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Alcohol and Substance Misuse in Older Adults

  • Geriatric Disorders (DC Steffens, Section Editor)
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Abstract

With the “Baby Boom” cohort reaching the age of 65 years, the older adult population is growing and will continue to grow at a rapid rate. There is a substantial and growing number of older adults who misuse alcohol, psychoactive prescription drugs, and/or other substances. The emerging literature on the cohort of aging adults indicates that they are continuing to use alcohol and psychoactive prescription medications at a higher rate than previous generations. The development and refinement of techniques to address these problems and provide early intervention services is going to be crucial to meeting the needs of this growing population. This chapter provides background on the extent of the problem, guidelines for alcohol and psychoactive medication use, and methods for screening and providing early interventions to improve the lives of older adults who misuse alcohol and/or psychoactive medications and drugs.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Division P (ed.). Projections of the population by age and sex for the United States: 2010 to 2050 (NP2008-T12). U.S. Census Bureau, Suitland, MD; 2008.

  2. Korper S, Council CL. Substance use by older adults: estimates of future impact on the treatment system. Substance Abuse Mental Health Services Administration, Washington, DC; 2002.

  3. Agency For Healthcare Research and Quality. Hospitalizations for medication and illicit drug-related conditions on the rise among Americans ages 45 and older. Agency For Healthcare Research and Quality, Washington, DC; 2010

  4. Blow, F. Substance abuse among older adults. Treatment Improvement Protocol (TIP) Series 26. Center for Substance Abuse Treatment Substance Abuse Among Older Adults, DHHS Publication No. (SMA) 98-3179, Rockville, MD; 1998.

  5. Adams WL, Barry K, Fleming M. Screening for problem drinking in older primary care patients. JAMA. 1996;276:1964.

    Article  PubMed  CAS  Google Scholar 

  6. Barry KL. Alcohol and drug abuse, in Fundamentals of clinical practice: A textbook on the patient, doctor, and society. New York: Plenum Medical Book Company; 1997.

    Google Scholar 

  7. Fleming MF, et al. Brief physician advice for alcohol problems in older adults: a randomized community-based trial. J Fam Pract. 1999;48:378–84.

    PubMed  CAS  Google Scholar 

  8. Menninger JA. Assessment and treatment of alcoholism and substance-related disorders in the elderly. Bull Menninger Clin. 2002;66:166–83.

    Article  PubMed  Google Scholar 

  9. Moore AA, et al. A new paradigm for alcohol use in older persons. Med Care. 1999;37:165–79.

    Article  PubMed  CAS  Google Scholar 

  10. Office of Applied Studies. The DASIS Report: Older adults in substance abuse treatment. 2005. http://OAS.samhsa.gov/2k7/older/older.cfm.

  11. Office of Applied Studies, Results From the 2003 National Survey on Drug Use and Health: National Findings, in NSDUH Series H-25. Substance Abuse and Mental Health Services Administration, Rockville, MD; 2004.

  12. Office of Applied Studies. Summary of findings from the 2002 National Survey on Drug Use and Health. Department of Health & Human Services Substance Abuse and Mental Health Services Administration, Rockville, MD; 2002.

  13. Office of Applied Studies. Results from the 2003 National Survey on Drug Use and Health: National Findings., Substance Abuse and Mental Health Services Administration. DHHS Publication No. (SMA) 04–3964. NSDUH Series H–25, Rockville, MD; 2004.

  14. Huang B, et al. Prevalence, correlates, and comorbidity of nonmedical prescription drug use and drug use disorders in the United States: results of the National Epidemiologic Survey on alcohol and related conditions. J Clin Psychiatry. 2006;67:1062–73.

    Article  PubMed  Google Scholar 

  15. • Blazer DG, Wu LT. The epidemiology of at-risk and binge drinking among middle-aged and elderly community adults: National Survey on Drug Use and Health. Am J Psychiatry. 2009;166:1162. The results of this analysis showed that at-risk and binge drinking are frequently reported by middle-aged and elderly adults nationwide and are therefore of public health concern. Clinicians working with middle-aged and older adults should screen for binge drinking and co-existing use of other substances.

