Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-26T23:03:45.872Z Has data issue: false hasContentIssue false

Chapter 20 - Unhealthy substance use in older adults

from Section III - Care of the elderly by organ system

Published online by Cambridge University Press:  05 June 2016

Jan Busby-Whitehead
Affiliation:
University of North Carolina
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Samuel C. Durso
Affiliation:
The Johns Hopkins University School of Medicine
Daniel Swagerty
Affiliation:
University of Kansas
Laura Mosqueda
Affiliation:
University of Southern California
Maria Fiatarone Singh
Affiliation:
University of Sydney
William Reichel
Affiliation:
Georgetown University, Washington DC
Get access

Summary

Older adults are a fast growing population, and the emerging cohort comprises older adults from the baby boomer generation who engage in unhealthy use of substances at higher rates than earlier cohorts. Though older adults use alcohol and illicit drugs at lower rates than younger adults, the sheer numbers of the older adult population and the aging of the baby boomers are expected to drive up the prevalence rates of substance use disorders among older adults. Thus, health care professionals need to know how to identify, assess, and intervene in substance use disorders among aging adults, which may involve unhealthy use of alcohol, tobacco, and illicit and non-medical prescription drugs.
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
, pp. 285 - 297
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

US Census Bureau. Population profile of the United States. 2012.Google Scholar
Kerr, WC, Greenfield, TK, Bond, J, et al. Age-period-cohort modelling of alcohol volume and heavy drinking days in the US National Alcohol Surveys: divergence in younger and older adult trends. Addiction. 2009 Jan;104(1):2737. doi: 10.1111/j.1360-0443.2008.02391.x.Google Scholar
Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of national findings. NSDUH Series H-46, HHS Publication No. (SMA) 13–4795. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.Google Scholar
Duncan, DF, Nicholson, T, White, JB, et al. The baby boomer effect: changing patterns of substance abuse among adults ages 55 and older. J Aging Soc Policy. 2010 Jul;22(3):237248. doi: 10.1080/08959420.2010.485511.CrossRefGoogle ScholarPubMed
Cummings, SM, Bride, B, Rawlins-Shaw, AM. Alcohol abuse treatment for older adults: a review of recent empirical research. Journal of Evidence-Based Social Work. 2006;3(1):7999.Google Scholar
Saitz, R. Unhealthy alcohol use. New Eng J Med. 2005;352(6):596607.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
Moore, AA, Karno, MP, Grella, CE, et al. Alcohol, tobacco, and nonmedical drug use in older US adults: Data from the 2001/02 National Epidemiologic Survey of Alcohol and Related Conditions. Journal of the American Geriatrics Society. 2009;57(12):22752281.CrossRefGoogle Scholar
Arndt, S, Clayton, R, Schultz, S. Trends in substance abuse treatment 1998–2008: Increasing older adult first time admissions for illicit drugs. American Journal of Geriatric Psychiatry. 2011;19:704711.Google Scholar
Moos, RH, Schutte, KK, Brennan, PL, Moos, BS. Older adults’ alcohol consumption and late-life drinking problems: a 20-year perspective. Addiction. 2009;104:12931302.Google Scholar
Kirchner, J, Zubritsky, C, Cody, M, et al. Alcohol consumption among older adults in primary care. Journal of General Internal Medicine. 2007;22:9297.Google Scholar
Center for Substance Abuse Treatment. Substance Abuse among Older Adults: Treatment Improvement Protocol (TIP) Series 26. Rockville, MD: Substance Abuse and Mental Health Services Administration; 1998.Google Scholar
Moore, AA, Gould, R, Reuben, DB, et al. Longitudinal patterns and predictors of alcohol consumption in the United States. American Journal of Public Health. 2005;95(3):458465.Google Scholar
