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)

Autonomy and the Provider’s Mission: A Dilemma

Americans attach extraordinary importance to being left alone. We pride ourselves on having perfected a social and political system that limits how far the government and others can control what we do. The principle of autonomy is enshrined in our Constitution, and our courts have repeatedly confirmed our right to make decisions for ourselves.

Most of us cherish our autonomy and fear its loss, particularly as we age. Although providers who screen or assess for substance abuse are genuinely concerned about an individual’s well-being, screening means seeking very personal information. It involves an unavoidable intrusion on a person’s autonomy and privacy. When faced with suggestions that their judgment or abilities are impaired, older adults may not always appreciate a provider’s effort to help.

Performed insensitively, screening or assessment may intensify denial. People in denial may not realize, or want to realize, that they need to reduce or stop using alcohol or prescription medications. An older person may view the provider’s questions and suggestions as intrusive, threatening, and offensive.

Suggestions that an older individual’s complaint has an emotional basis may tap an underlying reluctance to acknowledge an emotional component to any problem and reinforce the individual’s resistance. Because the substance abuse label carries a powerful stigma, an older individual may become alarmed if a provider intimates that alcohol or drug abuse may be involved. It can be tempting for older people to point to the normal infirmities of old age as the source of problems rather than acknowledging a problem with alcohol or other drugs.

How can providers raise the question of alcohol and drug use constructively, without eliciting a defensive response? Should they raise the issue and then drop it at the slightest hint of resistance? Or should they intervene more forcefully, with arguments or by involving the family?

To fulfill their ethical responsibility, providers should do more than simply raise the issue. Education is important. For example, most older adults do not know that their metabolism of alcohol and prescription drugs changes and that their tolerance decreases. Respect for autonomy means informing clients of all relevant medical facts and discussing alternatives.

If there is a substance abuse problem, the provider can supply information and encouragement. However, only the person with the problem has the power to change. Respecting patients’ autonomy—their right to make choices—is central to encouraging change.