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Older People and Substance Misuse

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Textbook of Addiction Treatment: International Perspectives

Abstract

This chapter will outline the scale of the problem of substance misuse in older people, the burden of disease it incurs, morbidity and mortality, societal costs, and financial liability. Predictions are that over the next 20 years, there will be both an increase in the proportion of older people in the population and that older people will be using more alcohol, illicit substances, and prescription drug use compared with the past two decades. The nature and extent, the predictors and preventive potential, and the adaptations of successful treatment interventions will be outlined. Evidence is provided to demonstrate that the detection, intervention, and development of care models that are likely to improve the health and well-being of older people with substance misuse should be instituted. This is an area of utmost relevance to all clinicians: old age psychiatrists, addiction specialists, geriatricians, nurses, psychologists, social workers, and their teams. Researchers in gerontology, sociology, and economics, as well as policy makers and commissioners, are likely to find the implications and gaps of interest.

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References

  • Bartels SJ, Coakle EH, Zubritsky C, Ware JH, Miles KM, Arean PA, Chen H, Oslin DW, Llorente MD, Costantino G, Quijano L, McIntyre JS, Linkins KW, Oxman TE, Maxwell J, Levkoff SE (2004) Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. Am J Psychiatry 161:8

    Article  Google Scholar 

  • Benyon C, McVeigh J, Roe B (2007) Problematic drug use, ageing and older people: trends in the age of drug users in North West England. Ageing Soc 27:799–810

    Article  Google Scholar 

  • Berks J, McCormick R (2008) Screening for alcohol misuse in elderly primary care patients: a systematic literature review. Int Psychogeriatr 20(6):1090–1103

    Article  PubMed  Google Scholar 

  • Blazer DG (2009) Depression in late life: review and commentary. Focus 7(1):118–136

    Article  Google Scholar 

  • Blazer DG, Wu LT (2009) 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 166:1162–1169

    Article  PubMed Central  PubMed  Google Scholar 

  • Blow FC (1998) Substance abuse among older adults (Treatment Improvement Protocol (TIP) Series 26). DHSS Publication No. (SMA) 98-3179. US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment

    Google Scholar 

  • Blow FC et al (1992) The Michigan Alcoholism Screening Test- Geriatric version (MAST-G): a new elderly specific screening instrument. Alcohol Clin Exp Res 16:372

    Google Scholar 

  • Blow FC, Walton MA, Barry KL et al (2000) The relationship between alcohol problems and health functioning of older adults in primary care settings. J Am Geriatr Soc 48:769–774

    Article  CAS  PubMed  Google Scholar 

  • Brennan PL, Nichol AC, Moos RH (2003) Older and younger patients with substance use disorders: outpatient mental health service use and functioning over a 12-month interval. Psychol Addict Behav 17:42–48

    Article  PubMed  Google Scholar 

  • British Geriatrics Society (2006) Guidelines for the prevention, diagnosis and management of delirium in older people in hospital. British Geriatrics Society

    Google Scholar 

  • British Geriatrics Society (2007) Falls (BGS best practice guide 4.5). British Geriatrics Society

    Google Scholar 

  • Brower KJ, Mudd S, Blow FC et al (1994) Severity and treatment of alcohol withdrawal in elderly versus younger patients. Alcohol Clin Exp Res 18:196–201

    Article  CAS  PubMed  Google Scholar 

  • Brymer C, Rusnell I (2000) Reducing substance dependence in elderly people: the side effects program. Can J Clin Pharmacol 7:161–166

    CAS  PubMed  Google Scholar 

  • Buschbaum DG et al (1992) Screening for drinking disorders in the elderly using the CAGE questionnaire. J Am Geriatr Soc 40:662–665

    Article  Google Scholar 

  • Bush K, Kivlahan DR, McDonnell MB et al (1998) The AUDIT Alcohol Consumption Questions (AUDIT-C): an effective, brief screening test for problem drinking. Arch Intern Med 158:1789–1795

    Article  CAS  PubMed  Google Scholar 

  • Byrne GJ, Raphael B, Arnold E (1999) Alcohol consumption and psychological distress in recently widowed older men. Aust N Z J Psychiatry 33:740–747

    Article  CAS  PubMed  Google Scholar 

  • Cainelli F (2008) Hepatitis C virus infection in the elderly: epidemiology, natural history and management. Drugs Aging 25:9–18