Blazer, DG, Wu, L. The epidemiology of at risk and binge drinking among middle-aged and elderly community adults: National Survey on Drug Use and Health. Am J Psychiat. 2009;166:11621169.Google Scholar
National Institute on Alcohol Abuse and Alcoholism. Rethinking Drinking. NIH Publication No. 13–3770. Bethesda, MD: NIH; 2010.Google Scholar
Grant, BF, Dawson, DA, Stinson, FS, et al. The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug Alcohol Depen. 2004;74:223234.Google Scholar
King, BA, Dube, SR, Tynan, MA. Current tobacco use among adults in the United States: findings from the National Adult Tobacco Survey. Am J Public Health. 2012 Nov;102(11):e93e100. doi: 10.2105/AJPH.2012.301002. Epub 2012 Sep 20.Google Scholar
Wu, LT, Blazer, DG. Illicit and nonmedical drug use among older adults: a review. J Aging Health. 2011;23:481504.Google Scholar
Lin, JC, Karno, MP, Grella, CE, et al. Alcohol, tobacco, and nonmedical drug use disorders in US adults aged 65 years and older: data from the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions. Am J Geriatr Psychiatry. 2011 Mar;19(3):292–9. doi: 10.1097/JGP.0b013e3181e898b4.Google Scholar
Blazer, DG, Wu, L. The epidemiology of substance use and disorders among middle aged and elderly community adults: national survey on drug use and health. Am J Geriatr Psychiatry. 2009;17:237245.Google Scholar
Blazer, DG, Wu, L. Nonprescription use of pain relievers by middle-aged and elderly community-living adults: national survey on drug use and health. J Am Geriatr Soc. 2009;57:12521257.Google Scholar
Bartels, SJ, Coakley, EH, Zubritsky, C, et al. Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. American Journal of Psychiatry. 2004;161:14551462.CrossRefGoogle ScholarPubMed
Kennedy, GJ, Efremova, I, Frazier, A, Saba, A. The emerging problems of alcohol and substance abuse in late life. J Soc Distress Homel. 1999;8(4):227239.Google Scholar
Oslin, DW. Alcohol use in late life: disability and comorbidity. J Geriatr Psychiat Neur. 2000;13:134140.Google Scholar
Gilbertson, R, Ceballos, NA, Prather, R, Nixon, SJ. Effects of acute alcohol consumption in older and younger adults: perceived impairment versus psychomotor performance. J Stud Alcohol Drugs. 2009;70(2):242252.Google Scholar
Blow, FC, Barry, KL. Older patients with at-risk and problem drinking patterns: new developments in brief interventions. J Geriatr Psychiat Neur. 2000;13:115123.Google Scholar
Sklar, AR, Gilbertson, R, Boissoneault, J, et al. Differential effects of moderate alcohol consumption on performance among older and younger adults. Alcoholism: Clinical & Experimental Research. 2012;36(12):21502156.Google Scholar
Linnoila, M, Erwin, CW, Cleveland, WP, et al. Effects of alcohol on psychomotor performance of men and women. J Stud Alcohol. 1978;39:745758.Google Scholar
Vestal, RE, McGuire, EA, Tobin, JD, et al. Aging and ethanol metabolism. Clin Pharmacol Ther. 1977;21:343354.Google Scholar
Moore, AA, Whiteman, EJ, Ward, KT. Risks of combined alcohol/medication use in older adults. Am J Geriatr Pharmacother. 2007;5:6474.Google Scholar
Moore, AA, Morton, SC, Beck, JC, et al. A new paradigm for alcohol use in older persons. Med Care. 1999;37:165179.Google Scholar
LaCroix, AZ, Guralnik, JM, Berkman, LF, et al. Maintaining mobility in late life. II. Smoking, alcohol consumption, physical activity and body mass index. American Journal of Epidemiology. 1993;137(8):858869.Google Scholar
LaCroix, AZ, Omenn, GS. Older adults and smoking. Clinics in Geriatric Medicine. 1992;8(1):6987.Google Scholar
Rimer, BK, Orleans, CT, Keintz, MK, et al. The older smoker: status, challenges and opportunities for intervention. Chest. 1990;97:547–53Google Scholar
