This makes them more vulnerable to risky behaviors like substance misuse. Seniors with co-occurring psychiatric disorders may be more likely to try drugs or alcohol to cope with their symptoms. It’s essential for family members and health care providers to be aware of this risk factor so they can take steps to prevent it in their loved ones. Unfortunately, chronic pain can also increase older adults’ risks of developing substance misuse issues. As they age, people may experience more aches and pains and seek out medications – both prescription and over-the-counter – to relieve their discomfort. Up to a quarter of all prescription drugs in the U.S. are used by older adults, and this increased exposure to drugs increases the risk of addiction or other negative consequences.
Guide to Substance Abuse in Older Adults: Risks, Warning Signs, and Treatments
For example, many older clients start taking pain medication to reduce physical discomfort. However, they may continue taking the medication to also manage emotional pain or to reduce withdrawal symptoms that occur when they try to stop taking it. Clients may misuse both prescribed and nonprescribed substances, such as alcohol, for such reasons. Thinking about the role of chronic physical conditions in older clients’ misuse of substances (e.g., use of substances to manage chronic pain). Such conditions can also affect symptoms of substance misuse and treatment response. Most older adults at risk for substance misuse do not need formal specialized SUD treatment.
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Meanwhile, recent data show less than half older adults with opioid use disorder (OUD) receive care for the condition. Make sure you have the required training and qualifications before assessing for or diagnosing SUDs. If no providers in your program have the necessary licenses and qualifications to assess for and diagnose mental disorders, make referrals as necessary to providers who can do so. The following sections describe some of the most common parts of a full assessment, targeting only those parts that are most appropriate for older clients who misuse substances. The sections do not cover questions about a client’s recreational, military, occupational, or avocational/retirement history. Sharing information that is specific to older clients, such as guidelines about low-risk levels of substance use for older adults or physical effects of substance misuse.
Prescription Drug Abuse
- If they are taking several prescription drugs for different health conditions at once, it would be very helpful to write down the doses and administration times in big letters on a sheet and put it up where they will see it, like on the fridge.
- Also remember that symptoms of SUDs are often the same as symptoms of other physical diseases and mental disorders.
- Information about NIMH, research results, summaries of scientific meetings, and mental health resources.
- Provides information about the scope of substance use in older adults, the risk factors for substance use disorders in…
The baby boom generation is unique in its exposure to, attitudes toward, and prevalence of substance use-causing projected rates of substance use to increase over the next twenty years. Given their unique biological vulnerabilities and life stage, older adults who misuse substances require special attention. Prevalence rates of substance use and misuse among older adults, methods of screening and assessment unique to older adults, and treatment options for older adults are reviewed. 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. It offers practical guidance for State Mental Health Agencies and behavioral health services providers on policy development and successful implementation and expansion of EBPs for older adults.
Prescription Drug Abuse
The CAGE-AID was adapted to include drugs (AID) in addition to alcohol use. It is one common, quick tool used by health professionals to determine if they need to look more closely at an older adult’s substance use. You may need to refer the client to an outside provider for SUD treatment if your setting cannot offer the level of care or types of services the client’s symptoms addiction and termination warrant. For example, a client may need inpatient drug and alcohol rehabilitation, but your program only offers outpatient care. But in clients who misuse or are at risk of misusing substances, managing chronic pain becomes even more difficult. This is because substance use can often affect chronic pain in positive ways, even though the substance itself is harmful.
Co-Occurring Psychiatric Disorders
For some individuals, major depression can result in severe impairments that interfere with or limit one’s ability to carry out major life activities. Health problems, both mental and physical, tend to increase with age. The older we get, the more likely we are to experience health-related concerns such as cognitive impairment, heart disease, cancer, depression and diabetes. As director of the Geriatric Day Hospital program, as well as the psychiatry clerkship, Lehmann feels an urgency to educate psychiatrists and physicians across all specialties about what she calls an under-recognized national public health problem. She believes the most effective intervention is to raise awareness among all clinicians, so that substance use disorder among older adults can be addressed sooner rather than later.
Primary Care PTSD Screen for DSM-5The Primary Care PTSD Screen for DSM-5419 (PC-PTSD-5) is a five-item questionnaire that identifies clients likely to have PTSD. It was approved for use in a sample of older veterans (mostly male; mean age 63 years).420 All questions are yes/no. A score of 3 or more “yes” responses is considered positive.421 More information on using this tool is available online (/professional/assessment/documents/pc-ptsd5-screen.pdf). This includes ability to complete daily activities, engage in self-care, and maintain intimate relationships and a healthy social life. Chapter 3 will help you decide which screening tools to use, how and when to administer them, and who should do so. Every practice should select screening tools and develop procedures for who will give the screenings and when to give them.
