Advertisement

Substance Use Disorders in Late Life

  • Jeffrey DeVido
  • Calvin H. Hirsch
  • Nitika Sanger
  • Tea Rosic
  • Zainab Samaan
  • James A. Bourgeois
Chapter

Abstract

In older populations, substance use disorders are highly prevalent, often underdiagnosed and undertreated, and are associated with significant systemic medical and psychiatric comorbidity. Diagnostic criteria for substance use disorders have changed with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, and these updated criteria are reviewed here. Furthermore, the epidemiology and proposed etiology of substance use disorders in late life are discussed. A particular focus is placed on reviewing the role of the psychiatrist in the evaluation and management of older adults with substance use disorders, especially when chronic pain is part of the clinical picture. Recommendations for evaluation and management of older adults with (or suspected to have) substance use disorders are outlined, and two case examples are provided to further solidify these concepts.

Keywords

Substance use disorder Intoxication Withdrawal Addiction Dual diagnosis Psychopharmacology Psychotherapy 

References

  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., Text Revision London: American Psychiatric Publishing; 2000.Google Scholar
  2. 2.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013.Google Scholar
  3. 3.
    Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health; 2015.Google Scholar
  4. 4.
    Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on drug use and health: summary of national findings, NSDUH series H-48, HHS Publication No. (SMA) 14–4863; 2014.Google Scholar
  5. 5.
    Substance Abuse and Mental Health Administration, Center for Behavioral Health Statistics and Quality. Drug Abuse Warning Network. 2008: National estimates of drug-related emergency department visits. HHS publication no. SMA 11–4618; 2011.Google Scholar
  6. 6.
    Compton WM, Thomas YF, Stinson FS, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry. 2007;64(5):566–76.PubMedGoogle Scholar
  7. 7.
    Grant BF. Prevalence and correlates of drug use and DSM-IV drug dependence in the United States: results of the National Longitudinal Alcohol Epidemiologic Survey. J Subst Abus. 1996;8(2):195–210.Google Scholar
  8. 8.
    Roe B, Beynon C, Pickering L, Duffy P. Experiences of drug use and ageing: health, quality of life, relationship and service implications. J Adv Nurs. 2010;66(9):1968–79.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Dowling GJ, Weiss SR, Condon TP. Drugs of abuse and the aging brain. Neuropsychopharmacology. 2008;33(2):209–18.PubMedGoogle Scholar
  10. 10.
    Simoni-Wastila L, Yang HK. Psychoactive drug abuse in older adults. Am J Geriatr Pharmacother. 2006;4(4):380–94.PubMedGoogle Scholar
  11. 11.
    De Leo D, Padoani W, Scocco P, et al. Attempted and completed suicide in older subjects: results from the WHO/EURO multicentre study of suicidal behaviour. Int J Geriatr Psychiatry. 2001;16(3):300–10.PubMedGoogle Scholar
  12. 12.
    Hawton K, Zahl D, Weatherall R. Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. Br J Psychiatry. 2003;182:537–42.PubMedGoogle Scholar
  13. 13.
    Le Roux C, Tang Y, Drexler K. Alcohol and opioid use disorder in older adults: neglected and treatable illnesses. Curr Psychiatry Rep. 2016;18(9):87.  https://doi.org/10.1007/s11920-016-0718-x.PubMedGoogle Scholar
  14. 14.
    Wu LT, Blazer DG. Illicit and nonmedical drug use among older adults: a review. J Aging Health. 2011;23(3):481–504.PubMedGoogle Scholar
  15. 15.
    Batts K, Pemberton M, Bose J, et al. Comparing and Evaluating Substance Use Treatment Utilization Estimates from the National Survey on Drug Use and Health and Other Data Sources. In: CBHSQ Data Review. Rockville, MD: Substance Abuse and Mental Health Services Administration (US); 2014. Available from: https://www-ncbi-nlm-nih-gov.ucsf.idm.oclc.org/books/NBK390288/.
