Evidence-Based Reviews

Substance abuse among older adults: A growing problem

Current Psychiatry. 2018 March;17(3):14-20

References

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On the other hand, individual psychotherapy, such as cognitive-behavioral therapy (CBT), interpersonal therapy, and psychodynamic therapy, can provide a private and confidential environment for older adults who are less social.²⁴

The highly structured nature of CBT may be well suited to older adults who have memory difficulties.¹A study of 110 older veterans with substance abuse problems found evidence for the effectiveness of group CBT among these patients.²⁵ All but 8 participants in this study were age ≥65. The intervention consisted of 16 weekly group sessions that began with analysis of substance use behavior to determine high-risk situations for use, followed by a series of modules to teach skills for coping with social pressure, being at home and alone, feelings of depression and loneliness, anxiety and tension, anger and frustration, cues for substance use, and other factors. Approximately 44% (49 of 110) completed treatment (≥13 sessions). Approximately 55% of those who completed the treatment were abstinent at 6-month follow-up.²⁵

Don’t assume your older patient is not using illicit substances

It is a myth that older adults do not use and abuse illicit substances. Illicit drug use among older adults is increasing. Older adults with SUDs may not present with the same symptoms as their younger counterparts, and thus it may be difficult to identify the problem. Maintain a high index of suspicion regarding the use of illicit substances in these patients.

Treatment options are generally limited and health care settings offer few interventions designed specifically for older adults. In general, proper identification of SUDs and targeted treatment can highly improve outcomes.

Bottom Line

The number of older adults who use illicit substances is increasing. Screening, diagnosis, and treatment of substance use disorders in these patients may be complicated by age-related factors and a lack of evidence specific to older adults. Maintaining a high index of suspicion for substance use by older adults is essential.

Related Resource

Drew SM, Wilkins KM, Trevisan LA. Managing medication and alcohol misuse by your older patients. Current Psychiatry. 2010;9(2):21-24,27-28,41.

Drug Brand Names

Buprenorphine • Buprenex, Probuphine
Buprenorphine transdermal • Butrans
Methadone • Dolophine, Methadose
Naltrexone • Revia, Vivitrol

Substance abuse among older adults: A growing problem

References

Don’t assume your older patient is not using illicit substances

Bottom Line

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