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)

Costs of Prevention

Probably the most sellable prevention services, at least in the short term, are those that will enhance or initiate secondary prevention or early identification and intervention. This is because of the lack of explicit cost data available about primary prevention activities. However, early identification and intervention efforts produce significant cost savings, according to a preliminary study by the National Center for the Advancement of Prevention. For a $10,000 investment, these efforts, when occurring as clinical prevention services, can save $14,000 to $25,000 per individual who drinks heavily or uses drugs.⁶⁵

In addition to identification and intervention, providers need training on substance abuse screening and brief counseling. Another important role for the substance abuse preventionist is to assist in developing organizational priorities, wherein prevention services are accepted and implemented. Among these are the development and integration of risk assessment and provider screening tools and referral services and tracking systems. These allow case managers to help patients access a complete array of community intervention services.⁶⁵

Substance abuse prevention programs can be implemented in a variety of ways. Many programs are operated by community-based organizations or government agencies. Health care organizations can participate in community partnerships, coalitions, or other prevention-related groups.

One cost-effective and inexpensive way to include substance abuse prevention in regular services is to hire a health educator. Many health educators have specialized in health education or health communications at the master's level. Another option is to hire a nurse, social worker, or other clinical specialist with experience in health education.

Because many prevention materials can be obtained free or at a very low cost, the bulk of expenses for prevention programs are for personnel. It is possible to implement an effective prevention program with a single staff person. The following example shows how a substance abuse prevention program can save money by helping avoid just a few substance abuse-related illnesses.

Prevention Program Cost

Potential Savings (based on preventing a single case of each disorder)

Preventive interventions for older adults can be quite cost-effective. One involved Bank of America retirees. They participated in a program that included lifestyle questionnaires, personal health risk reports, physician recommendation letters, nutrition tips, newsletters, and a self-management book. Estimated direct costs decreased by 22 percent. The cost of the program was $30 per participant per year. The benefit-cost ratio indicated that for every dollar spent on the program, roughly $5 was saved in direct costs.⁶⁶