    Article  CAS  PubMed  Google Scholar 

  • Chrischilles EA, Lemke JH, Wallace RB et al (1990) Prevalence and characteristics of multiple analgesic drug use in an elderly study group. J Am Geriatr Soc 38:979–984

    Article  CAS  PubMed  Google Scholar 

  • Crane M (1998) The associations between mental illness and homelessness among older people: an exploratory study. Aging Ment Health 2:171–180

    Article  Google Scholar 

  • Crane M, Warnes AM (2001) Older people and homelessness: prevalence and causes. Top Geriatr Rehabil 16:1–14

    Article  Google Scholar 

  • Crome P (1984) ABC of poisoning. Elder Br Med J 289:546–548

    Google Scholar 

  • Crome IB, Bloor R (2005a) Older substance misusers still deserve better services – an update (part 1). Rev Clin Gerontol 15:125–133

    Article  Google Scholar 

  • Crome IB, Bloor R (2005b) Older substance misusers still deserve better diagnosis – an update (part 2). Rev Clin Gerontol 15:255–262

    Article  Google Scholar 

  • Crome IB, Bloor R (2006) Older substance misusers still deserve better interventions – an update (part 3). Rev Clin Gerontol 16:45–57

    Article  Google Scholar 

  • Crome IB, Sidhu H, Crome P (2009) No longer only a young man’s disease: illicit drugs in older people. J Nutr Health Aging 13:141–143

    Article  CAS  PubMed  Google Scholar 

  • Crome IB, Rao T, Tarbuck A, Dar K, Janikiewicz S (2011) Our invisible addicts: Council Report 165. Royal College of Psychiatrists, London

    Google Scholar 

  • Crome IB, Li TK, Rao R, Wu LT (2012) Alcohol limits in older people. Addiction 9:1541–1543

    Article  Google Scholar 

  • Culberson JW, Ziska M (2008) Prescription drug misuse/abuse in the elderly. Geriatrics 63:22–31

    PubMed  Google Scholar 

  • De Wilde S, Carey IM, Harris T et al (2007) Trends in potentially inappropriate prescribing amongst older UK primary care patients. Pharmacoepidemiol Drug Saf 16:658–667

    Article  PubMed  Google Scholar 

  • Department of Health (1995) Sensible drinking: report of an inter-departmental working group. Department of Health

    Google Scholar 

  • Department of Health (2001) Modern standards and service models: older people – national service framework. Department of Health

    Google Scholar 

  • Department of Health (2006) NHS smoking helpline factsheet: smoking and mortality. (http://smokefree.nhs.uk/resources/downloads/Statistics_19-05-06PDF.pdf)

  • Department of Health (2007) Drug misuse and dependence: guidelines on clinical management. Department of Health

    Google Scholar 

  • Department of Health (2009) Achieving age equality in health and social care. Department of Health

    Google Scholar 

  • Dupree LW, Broskowski H, Schonfeld L (1984) The gerontology alcohol project: a behavioural treatment program for elderly alcohol abusers. Gerontologist 24:510–516

    Article  CAS  PubMed  Google Scholar 

  • European Monitoring Centre for Drugs and Drug Addiction (2008) Substance use among older adults: a neglected problem. Drugs in Focus, Issue 18. EMCDDA

    Google Scholar 

  • Fink A et al (2002) Comparing the alcohol-related problems survey (ARPS) to traditional alcohol screening measures in elderly outpatients. Arch Gerontol Geriatr 34(1):55–78

    Article  PubMed  Google Scholar 

  • Firoz S, Carlson G (2004) Characteristics and treatment outcome of older methadone maintenance patients. Am J Geriatr Psychiatry 12:539–541

    Article  PubMed  Google Scholar 

  • Fleming MF, Manwell LB, Barry KL, Adams W, Stauffacher EA (1999) Brief physician advice for alcohol problems in older adults: a randomized community-based trial. J Fam Pract 48(5):378–384

    CAS  PubMed  Google Scholar 

  • Frisher M, Crome I, Macleod J et al (2005) Substance misuse and psychiatric illness: a prospective observation study. J Epidemiol Community Health 58:847–850

    Article  Google Scholar 

  • Gallagher PF, O'Connor MN, O'Mahony D (2011) Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther 89(6):845–854

    Article  CAS  PubMed  Google Scholar 

  • Gottlieb S (2004) Inappropriate drug-prescribing in elderly people is common. BMJ 329:367

    Article  PubMed Central  PubMed  Google Scholar 

  • Gupta S, Warner J (2008) Alcohol-related dementia; a 21st-century silent epidemic? Br J Psychiatry 193:351–353