    Article  PubMed  Google Scholar 

  16. Fleming MF, et al. Brief physician advice for alcohol problems in older adults – A randomized community-based trial. J Fam Pract. 1999;48:378–84.

    PubMed  CAS  Google Scholar 

  17. Schonfeld L, et al. Screening and brief intervention for alcohol and other substance: the Florida BRITE project. Gerontologist. 2010;50:496.

    Google Scholar 

  18. National Institute on Alcohol Abuse and Alcoholism (NIAAA). Diagnostic criteria for alcohol abuse. p. PH 359: 1–6. NIAAA, Washington, DC; 1995.

  19. National Institute of Alcholism and Alcohol Abuse (NIAAA). The physician's guide to helping patients with alcohol problems. NIAAA, Washington, DC; 1995.

  20. Chermack S, et al. The relationship between alcohol symptoms and consumption among older drinkers. Alcohol Clin Exp Res. 1996;20:1153–8.

    Article  PubMed  CAS  Google Scholar 

  21. Office of Applied Studies. Summary of findings from the 2002 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Department of Health & Human Services, Rockville, MD; 2002.

  22. Barry KL, Blow FC. Screening, assessing and intervening for alcohol and medication. In: Lichtenberg P (ed.) Handbook of Assessment in Clinical Gerontology. 2nd edn. Wiley, New York; 2009.

  23. Simoni-Wastila L, et al. National estimates of exposure to prescription drugs with addiction potential in community-dwelling elders. Subst Abus. 2005;26:33–42.

    Article  PubMed  Google Scholar 

  24. Simoni-Wastila L, Yang H. Psychoactive drug abuse in older adults. Am J Geriatr Pharmacother. 2006;4:380–94.

    Article  PubMed  Google Scholar 

  25. Blow FC, et al. Evidence-based practices for preventing substance abuse and mental health problems in older adults. SAMHSA, Washington, DC: Older Americans Substance Abuse and Mental Health Technical Assistance Center; 2006.

    Google Scholar 

  26. Finlayson RE, Davis LJ. Prescription drug dependence in the elderly population: demographic and clinical features of 100 inpatients. Mayo Clin Proc. 1994;69:1137–45.

    PubMed  CAS  Google Scholar 

  27. Jinks MJ, Raschko RR. A profile of alcohol and prescription drug abuse in a high-risk community-based elderly population. Dicp. 1990;24:971–5.

    PubMed  CAS  Google Scholar 

  28. Simoni-Wastila L, Strickler G. Risk factors associated with problem use of prescription drugs. Am J Public Health. 2004;94:266–8.

    Article  PubMed  Google Scholar 

  29. Solomon K, et al. Alcoholism and prescription drug abuse in the elderly: St. Louis University grand rounds. J Am Geriatric Soc. 1993;41:57–69.

    CAS  Google Scholar 

  30. Dealberto MJ, et al. Psychotropic drug use and cognitive decline among older men and women. Int J Geriatr Psychiatry. 1997;12:567–74.

    Article  PubMed  CAS  Google Scholar 

  31. Hogan D, et al. Prevalence and potential consequences of benzodiazepine use in senior citizens: results from the Canadian Study of Health and Aging. Can J Clin Pharmacol. 2003;10:72–7.

    PubMed  Google Scholar 

  32. Hanlon JT, et al. Benzodiazepine use and cognitive function among community-dwelling elderly. Clin Pharmacol Ther. 1998;64:684–92.

    Article  PubMed  CAS  Google Scholar 

  33. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47:30–9.

    PubMed  CAS  Google Scholar 

  34. Adams WL, et al. Primary care for elderly people. Gerontologist. 2002;42:835–42.

    Article  PubMed  Google Scholar 

  35. Holmes HM, et al. Reconsidering medication appropriateness for patients late in life. Arch Intern Med. 2006;166:605–9.

