Studies have shown virtual outpatient care for the treatment of SUD to be a feasible alternative to in-person-only programming 79. However, access to these virtual programs can be limited by advanced age as older adults might have limited computer literacy, limited access to internet and technology, or hearing loss. Older adults also might prefer in-person visits, as suggested in a qualitative study of older adults in treatment for AUD during COVID-19, where they considered face-to-face provision to be essential 80. This study found that among adults assessed for substance use at 399 treatment centers during 2019, alcohol was the most commonly reported substance used during the past 30 days, followed by cannabis, prescription opioid misuse, and illicit stimulants. Nearly one third of all assessments involved polysubstance use, and co-occurring severe problems across multiple biopsychosocial domains were common.

Evidence-based practices and barriers to assessment and treatment

• The observed high rates of polysubstance use among adults assessed for substance use treatment in 2019 are concerning and are consistent with recent drug overdose death data (7) and substance use patterns in the general population (1).
• Just because someone is older doesn’t mean it’s too late for a better quality of life.
• Rates of benzodiazepine use are shown to be impacted by misdiagnosis, over-prescription, and misdosing.
• One can help an elderly parent or grandparent do so by asking if they are taking any medicines that could cause drug interaction and communicating the symptoms of prescription drug misuse or abuse to them.

When doing an SUD screen, if trauma or elder abuse screeners are negative, continue with routine clinical care. For instance, if a client reports disagreements with her husband and has visible bruises, screen for possible abuse. Living in the home with someone who misuses substances or has a mental disorder. Developed from the AUDIT measure, it is a short version of the 20-item CUDIT screener. Do not assume that a score below 13 means the client does not misuse cannabis.334 The CUDIT-R is available in the Chapter 3 Appendix. Chapter 3 will be useful across settings in which these workers encounter older adults.

Furthermore, the use of biologic screening (ie, laboratory tests) has limited utility and can be problematic in older adults, as isolating impaired bodily functions (ie, liver function) as the result of alcohol or other substances versus prescribed medications may be difficult. Each of the instruments listed next have strengths and weaknesses related to resources required to implement them or applicability to older adults. It is important to note that many of the health benefits of moderate alcohol use for older adults may come with negative trade-offs. Cannabis use by older adults is considerably more prevalent than other drugs. Among adults aged 50 years and older in 2012, 4.6 million reported past-year marijuana use, and less than one million reported cocaine, inhalants, hallucinogens, methamphetamine, and/or heroin use in the past year. Addiction Resource is an educational platform for sharing and disseminating information about addiction and substance abuse recovery centers.

However, even more follow-up sessions may be needed depending on the setting, the severity of the substance misuse, and clients’ responses. Questions that can be answered with a simple “yes” or “no” can seem harsh or judgmental. Older clients might already feel ashamed and uncomfortable talking about their substance use. Closed-ended questions could make those feelings even worse and cause clients to “shut down.” On the other hand, open-ended questions can help clients become aware of and express their own experiences and motivations related to substance use. Knowing what to do after screening is as important as knowing why and how to screen in the first place.

Treating Substance Use Disorder in Older Adults

Though evidence-based care is available, most older adults neither seek nor receive treatment because of multiple barriers. Low-income older adults often lack the financial and social capital resources and transportation necessary to get treatment. Lack of education and strong stigma about mental health problems often cause older adults and their informal support systems to deny or hide these problems.

Fall Risk Assessment

However, if you believe you have a medical emergency, you should immediately call 911. Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Also, baby boomers (those born between 1946 and 1964) came of age when opinions about alcohol, marijuana, and other drugs were changing.

It is also important to note the difference between pharmacologic preparations of cannabis and medicinal cannabis. Pharmacologic preparations are approved by the Food and Drug Administration (FDA) for specific indications such as seizures or anorexia 34. The FDA currently has approved one cannabis-derived and three cannabis-related drug products; these include cannabidiol, nabilone, and two brands of dronabinol 34. Medicinal cannabis, however, is part of an unregulated industry with no medical or government oversight and thus largely operates under the Herbal and Dietary Supplements Industry. It is thus regulated as a natural product, but the term “medical” has been used to make it more marketable to the medically untrained public 35.

Treatment Planning, Referrals, and Treatments

The treatment of cannabis use disorder in older adults is similar to that of the general population. Cannabis use disorder treatment is primarily done through CBT, motivational enhancement therapy (MET), and contingency management (CM) with a combination of the three modalities producing the best outcomes 47. For instance, a person who misuses alcohol may experience issues with balance and coordination, but these issues may also increase as we age.

Prescription Drugs

Material preparation, data collection, and analysis were performed by Jenny Lin. The first draft of the manuscript was written by Mitchell Arnovitz and Jenny Lin. We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. For example, prescription timer caps, which display the length of time that has passed since the bottle was last opened, can prevent people from accidentally taking a prescription twice. Therefore, some older adults may struggle to relate to the rest of the group, which may increase feelings of isolation rather than alleviate them.

INTERVENTIONS

In 2019, 65.8 million U.S. adults reported binge drinking and 35.8 million reported illicit drug use or prescription pain reliever misuse during the past month. Persons with substance use disorders are at high risk for overdose and other harms. Aging can alter the body’s response to drugs and alcohol due to changes in metabolism, liver and kidney function, and body composition. Older adults may experience increased sensitivity to substances, leading to a heightened risk of adverse effects and drug interactions, even with lower doses.

• The ASI-MV also collects detailed information on lifetime and past 30-day use of tobacco, alcohol, and illicit drugs, as well as use and misuse of prescription drugs.
• And buprenorphine, naloxone, and methadone are used in opiate, methamphetamine, and heroin use disorders.
• There’s no “wrong door” through which older adults can receive a diagnosis and the treatment they need.
• Assessments give detailed information for diagnosis, treatment decisions, and treatment planning.

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. Guide treatment planning, including giving clients the right level of care in the right setting. Refer high-risk clients to a program where specialized SUD treatment services are available, if possible.

Overview: Drug and Alcohol Treatment for Seniors and Older Adults

Some will not be available in many localities, but online and telephone meetings may be available. Treatment planning includes alcoholism preparing to provide treatment or refer to the most appropriate treatment provider. You should start with treatment planning, and then either give the treatment or refer to an outside provider if your program cannot provide the services or level of care the client needs. Although rare, age-specific treatment settings and programs may provide the most effective care for older clients.

Yet, even as the number of older adults suffering from these disorders climbs, the situation remains underestimated, underidentified, underdiagnosed, and undertreated. These include various levels of care and different substance abuse services. Trends suggest that aging Baby Boomers embrace marijuana and illicit drugs in far greater numbers than previous generations did. Seniors who dabbled with drugs in their youth may be more likely to turn to similar drugs, particularly marijuana, to treat ailments of old age including chronic pain. Furthermore, a significant rise in calls to the SAMHSA Helpline, increasing from 656,953 in 2019 to 833,598 in 2020, indicates growing concern over substance-related issues in this age group.