Simoni-Wastila, L, Yang, HK. Psychoactive drug abuse in older adults. American Journal of Geriatric Pharmacotherapy. 2006;4(4):380394.Google Scholar
National Institute on Drug Abuse. Marijuana Abuse. Bethesda, MD: National Institute on Drug Abuse; 2012.Google Scholar
Kuerbis, A, Sacco, P, Blazer, DG, Moore, AA. Substance abuse among older adults. Clin Geriatr Med. 2014 Aug;30(3):629654. doi: 10.1016/j.cger.2014.04.008. Epub 2014 Jun 12.Google Scholar
Merrick, EL, Horgan, CM, Hodgkin, D, et al. Unhealthy drinking patterns in older adults: prevalence and associated characteristics. J AmGeriatr Soc. 2008;56:214223.Google Scholar
Platt, A, Sloan, FA, Costanzo, P. Alcohol-consumption trajectories and associated characteristics among adults older than age 50. J Stud Alcohol Drugs. 2010;71:169179.CrossRefGoogle ScholarPubMed
Moos, RH, Brennan, PL, Schutte, KK, Moos, BS. Older adults’ health and late-life drinking patterns: a 20-year perspective. Aging Ment Health. 2010;14(1):3343.Google Scholar
Collins, PM, Kayser, K, Platt, S. Conjoint marital therapy: a practitioner’s approach to single-system evaluation. Families in Society. 1994;75:131141.Google Scholar
Sacco, P, Bucholz, KK, Spitznagel, EL. Alcohol use among older adults in the National Epidemiologic Survey on Alcohol and Related Conditions. J Stud Alcohol Drugs. 2009;70(6):829838.Google Scholar
Balsa, AI, Homer, JF, Fleming, MF, French, MT. Alcohol consumption and health among elders. Gerontologist. 2008;48(5):622636.Google Scholar
Adams, WL. Alcohol use in the retirement communities. J Am Geriatr Soc. 1996;44:10821085.Google Scholar
Brennan, PL, Schutte, KK, Moos, RH. Reciprocal relations between stressors and drinking behavior: a three-wave panel study of late middle-aged and older women and men. Addiction. 1999;94(5):737749.Google Scholar
Center for Substance Abuse Treatment. Substance Abuse Relapse Prevention for Older Adults: A Group Treatment Approach. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2005.Google Scholar
Myers, JE, Harper, MC. Evidence-based effective practices with older adults. Journal of Counseling & Development. 2004;82:207218.Google Scholar
Laidlaw, K, Pachana, NA. Aging, mental health, and demographic change: challenges for psychotherapists. Professional Psychology: Research and Practice. 2009;40(6):601608.Google Scholar
Kuerbis, A, Sacco, P. The impact of retirement on the drinking patterns of older adults: a review. Addict Behav. 2012;37:587595.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revision ed. Washington, DC: Author; 2000.Google Scholar
Sacco, P, Kuerbis, A. Older adults. In: Vaughn, MG, Perron, BE, eds. Social Work Practice in the Addictions. New York: Springer; 2013:213229.Google Scholar
Kuerbis, A, Hagman, BT, Sacco, P. Functioning of alcohol use disorders criteria among middle-aged and older adults: Implications for DSM-5. Substance Use & Misuse. 2013;48(4):309322.Google Scholar
Barry, KL, Blow, FC, Oslin, DW. Substance abuse in older adults: review and recommendations for education and practice in medical settings. Substance Abuse. 2002;23(3 Suppl):109.Google Scholar
Moyer, VA, US Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 Aug 6;159(3):210–8. doi: 10.7326/0003-4819-159-3-201308060-00652.Google Scholar
Duru, OK, Xu, H, Tseng, C-H, et al. Correlates of alcohol-related discussions between older adults and their physicians. J AmGeriatr Soc. 2010;58(12):23692374.Google Scholar
D’Amico, EJ, Paddock, SM, Burnam, A, Kung, FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005;43(3):229236.Google Scholar
Dar, K. Alcohol use disorders in elderly people: fact or fiction? Advances in Psychiatric Treatment. 2006;12:173181.Google Scholar
Barry, KL, Oslin, DW, Blow, FC. Alcohol Problems in Older Adults. New York: Springer Publishing Company; 2001.Google Scholar
Rodin, J. Aging and health: effects of the sense of control. Science. 1986;233:12711276.Google Scholar
