Other co-occurring psychiatric illness can often be seen in conjunction with alcohol use disorder. When active, untreated symptoms of a co-occurring psychiatric illness are present, treatment of the underlying psychiatric illness should also be addressed; successful addiction treatment is more likely if these conditions are stabilized 14•. Consultation with geriatric and/or addiction psychiatry specialists is recommended for older adults with co-morbid AUD and psychiatric illness.
Lessons From Two Weeks in a Senior Living Community
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The annual physical is a chance to screen for alcohol misuse and any changes in alcohol use related to life events, such as a death in the immediate family. The following scenario addresses the importance of conducting an annual screen for alcohol misuse with older adults and shows how to actively link clients to a referral for grief counseling and care coordination. To address comorbidity considerations, a comprehensive and integrated approach to treatment is necessary. This involves collaboration between healthcare providers from different specialties to ensure that all aspects of an older adult’s health are taken into account. By addressing both substance abuse and comorbidities simultaneously, treatment can be more effective and personalized for the individual.
What Causes Substance Use Disorders in Older Adults?
- The counselor then asks Rose to tell her more about her difficulties with worry and sleep, and conducts an anxiety screening.
- Continued care in residential or outpatient settings or both is often needed to sustain abstinence and promote long-term recovery.
- A key element for clients with AUD is learning skills for turning down drinks when in social situations.
A key factor in long-term recovery for older adults is not having people in their social networks who encourage alcohol use. Should also be involved throughout treatment, including during development of a posttreatment recovery plan for the older adult and ongoing recovery support. Although naltrexone’s potential side effects are relatively benign (e.g., dizziness, nausea, reduced appetite, increased daytime sleepiness), they can be significant in older adults.739 Clinicians should monitor older clients appropriately. To avoid harmful drug-drug interactions, prescribers must review all medications an older adult uses before giving a new prescription to treat AUD and consider a lower dose of the AUD medication when appropriate.
- Through our collaborative efforts, we aim not only to treat the symptoms but also to foster resilience and strengthen the foundations of long-term sobriety.
- Screening, assessing, and referring them to treatment for SUDs or mental disorders as needed.
- Chronic alcohol abuse, for example, can cause cognitive deficits resembling dementia and increase the risk of developing conditions such as Alzheimer’s disease.
- The sixth section presents clinical scenarios to show how to match treatment approaches to a client’s level of alcohol misuse, from those who are abstinent (not drinking at all) for health reasons to those with AUD requiring inpatient rehabilitation and ongoing recovery management.
Substance Use Disorders in Older Adults: Overview and Future Directions
Respond more effectively to the older adult’s drinking (e.g., make sure the older adult is safe, then follow through with the consequences agreed to in the contingency contract instead of arguing or judging; encourage reengagement with the recovery plan and return to treatment if needed). Which co-occurring medical conditions are present (e.g., heart disease, breathing problems, diabetes, cognitive impairment). See Chapter 6 for more information about assessing cognitive impairment in older adults.
When it comes to addressing substance abuse in older adults, there are various approaches to treatment. These approaches typically involve a combination of medical interventions and behavioral therapies. Older adults, aged 65 and up, are one of the fastest-growing demographics in the Nation and the State. Late-onset of SUDs is particularly high among this group and often hard to detect. Older adults are often more reluctant to enter treatment, as opposed to their younger counterparts, because of shame, guilt and the belief that they will find themselves in groups composed of much younger members.
Treatment options remain generally limited, as few programs or health care settings offer tailored interventions for older adults. Health care professionals need to continue to do as thorough of assessments as possible and enlist the help of formal measures, Web-based assessment, and build in the questions outlined earlier as routine. As the baby boom generation ages, the health care system will be challenged to provide culturally competent services to this group, as they are a unique generation of older adults. Knowledge about older-adult substance use and the issues that contribute to late onset or maintained addiction in late life will need to be continually updated as we learn how and why this generation of adults uses substances.
Medication-Assisted Treatment
Alcohol and prescription drug abuse affects up to 17% of adults over the age of 65 per the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Due to insufficient knowledge, limited research data, and hurried office visits, health care providers often overlook signs of substance abuse among the elderly. This is made worse by the fact that the elderly often have medical or behavioral disorders that mimic symptoms of substance abuse, such as depression, diabetes, or dementia. Older adults are at greater risk than younger adults for alcohol withdrawal-related medical and neurological problems. The consensus panel recommends widespread screening of older adults for alcohol misuse and alcohol-related problems in all healthcare settings and emergency departments, where older adults are frequently seen because of accidents and falls related to alcohol use.
Screening and Assessment
Staying in treatment longer allows Barb to improve her emotional regulation, work on relapse prevention, and improve her interpersonal skills in a safe, supportive place. It also helps her get connected to community-based support before she ends treatment. At the next visit, Carl says that his depression has gotten better and that he no longer feels tired or gets dizzy. The psychiatrist supports Carl’s efforts to avoid drinking and, after discussion with Carl, prescribes a different antidepressant medication for him. In future medication management visits, the psychiatrist tracks Carl’s depression, his response to the new medication, his blood pressure, and his success in avoiding alcohol. The client’s risk of falls while being treated with common medications for managing withdrawal symptoms (e.g., benzodiazepines).
Higher Intensity Treatment Approaches for AUD
- Connecting patients to social support is also key to recovery from alcohol use disorder.
- Finally, providers and interprofessional teams must gain comfort in managing older adults with substance use disorders (Han et al., 2022).
- Her pattern of returning to drinking tends to happen when she is having difficult relationships, intense emotions, and traumatic stress reactions.
- In this section, we will delve into understanding the issue of substance abuse in older adults and explore its prevalence and risk factors.
- The rate of alcohol misuse among older adults increases when including health status and overall functioning, rather than just amount of alcohol used and frequency of use.
Older adults face unique barriers to treatment such as social isolation, limited mobility, financial problems, transportation issues, and shame regarding substance amphetamine addiction treatment use 5. Choi et al. found that lack of readiness and cost/limited insurance were the most frequently mentioned barriers to treatment among older adults 85. The abundance of missed opportunities for screening and treating older adults with substance use problems will have devastating consequences if they are not appropriately addressed moving forward. Most older adults at risk for alcohol misuse do not need specialized SUD treatment. However, most can benefit from Screening, Brief Intervention, and Referral to Treatment (SBIRT) to prevent substance misuse before it occurs. Current research shows that brief interventions can reduce alcohol consumption and substance misuse among older adults 25, 26.
Understanding these risks highlights the importance of substance abuse in older adults seeking appropriate treatment options. Comprehensive addiction treatment can offer individualized care tailored to seniors’ needs. The effects of tobacco and alcohol, the two most commonly used drugs, on multiple organs, are well known. Other drugs, such as opioids and benzodiazepines can cause or exacerbate respiratory depression.