    Article  PubMed  Google Scholar 

  36. Patterson TL, Jeste DV. The potential impact of the baby-boom generation on substance abuse among elderly persons. Psychiatric Serv. 1999;50:1184–8.

    CAS  Google Scholar 

  37. • Schonfeld L, et al. Screening and brief intervention for substance misuse among older adults: the Florida BRITE Project. Am J Public Health. 2009;99:1–7. This study examined the effectiveness of the Florida Brief Intervention and Treatment for Elders (BRITE) project, a three-year, state-funded pilot program of screening and brief intervention for older adult substance misusers. Prescription medication misuse was the most prevalent substance use problem, followed by alcohol, over-the-counter medications, and illicit substances. Those who received the brief intervention had improvement in alcohol, medication misuse, and depression measures.

    Google Scholar 

  38. Blow FC, et al. Analysis of the National Health and Nutrition Examination Survey (NHANES): Longitudinal analysis of drinking over the lifespan. In: Korper SP, Council CL, editors. Substance use by older adults: Estimates of future impact on the treatment system. Rockville: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2002. p. 125–41.

    Google Scholar 

  39. National Institute of Alcholism and Alcohol Abuse (NIAAA). The physician's guide to helping patients with alcohol problems. NIAAA, Washington, DC; 1995.

  40. Vestal R, et al. Aging and ethanol metabolism. Clin Pharmacol Ther. 1977;21:343.

    PubMed  CAS  Google Scholar 

  41. Blow FC, Oslin DW, Barry KL. Misuse and abuse of alcohol, illicit drugs, and psychoactive medication among older people. J Am Soc Aging. 2002;26:50–4.

    Google Scholar 

  42. Culberson J, Ziska M. Prescription drug misuse/abuse in the elderly. Geriatrics. 2008;63:22–31.

    PubMed  Google Scholar 

  43. Barry KL, Fleming MF. Computerized administration of alcoholism screening tests in a primary care setting. J Am Board Fam Pract. 1990;3:93–8.

    PubMed  CAS  Google Scholar 

  44. Greist J, et al. Comparison of computer-and interviewer-administered versions of the Diagnostic Interview Schedule. Psychiatric Serv. 1987;38:1304.

    CAS  Google Scholar 

  45. National Institute on Alcohol Abuse and Alcoholism (NIAAA). Helping patients who drink too much. A clinician’s guide. U.S. Department of Health and Human Services, NIH Publication No. 07-3769. NIAAA, Washington, DC; 2005.

  46. Babor T, De La Fuente JR, Saunders J, Grant M. AUDIT: The alcohol use disorders identification test. Guidelines for use in primary health care. Geneva: WHO; 1989.

    Google Scholar 

  47. Barry K, Fleming MF. The alcohol use disorders identification test (AUDIT) and theSMAST-13: predictive validity in a rural primary care sample. Alcohol Alcohol. 1993;28:33–42.

    PubMed  CAS  Google Scholar 

  48. Fiellin DA, Reid C, O'Connor PG. Screening for alcohol problems in primary care – A systematic review. Arch Intern Med. 2000;160:1977–89.

    Article  PubMed  CAS  Google Scholar 

  49. Fleming MF, Barry KL, Macdonald R. The alcohol – use disorders identification test(AUDIT)in a college sample. Int J Addict. 1991;26:1173–85.

    PubMed  CAS  Google Scholar 

  50. Schmidt A, Barry KL, Fleming MF. Detection of problem drinkers – the alcohol-use disorders identification test (AUDIT). South Med J. 1995;88:52–9.

    Article  PubMed  CAS  Google Scholar 

  51. Blow FC, et al. Brief screening for alcohol problems in elderly populations using the Short Michigan Alcoholism Screening Test-Geriatric Version (SMAST-G). Hilton Head Island: Research Society on Alcoholism Annual Scientific Meeting; 1998.

