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)

Module 1: Overview

• Module Description
  
• Module Objectives
  
• Why It's Important to Recognize Substance Abuse in Older Persons
  
• Physical Changes and Alcohol Use
  
• Prescription Drugs
  
• Lack of Attention to Substance Abuse in Older Persons
  
• References
  
• Myths and Reality Quiz

Module 2: Recognizing Alcohol Misuse and Abuse in Older Adults

• Module Description
  
• Module Objectives
  
• What Is a Drink?
  
• Alcohol Use Guidelines for Older Adults
  
• "Healthy Drinking" Debate
  
• Cautions About "Healthy Drinking"
  
• Suggestions for Clinicians
  
• Patterns of Alcohol Use
  
• Patterns of Onset
  
• Epidemiology of Alcohol Problems Among Older Adults
  
• Difficulty Identifying Older Problem Drinkers
  
• Reasons Identifying Alcohol Problems in Older Adults Is Difficult
  
• Difficulties Diagnosing Alcohol Problems in Older Adults
  
• Projections of Future Growth of the Problem
  
• References
  
• Module 2 Quiz

Module 3: Alcohol and Aging

• Module Description
  
• Module Objectives
  
• Blood Alcohol Levels and Behaviors at Various Levels
  
• Driving
  
• Other Behaviors
  
• Aging-Related Changes in How Alcohol Affects the Body
  
• Alcohol, Illness, and Medical Conditions
  
• Physical Effects of Alcohol Use
  
• Psychiatric Effects
  
• References
  
• Module 3 Quiz

Module 4: Diagnosing Alcohol Problems in Older Adults

• Module Description
  
• Module Objectives
  
• Key Terms and Concepts
  
• Risk Factors for Alcohol Abuse
  
• Protective Factors
  
• Signs and Symptoms
  
• The Need for Diagnostic Criteria
  
• Medical and Psychological Profile of Stages/Types of Use
  
• Overview of Screening
  
• Opportunities To Screen
  
• When To Screen
  
• Asking Screening Questions
  
• Screening Guidelines
  
• Special Issues
  
• Screening Instruments
  
• Communicating Screening Results
  
• Assessment
  
• Substance Abuse Assessment Instruments
  
• Special Assessments of Comorbid Disorders
  
• Physical Comorbidities
  
• Overview of Psychiatric Comorbidities
  
• Cognitive Impairments
  
• Delirium
  
• Other Cognitive Impairments
  
• Affective Disorders
  
• Sleep Disorders
  
• Other Psychiatric Disorders
  
• Differential and Dual Diagnosis
  
• Steps in Developing a Differential Diagnosis Plan
  
• Dual Diagnosis
  
• References
  
• Module 4 Quiz

Module 5: Recognizing Other Forms of Substance Abuse

• Module Description
  
• Module Objectives
  
• Introduction
  
• Risk Factors and Dangers Associated With Prescription Drugs
  
• Other Substances
  
• Tobacco
  
• Psychoactive Drugs
  
• Harmful Interactions
  
• Drug-Alcohol Interactions
  
• Drug Interactions
  
• Psychoactive Drugs and Alcohol
  
• Aging-Related Changes in How Medications Affect the Body
  
• Risk Factors for Medication Misuse and Abuse
  
• Risks in Older Women
  
• System and Environmental Influences
  
• Internet Pharmacies
  
• History of Substance Abuse or Psychiatric Disorder
  
• Ways To Avoid Medication Misuse
  
• Medication Adherence by Patients
  
• Ways To Increase Patient Adherence
  
• Understanding Why Patients Do Not Take Medication Correctly
  
• Improving Prescribing Practices
  
• Improving Doctor-Patient Communication
  
• Complete Patient History
  
• Increased Literacy
  
• Consumer Aids
  
• Policy Issues
  
• Special Issues Related to Benzodiazepines
  
• Case Studies
  
• References
  
• Module 5 Quiz

Module 6: Prevention and Early Intervention Strategies

• Module Description
  
• Module Objectives
  
• Overview of Prevention
  
• Prevention Framework
  
• Substance Abuse Prevention and Early Intervention Strategies: Information Dissemination
  
• Substance Abuse Prevention and Early Intervention Strategies: Prevention Education
  
• Substance Abuse Prevention and Early Intervention Strategies: Alternative Activities
  
• Substance Abuse Prevention and Early Intervention Strategies: Peer Support
  
• Substance Abuse Prevention and Early Intervention Strategies: Community-Based Processes
  
• Aspects of Effective Prevention Programs for Older Adults
  
• Cultural Awareness
  
• Prevention Programs for Older Adults
  
• Early Intervention
  
• Matching Levels of Use to Prevention and Treatment Approaches
  
• Promising Practices
  
• References
  
• Module 6 Quiz

Module 7: Treatment

• Module Description
  
• Module Objectives
  
• Role of the Clinician
  
• Definitions of Treatment
  
• Directories of Local Substance Abuse Treatment Systems
  
• Goals of Treatment
  
• Effectiveness of Treatment
  
• Barriers to Treatment
  
• Guidelines for Treating Older Adults
  
• Patient Placement and Patient Matching
  
• Levels of Treatment Services
  
• Program Philosophy and Basic Principles
  
• Types of Treatment
  
• Terminating Treatment
  
• Staffing Considerations
  
• Special Treatment Issues for Prescription Drug Abuse
  
• Special Issues Related to Heavy Drinking
  
• References
  
• Module 7 Quiz

Module 8: Outcomes and Cost Issues in Alcohol Treatment

• Module Description
  
• Module Objectives
  
• Introduction
  
• Alcohol Treatment Outcomes
  
• Compliance Studies
  
• Prospective Studies of Treatment Outcomes
  
• Lack of Studies
  
• Inpatient Treatment Results
  
• Measurement of Multidimensional Outcomes for Older Adults
  
• Measures of Alcohol Use
  
• Measures of Alcohol Problems
  
• Measures of Physical and Emotional Health
  
• Measures of Quality of Life
  
• Areas Requiring Future Research
  
• Costs of Alcohol Treatment
  
• Cost-Effectiveness
  
• Potential Cost Savings
  
• Data Limitations
  
• Reimbursement Issues in the Treatment of Older Adults
  
• Costs of Diseases Related to Substance Abuse
  
• Costs of Prevention
  
• References
  
• Module 8 Quiz

Module 9: Legal and Ethical Issues

• Module Description
  
• Module Objectives
  
• Introduction
  
• Autonomy and the Provider's Mission: A Dilemma
  
• Privacy and Confidentiality
  
• Federal Privacy Laws
  
• State Privacy Laws
  
• Professionals Covered by the "Doctor-Patient" or "Therapist-Client" Privilege
  
• The Context in Which Information Is Communicated
  
• Circumstances in Which "Confidential" Information Is Protected From Disclosure
  
• Exceptions to State Laws Protecting Medical and Mental Health Information
  
• Enforcing Confidentiality Protections
  
• Charting Substance Use Information
  
• Communicating With Others
  
• Dealing With Questions of Incapacity
  
• Maximizing Autonomy
  
• Enlisting the Help of Others
  
• Guardianship
  
• Making Referrals to Substance Abuse Treatment Programs
  
• Communicating With Insurers, HMOs, and Other Third-Party Payers
  
• Communicating With the Legal System
  
• Responding to Lawyers' Inquiries
  
• Visits by Law Enforcement
  
• Responding to Subpoenas
  
• Legal Issues Related to Internet Pharmacies
  
• Conclusion
  
• References
  
• Module 9 Quiz