Information For Providers
Text: Substance Abuse Among Older
Adults" U.S. Department of Health and Human Services
Center for Substance Abuse Treatment
Many Americans who are now young or middle-aged will carry
their use and abuse of alcohol and other drugs with them into
old age - and they will also live longer. Life expectancy
jumped almost 30 years between 1900 and 1989, and it continues
to climb. By the year 2050, one out of four Americans over
age 65 will be 85 and older. Substance use disorders, if not
diagnosed and treated, may ruin the last stage of life for
countless Americans.
Every person 65 and older should be screened for alcohol
and prescription drug abuse as part of his or her regular
physical exam. Although it is preferable to use standardized
screening questionnaires, friendly visitors, Meals-on-Wheels
volunteers, caretakers, and health care providers also can
interject screening questions into their normal conversations.
Although widely used, the DSM-IV criteria may not apply to
many older adults who experience neither the legal, social,
nor psychological consequences specified.
Anyone would is concerned about an older adult's drinking
practices can try direct questions such as " I'm wondering
if alcohol may be the reason why your diabetes isn't responding
as it should", or "Sometimes on prescription drug
can affect how well another medication is working. Let's go
over the drugs you're taking and see if we can figure this
problem out."
Often drug trials of new medications do not include older
subjects, so a clinician has no way of predicting or recognizing
an adverse reaction or unexpected psychoactive effect.
The following general approaches are recommended for effective
treatment of older adult substance abusers:
- Cognitive-behavioral approaches
- Group-based approaches
- Individual counseling
- Medical/psychiatric approaches
- Marital and family involvement/family therapy
- Case management/community-linked services and outreach
It is essential for those who work with older adults to respect
their client's autonomy and rights to privacy and confidentiality
if they are to be effective in screening and assessing clients
for substance use disorders and persuading them to cut down
their use or enter treatment. In most situations, providers
can follow these simple rules:
- consult the client
- let the client decide
- be sensitive to how information is recorded or disclosed
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