Recent research has found that people addicted to cocaine in their youth may have an accelerated age-related decline in temporal lobe gray matter, which increases their risk of addiction. This is because cocaine use during adolescence and young adulthood can cause brain structure and function changes that persist into later life. The latest information and resources on mental disorders shared on X, Facebook, YouTube, LinkedIn, and Instagram. NIMH statistics pages include statistics on the prevalence, treatment, and costs of mental illness for the population of the United States. Substance use is a major mental health problem in older adults, and is often unrecognized and undertreated, leading to a reduced quality of life. “That type of polypharmacy (or taking many medications at the same time) not only creates the potential for addiction, it’s also dangerous,” Dr. Bulat says.
That is why objective information about the dangers of alcohol or prescription drug use can be helpful. Taking part in 12-step program meetings such as Alcoholic Anonymous is an important approach to relapse prevention and treatment in general. Meetings with same-age cohorts enable peer bonding, provide mutual support, and help establish peer sobriety networks. Families also play a crucial role in supporting the recovery of their seniors and preventing relapse. Family members should communicate with the elderly in a respectful, empathic way.
Many believe these structural changes could contribute to a heightened vulnerability toward addiction and other mental health issues. Early intervention strategies such as cognitive-behavioral therapy or family counseling may be beneficial for preventing substance abuse issues among those at high risk for developing them. A family history of substance abuse or addiction can also be a risk factor for seniors developing addiction issues. Studies have shown that people are more likely to engage in risky behaviors like binge drinking or drug use if someone close to them has had similar problems. There are several short assessment tools that health care professionals can use to point to possible substance abuse in older adults. According to the Alcohol and Drug Abuse Institute of Washington, the CAGE-AID questionnaire is the most common screening tool used to assess for potential alcohol dependence.
The client appears to be at risk for harm because of current substance use. The severity of substance use (including what, how often, and how much the client uses). Physical conditions that are often alcohol or drug related (e.g., high blood pressure, insomnia).
According to Dr. Blow’s article, substance use is more prevalent among persons who suffer losses, such as the death of loved ones, retirement and loss of health. The fact that women are more likely to have lost a spouse because of death or divorce, to have had experience with depression, and to have been prescribed medicines that increase the negative effects of alcohol help explain these gender differences. This manual serves as a quick reference guide for clinicians treating chronic pain in adults living with a history of substance use. It covers patient assessment and treatment, and provides an algorithm for managing chronic pain, as well as a summary of non-opioid analgesics.
If your program cannot offer treatment for SUDs, refer your clients to counseling and tailored psychosocial supports that have the capacity to meet older adults’ unique needs. You should refer to the level of care that is the least intense yet will address all the client’s needs. Having a first-degree relative (i.e., a parent, child, sister, or brother) who misuses substances. For instance, a person has five times the risk of developing alcohol dependence if he or no level of alcohol consumption is safe for our health she has any first-degree relative with alcohol dependence.516 The client’s misuse may have a basis in genetic factors, modeling of behavior of others, or both. Depending on the client’s cognitive abilities, you may need to speak with a family member or a family caregiver to get information about the client’s mental health and history. Full mental health, medical, family, vocational, social, sexual, financial, legal, substance use, and SUD treatment histories.
Behavioral health service and healthcare providers in any setting should screen older clients for substance misuse. There is no “wrong door” through which older adults can arrive at the right diagnosis and care. This report provides evidence-based practices for screening and assessment of adults in the justice system barbiturates: usage effects and signs of barbiturate overdose with mental illness, substance use disorders, or both. It discusses the importance of instrument selection for screening and assessment and provides detailed descriptions of recommended instruments. Many of these treatments can also address MDD, PTSD, and other CODs in older clients who misuse substances.
Become more aware of common myths about substance misuse in older adults. There has been little research on the effects of vaping nicotine (e-cigarettes) among older adults; however, certain risks exist in all age groups. Some research suggests that e-cigarettes might be less harmful than cigarettes when people who regularly smoke switch to vaping as a complete replacement.
Make referrals to medical services that provide respectful, consistent physical health care. As with any client, you should make appropriate referrals for medical care that is beyond what your practice setting offers. Level of safety at home, especially in terms of potential for violence. Note that substance use greatly increases the risk of intimate partner violence. Screen all women who seek SUD treatment for intimate partner abuse, regardless of their age.512 Substance use increases the risk of abuse toward older adults,513 and experiencing elder abuse can contribute to substance misuse among older adults. If you suspect an older adult is misusing substances, screen for elder abuse.
Sometimes referral to an outside provider (e.g., licensed psychologist, clinical social worker) is needed, depending on the expertise of the staff members in your program. However, even more follow-up sessions may be needed depending on the setting, the severity of the substance misuse, and clients’ responses. Per SAMHSA, it is a clinical approach to helping clients make positive changes in their behavior.
Screen and assess clients for factors that increase the odds of misuse and addiction. 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.