Klein, WC, Jess, C. One last pleasure? Alcohol use among elderly people in nursing homes. Health & Social Work. 2002;27(3):193203.Google Scholar
Barry, KL, Blow, FC, Oslin, DW. Substance abuse in older adults: review and recommendations for education and practice in medical settings. Substance Abuse. 2002;23(3 Suppl):105131.Google Scholar
Dupree, LW, Broskowski, H, Schonfeld, L. The Gerontology Alcohol Project: a behavioral treatment program for elderly alcohol abusers. Gerontologist. 1984;24:510516.Google Scholar
Schonfeld, L, Dupree, LW. Treatment approaches for older problem drinkers. International Journal of the Addictions. 1995;30(13–14):18191842.Google Scholar
Schonfeld, L, Dupree, LW, Dickson-Fuhrman, E, et al. Cognitive-behavioral treatment of older veterans with substance abuse problems. J Geriatr Psychiat Neur. 2000;13:124128.Google Scholar
National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician’s Guide. 2005 Edition. Bethesda, MD: Author; 2007.Google Scholar
Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, MG. The Alcohol Use Disorders Identification Test (AUDIT): Guidelines for Use in Primary Care. 2nd ed. Geneva: Department of Mental Health and Substance Dependence, World Health Organization; 2001.Google Scholar
Piccinelli, M, Tessari, E, Bortolomasi, M, et al. Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study. British Medical Journal. 1997;314(8):420424.Google Scholar
Humeniuk, R, Henry-Edwards, S, Ali, R, et al. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Geneva: World Health Organization; 2010.Google Scholar
Moore, AA, Beck, JC, Babor, TF, et al. Beyond alcoholism: identifying older, at-risk drinkers in primary care. J Stud Alcohol. 2002;63(3):316324.Google Scholar
Barnes, AJ, Moore, AA, Xu, H, et al. Prevalence and correlates of at-risk drinking among older adults: the Project SHARE study. JGIM. 2010;25(8):840846.CrossRefGoogle Scholar
Moore, AA, Blow, FC, Hoffing, M, et al. Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trial. Addiction. 2011;106(1):111120.Google Scholar
Stewart, D, Oslin, DW. Recognition and treatment of late-life addictions in medical settings. Journal of Clinical Geropsychology. 2001;7(2):145158.Google Scholar
Buchsbaum, DG, Buchanan, R, Welsh, J, et al. Screening for drinking disorders in the elderly using the CAGE questionnaire. J Am Geriatr Soc. 1992;40:662665.Google Scholar
Brennan, PL, Nichol, AC, Moos, RH. Older and younger patients with substance use disorders: Outpatient mental health service use and functioning over a 12-month interval. Psychol Addict Behav. 2003;17(1):4248.Google Scholar
Ewing, JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905–7.Google Scholar
Brown, RL, Rounds, LA. Conjoint screening questionnaires for alcohol and other drug abuse. Wisconsin Medical Journal. 1995;94(3):135140.Google Scholar
Barry, KL, Blow, FC. Screening, assessing and intervening for alcohol and medication misuse in older adults. In: Lichtenberg, PA, ed. Handbook of Assessment in Clinical Gerontology. Burlington, MA: Elsevier; 2010:307330.Google Scholar
O’Connell, H, Chin, A-V, Hamilton, F, et al. A systematic review of the utility of self-report alcohol screening instruments in the elderly. International Journal of Geriatric Psychiatry. 2004;19:10741086.Google Scholar
Fink, A, Morton, SC, Beck, JC, et al. The Alcohol-Related Problems Survey: identifying hazardous and harmful drinking in older primary care patients. J Am Geriatr Soc. 2002;50:17171722.Google Scholar
Brennan, PL, Nichol, AC, Moos, RH. Older and younger patients with substance use disorders: outpatient mental health service use and functioning over a 12-month interval. Psychol Addict Behav. 2003;17(1):4248.Google Scholar
