Acknowledgments: This work was supported, in part, by grant K23-AA015616 from the National Institute on Alcohol Abuse and Alcoholism (RDB and LMF).

INTRODUCTION

Alcohol and drug use disorders are significant problems among older patients. These problems may be underappreciated by health care professionals because of limited clinical evidence and research data to form practice guidelines, insufficient training, and rushed office visits that tend to focus on acute and chronic physical problems, which can easily consume all the clinician's attention leaving little time to screen, diagnose, and perform an intervention for a substance use disorder.

Diagnosis of a substance use disorder can be difficult in the older patient. Embarrassment, shame, and fear of disapproval by family members may lead older individuals to conceal their drinking or drug use. Family members, who would be unlikely to ignore alcohol or drug abuse in a young person, may tolerate alcohol or drug abuse in an older person because they may think that after a long life the person “deserves it,” or that “it makes no difference anyway.” Family members may also believe that an oversedated elderly patient is “more manageable.” Furthermore, the signs and symptoms of substance abuse often mimic the clinical presentation of other common medical or psychiatric disorders and health care providers may perceive their diagnostic role as being directed mainly toward the chief complaint.

Definitions

There is a confusing array of terms used to describe individuals who use and misuse alcohol and other drugs: “alcohol abuse,” “alcoholism,” “chemical dependency,” “drug addiction,” and “substance abuse.”