  16. 16.
    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. 2013.Google Scholar
  17. 17.
    Wu LT, Pan JJ, Blazer DG, et al. The construct and measurement equivalence of cocaine and opioid dependences: a National Drug Abuse Treatment Clinical Trials Network (CTN) study. Drug Alcohol Depend. 2009;103(3):114–23.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Wang YP, Andrade LH. Epidemiology of alcohol and drug use in the elderly. Curr Opin Psychiatry. 2013;26(4):343–8.PubMedGoogle Scholar
  19. 19.
    Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64(50–51):1378–82.PubMedGoogle Scholar
  20. 20.
    Schonfeld L, King-Kallimanis BL, Duchene DM, et al. Screening and brief intervention for substance misuse among older adults: the Florida BRITE project. Am J Public Health. 2010;100(1):108–14.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Olfson M, Wang S, Iza M, Crystal S, Blanco C. National trends in the office-based prescription of schedule II opioids. J Clin Psychiatry. 2013;74(9):932–9.PubMedGoogle Scholar
  22. 22.
    West NA, Dart RC. Prescription opioid exposures and adverse outcomes among older adults. Pharmacoepidemiol Drug Saf. 2016;25(5):539–44.PubMedGoogle Scholar
  23. 23.
    Lofwall MR, Schuster A, Strain EC. Changing profile of abused substances by older persons entering treatment. J Nerv Ment Dis. 2008;196(12):898–905.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Arndt S, Clayton R, Schultz SK. Trends in substance abuse treatment 1998–2008: increasing older adult first-time admissions for illicit drugs. Am J Geriatr Psychiatry. 2011;19(8):704–11.PubMedGoogle Scholar
  25. 25.
    Kuerbis A, Sacco P. A review of existing treatments for substance abuse among the elderly and recommendations for future directions. Subst Abuse. 2013;7:13–37.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Abdulla A, Adams N, Bone M, et al. Guidance on the management of pain in older people. Age Ageing. 2013;42(Suppl 1):i1–57.PubMedGoogle Scholar
  27. 27.
    Substance Abuse and Mental Health Services Administration, Office of Applied Studies: Drug Abuse Warning Network, 2003: Area profiles of drug-related mortality. (DAWN Series D-27, DHHS Publication No. SMA 05-4023.) Rockville, MD: Department of Health and Human Services; 2005.Google Scholar
  28. 28.
    Substance Abuse and Mental Health Services Administration. Office of Applied Studies. Drug Abuse Warning Network (DAWN), 2007. ICPSR32861-v4. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2015:11–23.Google Scholar
  29. 29.
    Kalapatapu RK, Sullivan MA. Prescription use disorders in older adults. Am J Addict. 2010;19(6):515–22.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Reitsma M, Tranmer JE, Buchanan DM, VanDenKerkhof EG. The epidemiology of chronic pain in Canadian men and women between 1994 and 2007: longitudinal results of the National Population Health Survey. Pain Res Manag. 2012;17(3):166–72.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Jakobsson U. The epidemiology of chronic pain in a general population: results of a survey in southern Sweden. Scand J Rheumatol. 2010;39(5):421–9.PubMedGoogle Scholar
  32. 32.
    Scherer M, Hansen H, Gensichen J, et al. Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract. 2016;17:68.  https://doi.org/10.1186/s12875-016-0468-1.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Gianni W, Madaio RA, Di Cioccio L, et al. Prevalence of pain in elderly hospitalized patients. Arch Gerontol Geriatr. 2010;51(3):273–6.PubMedGoogle Scholar
  34. 34.
    Bates C, Laciak R, Southwick A, Bishoff J. Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol. 2011;185(2):551–5.PubMedGoogle Scholar
  35. 35.
    Edlund MJ, Sullivan M, Steffick D, Harris KM, Wells KB. Do users of regularly prescribed opioids have higher rates of substance use problems than nonusers? Pain Med. 2007;8(8):647–56.PubMedGoogle Scholar
  36. 36.