    Article  PubMed  Google Scholar 

  • Hall SM, Hurnfleet GL, Munoz RF, Reus VI, Robbins JA, Prochaska JJ (2009) Extended treatment of older cigarette smokers. Addiction 104(6):1043–1052

    Article  PubMed Central  PubMed  Google Scholar 

  • Han B, Gfroerer JC, Colliver JD et al (2009) Substance use disorder among older adults in the United States, 2020. Addiction 104:88–96

    Article  PubMed  Google Scholar 

  • Hinkin CH et al (2001) Screening for drug and alcohol abuse among older adults using a modified version of the CAGE. Am J Addict 10(4):319–326

    Article  CAS  PubMed  Google Scholar 

  • Hser YI, Hoffman V, Grella CE, Anglin MD (2001) A 33 follow up of narcotics addicts. Arch Gen Psychiatry 58(5):503–508

    Article  CAS  PubMed  Google Scholar 

  • NHS Information Centre (2010) Statistics on alcohol: England, 2010. The Health and Social Care Information Centre

    Google Scholar 

  • NHS Information Centre (2011) Statistics on alcohol: England 2011. Health and Social Care Information Centre

    Google Scholar 

  • Institute of Medicine (2012) The mental health and substance use workforce for older adults. In whose hands? The National Academies Press, Washington, DC

    Google Scholar 

  • International Centre for Drug Policy (2007) Substance misuse in the undergraduate medical curriculum. St George’s University of London, London

    Google Scholar 

  • IOM (2008) Retooling for an aging America: building the health care workforce. The National Academies Press, Washington, DC

    Google Scholar 

  • Jacob T, Koening LB, Howell DN et al (2009) Drinking trajectories from adolescence to the fifties among alcohol dependent men. J Stud Alcohol Drugs 70:859–869

    Article  PubMed Central  PubMed  Google Scholar 

  • Lam MP, Cheung BM (2012) The use of the STOPP/START criteria as a screening tool for assessing the appropriateness of medications in the elderly population. Expert Rev Clin Pharmacol 5:187–197. doi:10.1586/ecp.12.6

    Article  CAS  PubMed  Google Scholar 

  • Lemke S, Moos RH (2003a) Outcomes at 1 and 5 years for older patients with alcohol use disorders. J Subst Abus Treat 24:43–50

    Article  Google Scholar 

  • Lemke S, Moos RH (2003b) Treatment and outcomes of older patients with alcohol use disorders in community residential programs. J Stud Alcohol 64:216–219

    Article  Google Scholar 

  • Lin JC, Karno MP, Barry KL, Blow FC, Davis JW, Tang L, Moore AA (2010) Determinants of early reductions in drinking in older at-risk drinkers participating in the intervention arm of a trial to reduce at-risk drinking in primary care. J Am Geriatr Soc 58(2):227–233

    Article  PubMed Central  PubMed  Google Scholar 

  • Lin WC, Zhang J, Clark RE, Leung GY (2011) Chronic physical conditions in older adults with mental illness and/or substance use disorders. J Am Geriatr Soc 59(10):1913–1921

    Article  PubMed  Google Scholar 

  • Lingford-Hughes A, Welch S, Peters L, Nutt D (2012) BAP updated guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol 26(7):899–952

    Article  CAS  PubMed  Google Scholar 

  • Mayo-Smith MF (1997) Pharmacological management of alcohol withdrawal: a meta analysis and evidence-based guideline. JAMA 278:144–151

    Article  CAS  PubMed  Google Scholar 

  • Mehta MM et al (2006) Alcohol misuse in older people: heavy consumption and protean presentations. J Epidemiol Community Health 60(12):1048–1052

    Article  PubMed Central  PubMed  Google Scholar 

  • Moore AA et al (2002a) Beyond alcoholism: identifying older, at risk drinkers in primary care. J Stu Alcohol 63:316–324

    Article  Google Scholar 

  • Moore AA et al (2002b) Are there differences between older persons who screen positive on the CAGE questionnaire and the Short Michigan Alcoholism Screening Test-Geriatric version. J Am Geriatr Soc 50:858–862

    Article  PubMed  Google Scholar 

  • Moore AA, Endo JO, Kalin M (2003) Is there a relationship between excessive drinking and functional impairment in older persons? J Am Geriatr Soc 51:44–49

