This alarming trend is due to a combination of factors — including an increase in access to prescription drugs and alcohol and a decrease in family support and social interaction that occurred during the pandemic. Additionally, many older adults deal with chronic physical or mental health issues that substance use disorders can exacerbate. Lower amounts of alcohol or drugs may have bigger effects, and tolerance levels may be lower.
Opioid Pain Medicines
Older clients may have limited vision or difficulty writing and may need help completing screens. Some health experts have called older adults who misuse substances an “invisible” population.307,308 Although older adults have frequent medical visits, behavioral health or healthcare providers often do not recognize substance misuse in their older clients. The questions can be adapted to a specific substance, such as a prescription medication, and they can be asked either in the context of an interview or self-administered. Psychometric properties of the CAGE-AID have not been reported, yet the CAGE has been extensively studied. Because of the brief nature of the CAGE-AID, it can be a useful screening tool; but it should not be a substitute for a more thorough assessment, such as consumption levels, consequences of use, and functional deficits. It may not be as simple to recognize or diagnose a substance abuse or dependency concern in adults over the age of 65.
Alcohol and Drug Use Screening
- Substance use disorder (SUD) is a treatable mental disorder that affects a person’s brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications.
- Targeting short-term, easily attainable goals that build toward larger goals.
- For more on mindfulness and mindfulness-based programs, see the website of the Center for Mindfulness in Medicine, Health Care, and Society at /cfm.
- Talk to your health care provider to determine what treatment may be best for you and give the treatment time to work.
All three of these tools (the IPT-R, the revised Faces Pain Scale, and VDS instruments) are easy to use and easy for older clients to understand. Assessment and treatment planning should consider not just how a client rates on a pain scale but also his or her level of functioning in the presence of pain. Physical health issues (e.g., severe liver disease) that affect whether medications can be given for certain SUDs, such as opioid use disorder. Guide treatment planning, including giving clients the right level of care in the right setting. Other special physical and mental factors (e.g., whether a mental or physical disorder is present that could be making the person’s substance-related symptoms worse). When doing an SUD screen, if trauma or elder abuse screeners are negative, continue with routine clinical care.
RISK FACTORS FOR OLDER ADULTS USING SUBSTANCES
Ruth frequently tells people that “smoking is a bad habit I picked up at meetings.” She recently stopped after she was diagnosed with chronic obstructive pulmonary disease (COPD). Ruth’s pulmonologist referred her to counseling at the hospital’s outpatient program given her score of 12 on the Patient Health Questionnaire, indicating moderate depression. (Chapter 3 of this TIP offers screening and assessment tools.) She also was not following instructions for managing her COPD. SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. Supporting the Mental Health Needs of Older Adults – State TA Brief Reference Document (1.7 MB)This concise reference document highlights evidence-based practices (EBPs) that have proven effective in addressing mental health challenges faced by older adults.
UNIQUE VULNERABILITIES FOR OLDER ADULTS USING MOOD-ALTERING SUBSTANCES
Substance abuse is difficult to recognize in the older adults, but once identified, presents its own challenges as only 18% of substance abuse treatment programs are designed for this growing population. Substance abuse overall may increase the risk of fractures secondary to recurrent falls, memory loss, sleep disturbances, anxiety, and depression. In this article, we will review the are all toads poisonous signs and symptoms, risk factors, screening tools, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria, and challenges of treating substance abuse in the older adults. A well-thought-out approach to comprehensive screening and assessment will help you identify older adults with or at risk for substance misuse and related conditions.
Nevertheless, healthcare and behavioral health service providers should assess how older adults use such medications, with an eye toward potential adverse reactions and interactions. The American Geriatrics Society’s 2019 Beers Criteria® address medications that are potentially inappropriately prescribed for older adults.319 See the Chapter 6 text box on the 2019 Beers Criteria®. Because of the unique issues facing older adults, both individual and group treatments are recommended. Although group treatment can reduce isolation and shame related to substance use and is often the preferred method of providing substance abuse treatment, the lack of elder-specific treatment available in the community113 may actually enhance feelings of isolation and shame in a group context.
Have clinical assistants administer screening instruments in an interview or as part of other health screenings. Provide a paper or digital tablet version for clients to complete by themselves. USPSTF recommends electronic screening and brief intervention as an effective strategy to prevent excessive alcohol use.320 Some older adults may not be comfortable using computers or tablets. Be sensitive to each client’s skills and abilities when selecting screening formats.
You can help clients discover their own reasons for wanting to change by talking about these mixed feelings and pointing out problem areas. The PTSD Checklist for DSM-5 (PCL-5; Exhibit 3.6) is an updated version of the widely used and researched PTSD Checklist (PCL), which was based on DSM-IV criteria. Not much research has yet been conducted on the use of the PCL-5 with older adults. The PCL-5 has been used to screen for PTSD in some studies who are the most famous alcoholics of older veterans,413,414,415 but these studies were not designed to look at the validity of the PCL-5 in aging populations. Use a checklist or question list to make sure you cover all possible traumas and not just ones that are commonly thought of (like physical and sexual abuse). You can find more information about Adverse Childhood Experiences (ACEs) on the CDC’s website (/violenceprevention/childabuseandneglect/acestudy/index.html).
Ask clients to describe how close they are to each member of their network, how long they have known them, and how frequently they see them. Note the type and frequency of support each person listed in each domain can offer. Exploring with them whether reconnecting to a faith community could provide meaning and purpose.
Consequences of substance misuse that might get clients to change (e.g., elevated blood pressure, worsening acid reflux symptoms, increased risk of falls). Referrals to SUD treatment programs or group activities for substance abuse mental health services for clients who need more indepth assessment or intervention. Even if a screener is negative, the TIP consensus panel recommends that you occasionally rescreen clients.