    Levi-Minzi MA, Surratt HL, Kurtz SP, Buttram ME. Under treatment of pain: a prescription for opioid misuse among the elderly? Pain Med. 2013;14(11):1719–29.PubMedGoogle Scholar
  37. 37.
    Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain. MMWR Recomm Rep. 2016;65(1):1–49.PubMedGoogle Scholar
  38. 38.
    Prommer E, Ficek B. Management of pain in the elderly at the end of life. Drugs Aging. 2012;29(4):285–305.PubMedGoogle Scholar
  39. 39.
    Moore RA, Cai N, Skljarevski V, Tolle TR. Duloxetine use in chronic painful conditions—individual patient data responder analysis. Eur J Pain. 2014;18(1):67–75.PubMedGoogle Scholar
  40. 40.
    Tong Q, Zhang L, Yuan Y, et al. Reduced plasma serotonin and 5-hydroxyindoleacetic acid levels in Parkinson’s disease are associated with nonmotor symptoms. Parkinsonism Relat Disord. 2015;21(8):882–7.PubMedGoogle Scholar
  41. 41.
    MacQueen GM, Memedovich KA. Cognitive dysfunction in major depression and bipolar disorder: assessment and treatment options. Psychiatry Clin Neurosci. 2017;71(1):18–27.PubMedGoogle Scholar
  42. 42.
    Moulin D, Boulanger A, Clark AJ, et al. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014;19(6):328–35.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Arendt-Nielsen L, Skou ST, Nielsen TA, Petersen KK. Altered central sensitization and pain modulation in the CNS in chronic joint pain. Curr Osteoporos Rep. 2015;13(4):225–34.PubMedGoogle Scholar
  44. 44.
    Lavand’homme P, Thienpont E. Pain after total knee arthroplasty: a narrative review focusing on the stratification of patients at risk for persistent pain. Bone Joint J. 2015;97-B(10 Suppl A):45–8.PubMedGoogle Scholar
  45. 45.
    Mavandadi S, Ten Have TR, Katz IR, et al. Effect of depression treatment on depressive symptoms in older adulthood: the moderating role of pain. J Am Geriatr Soc. 2007;55(2):202–11.PubMedGoogle Scholar
  46. 46.
    Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804.PubMedGoogle Scholar
  47. 47.
    Gerrits MM, van Marwijk HW, van Oppen P, van der Horst H, Penninx BW. Longitudinal association between pain, and depression and anxiety over four years. J Psychosom Res. 2015;78(1):64–70.PubMedGoogle Scholar
  48. 48.
    Hah JM, Sharifzadeh Y, Wang BM, et al. Factors associated with opioid use in a cohort of patients presenting for surgery. Pain Res Treat. 2015;2015:829696.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Vijayaraghavan M, Penko J, Guzman D, Miaskowski C, Kushel MB. Primary care providers’ views on chronic pain management among high-risk patients in safety net settings. Pain Med. 2012;13(9):1141–8.PubMedPubMedCentralGoogle Scholar
  50. 50.
    State of California Department of Justice. Controlled Substance Utilization Review and Evaluation System (CURES 2.0). Retrieved 12–29–16, 2016, from https://oag.ca.gov/cures. 2016.
  51. 51.
    Sproule B. Prescription monitoring programs in Canada: best practice and program review. Retrieved 12–19–16, 2016, from http://www.ccsa.ca/ResourceLibrary/CCSA-Prescription-Monitoring-Programs-in-Canada-Report-2015-en.pdf. 2015.
  52. 52.
    Volkow ND, Koob G. Brain disease model of addiction: why is it so controversial? Lancet Psychiatry. 2015;2(8):677–9.PubMedPubMedCentralGoogle Scholar
  53. 53.
    McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689–95.PubMedGoogle Scholar
  54. 54.
    Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci. 2011;12(11):652–69.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Koob GF, Volkow ND. Neurobiology of addiction: a neurocircuitry analysis. Lancet Psychiatry. 2016;3(8):760–73.PubMedGoogle Scholar
  56. 56.
    Kaiser R. Physiological and clinical considerations of geriatric patient care. In: Blazer D, Steffens D, editors. The American psychiatric publishing textbook of geriatric psychiatry. Washington, DC: American Psychiatric Publishing; 2009. p. 213–26.Google Scholar
  57. 57.