    Article  PubMed  Google Scholar 

  • Moore AA, Blow FC, Hoffing M, Welgreen S, Davis JW, Lin JC, Ramirez KD, Liao DH, Tang L, Gould R, Gill M, Chen OO, Barry KL (2011) Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trial. Addiction 106(1):111–120

    Article  PubMed Central  PubMed  Google Scholar 

  • Moos RH, Schutte KK, Brennan P et al (2009) Older adults’ alcohol consumption and late life drinking problems: a 20 year perspective. Addiction 104:1293–1302

    Article  PubMed Central  PubMed  Google Scholar 

  • Morgan GD, Noll EL, Orleans CT et al (1996) Reaching midlife and older smokers: tailored interventions for routine medical care. Prev Med 25:346–354

    Article  CAS  PubMed  Google Scholar 

  • Morton JL et al (1996) Performance of alcoholism screening questionnaires in elderly veterans. Am J Med 101:153–159

    Article  CAS  PubMed  Google Scholar 

  • Moy I, Frisher M, Crome P et al (2011) Systematic review of treatment for older people with substance problems. Eur Geriatr Med 2:212–236

    Article  Google Scholar 

  • Naegle MA (2008) Screening for alcohol use and misuse in older adults: using the Short Michigan Alcoholism Screening Test–Geriatric version. Am J Nurs 108(11):50–58, quiz 58–9

    Article  PubMed  Google Scholar 

  • National Audit Office (2008) Reducing alcohol related harm: health service in England for alcohol misuse NAO

    Google Scholar 

  • National Collaborating Centre for Chronic Conditions (2010) Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications (NICE clinical guideline 100). NICE

    Google Scholar 

  • National Collaborating Centre for Mental Health (2007a) Drug misuse: psychosocial interventions (NICE clinical practice guideline 51). NICE

    Google Scholar 

  • National Collaborating Centre for Mental Health (2007b) Drug misuse: opioid detoxification (NICE clinical practice guideline 52). NICE

    Google Scholar 

  • National Collaborating Centre for Mental Health (2011) Alcohol use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (National clinical practice guideline 115). NICE. http://guidance.nice.org.uk/CG115

  • National Information Centre (2011) Statistics on alcohol: England 2011. Health and Social Care Information Centre

    Google Scholar 

  • National Institute for Health and Clinical Excellence (NICE) (2007a) Methadone and buprenorphine for the management of opioid dependence (NICE technology appraisal guidance 114). NICE

    Google Scholar 

  • National Institute for Health and Clinical Excellence (NICE) (2007b) Naltrexone for the management of opioid dependence (NICE technology appraisal guidance 115). NICE

    Google Scholar 

  • National Institute for Health and Clinical Excellence (2010) Alcohol-use disorders: preventing the development of hazardous and harmful drinking (NICE public health guidance 24). NICE. http://www.nice.org.uk/nicemedia/live/13001/48984/48984.pdf

  • National Treatment Agency for Substance Misuse (2010) Drug treatment in 2009–10. NTA. http://www.nta.nhs.uk/uploads/nta_annualreport_0910.pdf

  • Okura TBL, Plassman DC, Steffens DJ, Llewellyn G, Potter G, Langa KM (2010) Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: the aging, demographics, and memory study. J Am Geriatr Soc 58(20374406):330–337

    Article  PubMed Central  PubMed  Google Scholar 

  • Oslin D, Atkinson RM, Smith DM et al (1998) Alcohol-related dementia: proposed clinical criteria. Int J Geriatr Psychiatry 13:203–212

    Article  CAS  PubMed  Google Scholar 

  • Oslin DW, Pettinati H, Volpicelli JR (2002) Alcoholism treatment adherence: old age predicts better adherence and drinking outcomes. Am J Geriatr Psychiatry 10:740–746

    Article  PubMed  Google Scholar 

  • Oslin DW, Slaymaker VJ, Blow FC et al (2005) Treatment outcomes for alcohol dependence among middle-aged and older adults. Addict Behav 30:1431–1436

    Article  PubMed  Google Scholar 

  • Oslin DW, Grantham S, Coakley E, Maxwell J, Miles K, Ware J, Blow FC, Krahn DD, Bartels SJ, Zubritsky C, Prism-E Group (2006) PRISM-E: comparison of integrated care and enhanced specialty referral in managing at-risk alcohol use. Psychiatr Serv 57(7):954–958

    Article  PubMed Central  PubMed  Google Scholar 

  • Royal College of Physicians (1995) Alcohol and the heart in perspective: sensible limits reaffirmed. A working group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners. J R Coll Physicians Lond 29:266–271