    Google Scholar 

  52. Babor T, Grant M. Project on identification and management of alcohol-related problems. Report on phase II: a randomized clinical trial of brief interventions in primary health care. Geneva: WHO; 1992.

    Google Scholar 

  53. Blow FC, et al. The efficacy of two brief intervention strategies among injured, at-risk drinkers in the emergency department: impact of tailored messaging and brief advice. J Stud Alcohol. 2006;67:568–78.

    PubMed  Google Scholar 

  54. Chick J, Lloyd G, Crombie E. Counseling problem drinkers in medical wards - a controlled study. BMJ. 1985;290:965–7.

    Article  PubMed  CAS  Google Scholar 

  55. Fleming MF, et al. Brief physician advice for problem alcohol drinkers - A randomized controlled trial in community-based primary care practices. JAMA. 1997;277:1039–45.

    Article  PubMed  CAS  Google Scholar 

  56. Harris K, Miller WR. Behavioral self-control training for problem drinkers. Psychol Addict Behav. 1990;4:82–90.

    Article  Google Scholar 

  57. Wallace P, Cutler S, Haines A. Randomized controlled trial of general-practitioner intervention in patients with excessive alcohol-consumption. BMJ. 1988;297:663–8.

    Article  PubMed  CAS  Google Scholar 

  58. •• Moore AA, et al. Reducing at-risk drinking among older adults in primary care: the healthy living as age study. Alcohol Clin Exp Res. 2011;35:302A. This was a randomized controlled trial of 631 participants aged >55 years who were at-risk. Fifty-three drinkers were identified by the Comorbidity Alcohol Risk Evaluation Tool (CARET). Participants were randomly assigned to the 55 intervention (N = 310) or to control (N = 321) groups. At 3 months, 49.46 % of intervention vs 61.21 % control participants and at 12 months, 53.87 % of intervention vs 60.38 % of 65 controls were at-risk drinkers.

    Google Scholar 

  59. Whitlock EP, et al. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2004;140:557–68.

    PubMed  Google Scholar 

  60. Blow F, Barry KL. Advances in alcohol screening and brief intervention with older adults. In: Lichtenberg XX (ed.) Advances in medical psychotherapy. Vol. 10. Kendall Hunt: Dubuque, IA; 1999.

  61. • Lin JC, et al. Determinants of early reductions in drinking in older at-risk drinkers participating in the intervention arm of a trial to at-risk drinking in primary care. J Am Geriatr Soc. 2010;58:227–33. Early reductions in drinking were common among older at-risk drinkers receiving a brief intervention. Older adults' concerns about risks, reading educational materials, and the perception of physicians providing advice to reduce drinking were associated with early reduction in risky alcohol use.

    Article  PubMed  Google Scholar 

  62. Oslin DW, et al. PRISM-E: comparison of integrated care and enhanced specialty referral in managing at-risk alcohol use. Psychiatr Serv. 2006;57:954–8.

    Article  PubMed  Google Scholar 

  63. Barry K, Oslin D, Blow FC. Alcohol problems in older adults: prevention and management. New York: Springer; 2001.

    Google Scholar 

  64. Barry KL. Brief Interventions and brief therapies for substance abuse. Treatment improvement protocol (TIP) Series 34. Rockville: Substance Abuse and Mental Health Services Administration; 1999.

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, North Campus Research Complex, University of Michigan, Building 14, Ann Arbor, MI, 49109, USA

    Frederic C. Blow & Kristen L. Barry

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  1. Frederic C. Blow
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  2. Kristen L. Barry
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Correspondence to Kristen L. Barry.

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Blow, F.C., Barry, K.L. Alcohol and Substance Misuse in Older Adults. Curr Psychiatry Rep 14, 310–319 (2012). https://doi.org/10.1007/s11920-012-0292-9

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