    Bielefeld L, Auwarter V, Pollak S, Thierauf-Emberger A. Differences between the measured blood ethanol concentration and the estimated concentration by Widmark’s equation in elderly persons. Forensic Sci Int. 2015;247:23–7.PubMedGoogle Scholar
  58. 58.
    Wilson KC, Saukkonen JJ. Acute respiratory failure from abused substances. J Intensive Care Med. 2004;19(4):183–93.PubMedGoogle Scholar
  59. 59.
    Holroyd S, Duryee JJ. Substance use disorders in a geriatric psychiatry outpatient clinic: prevalence and epidemiologic characteristics. J Nerv Ment Dis. 1997;185(10):627–32.PubMedGoogle Scholar
  60. 60.
    Blazer D, Williams CD. Epidemiology of dysphoria and depression in an elderly population. Am J Psychiatry. 1980;137(4):439–44.PubMedGoogle Scholar
  61. 61.
    Atkinson R. Depression, alcoholism and ageing: a brief review. Int J Geriatr Psychiatry. 1999;14(11):905–10.PubMedGoogle Scholar
  62. 62.
    Conwell Y, Olsen K, Caine ED, Flannery C. Suicide in later life: psychological autopsy findings. Int Psychogeriatr. 1991;3(1):59–66.PubMedGoogle Scholar
  63. 63.
    Gilman SE, Abraham HD. A longitudinal study of the order of onset of alcohol dependence and major depression. Drug Alcohol Depend. 2001;63(3):277–86.PubMedGoogle Scholar
  64. 64.
    Jinks MJ, Raschko RR. A profile of alcohol and prescription drug abuse in a high-risk community-based elderly population. DICP. 1990;24(10):971–5.PubMedGoogle Scholar
  65. 65.
    Center for Substance Abuse Treatment. Substance abuse among older adults. Treatment Improvement Protocol (TIP) Series 26. HHS Publication (SMA) 12-3918. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1998.Google Scholar
  66. 66.
    Schmidt A, Barry KL, Fleming MF. Detection of problem drinkers: the alcohol use disorders identification test (AUDIT). South Med J. 1995;88(1):52–9.PubMedGoogle Scholar
  67. 67.
    Blow F, Brower K, Schulenberg J, Demo-Dananberg L, Young J, Beresford T. The Michigan alcoholism screening test-geriatric version (MAST-G): a new elderly specific screening instrument. Alcohol Clin Exp Res. 1992;16:372.Google Scholar
  68. 68.
    Dawson DA, Grant BF, Stinson FS, Zhou Y. Effectiveness of the derived alcohol use disorders identification test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcohol Clin Exp Res. 2005;29(5):844–54.PubMedGoogle Scholar
  69. 69.
    Naegle MA. Screening for alcohol use and misuse in older adults: using the short Michigan alcoholism screening test—geriatric version. Am J Nurs. 2008;108(11):50–8; quiz 58–9PubMedGoogle Scholar
  70. 70.
    Draper B, Ridley N, Johnco C, Withall A, Sim W, Freeman M, et al. Screening for alcohol and substance use for older people in geriatric hospital and community health settings. Int Psychogeriatr. 2015;27(1):157–66.PubMedGoogle Scholar
  71. 71.
    Greenfield SF, Hennessy G. Assessment of the patient. In: The American Psychiatric Publishing textbook of substance abuse treatment. Washington, D.C.: American Psychiatric Publishing; 2014.Google Scholar
  72. 72.
    Booth BM, Blow FC. The kindling hypothesis: further evidence from a U.S. national study of alcoholic men. Alcohol Alcohol. 1993;28(5):593–8.PubMedGoogle Scholar
  73. 73.
    Drake RE, Mueser KT, Brunette MF, McHugo GJ. A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatr Rehabil J. 2004;27(4):360–74.PubMedGoogle Scholar
  74. 74.
    Ross S. Substance abuse and mental illness. In: The American Psychiatric Publishing textbook of substance abuse treatment. Washington, D.C.: American Psychiatric Publishing; 2014.Google Scholar
  75. 75.
    Scharf RE, Aul C. Alcohol-induced disorders of the hematopoietic system. Z Gastroenterol. 1988;26(Suppl 3):75–83.PubMedGoogle Scholar
  76. 76.
    Lindenbaum J, Roman MJ. Nutritional anemia in alcoholism. Am J Clin Nutr. 1980;33(12):2727–35.PubMedGoogle Scholar
  77. 77.
    Nanau RM, Neuman MG. Biomolecules and biomarkers used in diagnosis of alcohol drinking and in monitoring therapeutic interventions. Biomol Ther. 2015;5(3):1339–85.Google Scholar