    Google Scholar 

  • Royal College of Psychiatrists (2009) Age discrimination in mental health services: making equality a reality (Position statement PS2/2009). Royal College of Psychiatrists

    Google Scholar 

  • Royal College of Psychiatrists (2011) Our invisible addicts. Royal College of Psychiatrists, London

    Google Scholar 

  • Royal College of Psychiatrists (2012) Alcohol and other drugs: core medical competencies occasional paper OP 85. Royal College of Psychiatrists, London

    Google Scholar 

  • Ryou YI et al (2012) Usefulness of alcohol-screening instruments in detecting problem drinking among elderly male drinkers. Korean J Fam Med 33(3):126–133

    Article  PubMed Central  PubMed  Google Scholar 

  • Satre DD, Mertens J, Arean PA et al (2003) Contrasting outcomes of older versus middle-aged and younger adult chemical dependency patients in a managed care program. J Stud Alcohol 64:520–531

    Article  PubMed  Google Scholar 

  • Satre DD, Mertens J, Arean PA et al (2004a) Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program. Addiction 19:1286–1297

    Article  Google Scholar 

  • Satre D, Mertens JR, Weisner C (2004b) Gender differences in treatment outcomes for alcohol dependence among older adults. J Stud Alcohol 65:638–642

    Article  PubMed  Google Scholar 

  • Saunders JB, Aasland OG, Babor TF et al (1993) Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption – II. Addiction 88:791–804

    Article  CAS  PubMed  Google Scholar 

  • Schonfeld L, King-Kallimanis BL, Duchene DM, Etheridge RL, Herrera JR, Barry KL, Lynn N (2010) Screening and brief intervention for substance misuse among older adults: the Florida BRITE project. Am J Public Health 100(1):108–114

    Article  PubMed Central  PubMed  Google Scholar 

  • Schroeder K, Lawlor D, Montaner D et al (2006) Self-reported smoking cessation interventions were not associated with quitting in older women. J Clin Epidemiol 59:622–628

    PubMed  Google Scholar 

  • Schutte KK, Nichols KA, Brennan PL et al (2003) A ten-year follow-up of older former problem drinkers: risk of relapse and implications of successfully sustained remission. J Stud Alcohol 64:367–374

    Article  CAS  PubMed  Google Scholar 

  • Seymour R, Booth L (2010) Statistics on smoking. House of Commons Library. http://www.parliament.uk/briefingpapers/commons/lib/research/briefings/snsg-03312. pdf

  • Sidhu H, Crome P, Crome IB (2012) Psychosocial factors in older substance misusers in treatment. Rev Clin Gerontol. doi:10.1017/S0959259811000177

    Google Scholar 

  • Simoni-Wastila L, Yang HK (2006) Psychoactive drug abuse in older adults. Am J Geriatr Pharmacother 4:380–394

    Article  PubMed  Google Scholar 

  • Svarstad BL, Mount J (2005) Chronic benzodiazepine use in nursing homes: effects of federal guidelines, resident mix, and nurse staffing. J Am Geriatr Soc 49:1673–1678

    Article  Google Scholar 

  • The Health and Social Care Centre (2011) Statistics on alcohol: England. The Health and Social Care Information Centre, London

    Google Scholar 

  • U.S. Department of Health and Human Services (1998) Substance abuse among older adults (Treatment Improvement Protocol (TIP) Series No. 26). U.S. Department of Health and Human Services

    Google Scholar 

  • Vetter NJ, Ford D (1990) Smoking prevention among people aged 60 and over: a randomised controlled trial. Age Ageing 19:164–168

    Article  CAS  PubMed  Google Scholar 

  • Whelan G (2003) Alcohol: a much neglected risk factor in the elderly mental disorders. Curr Opin Psychiatry 16:609–614

    Article  Google Scholar 

  • Yudko E, Lozhkina O, Fouts A (2007) A comprehensive review of the psychometric properties of the drug abuse screening test. J Subst Abus Treat 32(2):189–198

    Article  Google Scholar 

  • Zbikowski SM, Magnusson B, Pockey JR et al (2012) A review of smoking cessation intervention for smokers aged 50 and older. Maturitas 71:131–141

    Article  PubMed  Google Scholar 

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Crome, I.B. (2015). Older People and Substance Misuse. In: el-Guebaly, N., Carrà, G., Galanter, M. (eds) Textbook of Addiction Treatment: International Perspectives. Springer, Milano. https://doi.org/10.1007/978-88-470-5322-9_97

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