverty status
• Dislocation

Discussing life changes with patients can help them develop insight into the causes of their substance abuse problems. For example, when clinicians discuss nondrinking problems with an older adult, the drinking problem may emerge as a topic.

The problems associated with aging can be overwhelming, but patients need not accept them passively. They can develop a self-care skill or positive attitude and can obtain appropriate help. This may include the pharmacological alleviation of pain, management of grief, or skills for improving relationships.

It is important to ensure proper prescribing of any pain medication. In taking a holistic approach, it is essential to be aware of potential drug interactions and side effects. See Module 5 for more information on medication misuse.

Reference

1. Schonfeld, L., and Dupree, L.W. Treatment approaches for older problem drinkers. International Journal of the Addictions 1995, 30(13-14):1819-1842.

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