This TIP, Substance Abuse Among Older Adults, presents treatment providers with much-needed information about a population that is underdiagnosed and underserved. Substance abuse, particularly of alcohol and prescription drugs, often goes undetected among adults over 60 in part due to societal reasons - older adults tend to be ashamed about drinking or drug problems and see them as a moral failing. Providers, for their part, may confuse symptoms of substance use disorders with age-related changes. Because so much of older adults' substance abuse is never even identified, this TIP is aimed at not only substance abuse treatment providers but also primary care clinicians, social workers, senior center staff, and anyone else who has regular contact with older adults.

The TIP discusses the relationship between aging and substance abuse and offers guidance on identifying, screening, and assessing not only substance abuse but also disorders such as dementia and delirium that can mask or mimic an alcohol or prescription drug problem. Practical accommodations to treatment for older adults and a discussion of how to assess outcomes and treat within a managed care context round out the document.

Contents

• What Is a TIP?
• Editorial Advisory Board
• Consensus Panel
• Foreword
• Executive Summary and Recommendations
• Chapter 1 - Substance Abuse Among Older Adults: An Invisible Epidemic
  • The Problem Projected
  • The Problem Now
  • Older Adults' Unique Vulnerabilities
  • Barriers To Identifying And Treating Older Adults With Substance Abuse Problems
  • Summary
• Chapter 2 - Alcohol
  • Alcohol and Aging
  • Classifying Drinking Practices and Problems Among Older Adults
  • Drinking Patterns Among Older Adults
  • Risk Factors for Alcohol Abuse
  • Concomitant Substance Use
• Chapter 3 - Use and Abuse of Psychoactive Prescription Drugs and Over-the-Counter Medications
  • Evolution of Psychoactive Prescribing
  • Patterns of Use
  • Risk Factors for Misuse And Abuse of Psychoactive Drugs
  • Adverse Effects
  • Interactions With Other Drugs and With Alcohol
• Chapter 4 - Identification, Screening, and Assessment
  • Screening for Alcohol and Prescription Drug Abuse
  • Screening Instruments
  • Communicating Positive Screening Results
  • Communicating Negative Screening Results
  • Assessment
  • Special Assessments
  • Moving the Older Adult Into Treatment
• Chapter 5 - Referral and Treatment Approaches
  • Least Intensive Options
  • Specialized Treatment of Older Problem Drinkers And Substance Abusers
  • Levels of Treatment Services
  • Program Philosophy and Basic Principles
  • Treatment Approaches
  • Specialized Treatment Issues for Prescription Drug Abuse
  • Staffing Considerations
• Chapter 6 - Outcomes and Cost Issues in Alcohol Treatment for Older Adults
  • Spectrum of Alcohol Treatment Outcomes
  • Measurement of Multidimensional Outcomes for Older Adults
  • Costs of Alcohol Treatment
  • Reimbursement Issues in The Treatment of Older Adults
  • Areas Requiring Future Research
• Appendix A - Legal and Ethical Issues
• Appendix B - Tools
• Appendix C - Bibliography
• Appendix D - Resource Panel
• Appendix E - Field Reviewers

The opinions expressed herein are the views of the Consensus Panel members and do not reflect the official position of CSAT, SAMHSA, or the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT, SAMHSA, or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines in this document should not be considered substitutes for individualized patient care and treatment decisions.