  78. 78.
    Sullivan EV, Pfefferbaum A. Neuroimaging of the Wernicke-Korsakoff syndrome. Alcohol Alcohol. 2009;44(2):155–65.PubMedGoogle Scholar
  79. 79.
    Cummings SM, Cooper RL, Cassie KM. Motivational interviewing to affect behavioral change in older adults. Res Soc Work Pract. 2009;19(2):195–204.Google Scholar
  80. 80.
    Blow FC, Barry KL. Older patients with at-risk and problem drinking patterns: new developments in brief interventions. J Geriatr Psychiatry Neurol. 2000;13(3):115–23.PubMedGoogle Scholar
  81. 81.
    Barrick C, Connors GJ. Relapse prevention and maintaining abstinence in older adults with alcohol-use disorders. Drugs Aging. 2002;19(8):583–94.PubMedGoogle Scholar
  82. 82.
    Schonfeld L, Dupree LW. Antecedents of drinking for early- and late-onset elderly alcohol abusers. J Stud Alcohol. 1991;52(6):587–92.PubMedGoogle Scholar
  83. 83.
    Lemke S, Moos RH. Outcomes at 1 and 5 years for older patients with alcohol use disorders. J Subst Abus Treat. 2003;24(1):43–50.Google Scholar
  84. 84.
    Lemke S, Moos RH. Treatment and outcomes of older patients with alcohol use disorders in community residential programs. J Stud Alcohol. 2003;64(2):219–26.PubMedGoogle Scholar
  85. 85.
    Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005;18(3):249–55.PubMedGoogle Scholar
  86. 86.
    Sachdev G, Gesin G, Christmas AB, Sing RF. Failure of lorazepam to treat alprazolam withdrawal in a critically ill patient. World J Crit Care Med. 2014;3(1):42–4.PubMedPubMedCentralGoogle Scholar
  87. 87.
    Airagnes G, Pelissolo A, Lavallee M, Flament M, Limosin F. Benzodiazepine misuse in the elderly: risk factors, consequences, and management. Curr Psychiatry Rep. 2016;18(10):89.  https://doi.org/10.1007/s11920-016-0727-9.PubMedGoogle Scholar
  88. 88.
    Kurko TA, Saastamoinen LK, Tahkapaa S, et al. Long-term use of benzodiazepines: definitions, prevalence and usage patterns—a systematic review of register-based studies. Eur Psychiatry. 2015;30(8):1037–47.PubMedGoogle Scholar
  89. 89.
    Busuttil W. Presentations and management of post traumatic stress disorder and the elderly: a need for investigation. Int J Geriatr Psychiatry. 2004;19(5):429–39.PubMedGoogle Scholar
  90. 90.
    Albeck JH. Withdrawal and detoxification from benzodiazepine dependence: a potential role for clonazepam. J Clin Psychiatry. 1987;48(Suppl):43–9.PubMedGoogle Scholar
  91. 91.
    Waye C, Wong M, Lee S. Implementation of a CIWA-Ar alcohol withdrawal protocol in a veterans hospital. South Med J. 2015;108(1):23–8.PubMedGoogle Scholar
  92. 92.
    Weaver MF, Hoffman HJ, Johnson RE, Mauck K. Alcohol withdrawal pharmacotherapy for inpatients with medical comorbidity. J Addict Dis. 2006;25(2):17–24.PubMedGoogle Scholar
  93. 93.
    Risse SC, Whitters A, Burke J, Chen S, Scurfield RM, Raskind MA. Severe withdrawal symptoms after discontinuation of alprazolam in eight patients with combat-induced posttraumatic stress disorder. J Clin Psychiatry. 1990;51(5):206–9.PubMedGoogle Scholar
  94. 94.
    Patterson JF. Alprazolam dependency: use of clonazepam for withdrawal. South Med J. 1988;81(7):830–1,836.PubMedGoogle Scholar
  95. 95.
    Patterson JF. Withdrawal from alprazolam dependency using clonazepam: clinical observations. J Clin Psychiatry. 1990;51(Suppl):47–9; discussion 50–3.PubMedGoogle Scholar
  96. 96.
    Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jeffrey DeVido
    • 1
  • Calvin H. Hirsch
    • 2
  • Nitika Sanger
    • 3
  • Tea Rosic
    • 4
  • Zainab Samaan
    • 4
  • James A. Bourgeois
    • 5
  1. 1.Behavioral Health and Recovery ServicesSan RafaelUSA
  2. 2.Division of General MedicineUniversity of California Davis Medical CenterSacramentoUSA
  3. 3.Medical Science Graduate ProgramMcMaster UniversityHamiltonCanada
  4. 4.McMaster UniversityHamiltonCanada
  5. 5.Baylor Scott and White Department of PsychiatryTexas A&M University College of MedicineTempleUSA

Personalised recommendations