Kuerbis, AN, Sacco, P. A review of existing treatments for substance abuse among the elderly and recommendations for future directions. Substance Abuse: Research and Treatment. 2013;7:1337.Google Scholar
Han, B, Gfroerer, JC, Colliver, JD, Penne, MA. Substance use disorder among older adults in the United States in 2020. Addiction. 2009;104:8896.Google Scholar
Schultz, SK, Arndt, S, Liesveld, J. Locations of facilities with special programs for older substance abuse clients in the US. International Journal of Geriatric Psychiatry. 2003;18(9):839843.Google Scholar
Fleming, MF, Manwell, LB, Barry, KL, et al. Brief physician advice for alcohol problems in older adults: a randomized community-based trial. Journal of Family Practice. 1999;48(5):378384.Google Scholar
Fink, A, Elliot, MN, Tsai, M, Beck, JC. An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol. J Am Geriatr Soc. 2005;53:19371943.Google Scholar
Miller, WR, Rollnick, S. Motivational Interviewing: Preparing People for Change. 2nd ed. New York: The Guilford Press; 2002.Google Scholar
Miller, WR, Zweben, A, DiClemente, CC, Rychtarik, RG. Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism; 1992.Google Scholar
Kofoed, LL, Tolson, RL, Atkinson, RM, et al. Treatment compliance of older alcoholics: an elder-specific approach is superior to “mainstreaming.” J Stud Alcohol. 1987;48:4751.Google Scholar
Rice, C, Longabaugh, R, Beattie, M, Noel, N. Age group differences in response to treatment for problematic alcohol use. Addiction. 1993;88:13691375.Google Scholar
Schonfeld, L, Dupree, LW. Age-specific cognitive behavioral and self management treatment approaches. In: Gurnack, AM, Atkinson, RM, Osgood, NJ, eds. Treating Alcohol and Drug Abuse in the Elderly. New York: Springer Publishing Company; 2002:109130.Google Scholar
Rotgers, F. Cognitive-behavioral theories of substance abuse. In: Rotgers, F, Morgenstern, J, Walters, ST, eds. Treating Substance Abuse: Theory and Technique. 2nd ed. New York: The Guilford Press; 2003:166189.Google Scholar
Oslin, DW, Liberto, JG, O’Brien, J, et al. Naltrexone as an adjunctive treatment for older patients with alcohol dependence. American Journal of Geriatric Psychiatry. 1997;5(4):324332.Google Scholar
Oslin, DW, Pettinati, H, Volpicelli, JR. Alcoholism treatment adherence: older age predicts better adherence and drinking outcomes. American Journal of Geriatric Psychiatry. 2002;10(6):740747.Google Scholar
Rösner, S, Hackl-Herrwerth, A, Leucht, S, et al. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. 2010;12:CD001867.Google Scholar
Barrick, C, Connors, GD. Relapse prevention and maintaining abstinence in older adults with alcohol-use disorders. Drugs & Aging. 2002;19(8):583594.Google Scholar
Tempesta, E, Janiri, L, Bignamini, A, et al. Acamprosate and relapse prevention in the treatment of alcohol dependence: a placebo controlled trial. Pharmacopsychiatry. 2000;29:2729.Google Scholar
US National Library of Congress. DailyMed. 2013; http://dailymed.nlm.nih.gov/dailymed/about.cfm.Google Scholar
Hays, JT, Ebbert, JO. Adverse effects and tolerability of medications for the treatment of tobacco use and dependence. Drugs. 2010;70(18):23572372.Google Scholar
Smith, SS, McCarthy, DE, Japuntich, SJ, et al. Comparative effectiveness of five smoking cessation pharmacotherapies in primary care clinics. Arch Intern Med. 2009;169(22):2148.Google Scholar
Keating, GM, Lyseng-Williamson, KA. Varenicline: a pharmacoeconomic review of its use as an aid to smoking cessation. Pharmacoeconomics. 2010;28(3):231254.Google Scholar
Garrison, GD, Dugan, SE. Varenicline: a first-line treatment option for smoking cessation. Clinical Therapeutics. 2009;31(3):463491.Google Scholar
Fudala, PJ, Bridge, TP, Herbert, S, et al. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. N Engl J Med. 2003;349(10):949958.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×