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Chapter 23. Alcohol and Drug Problems

David W. Oslin, M.D.; Shahrzad Mavandadi, Ph.D.
DOI: 10.1176/appi.books.9781585623754.394906

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Excerpt

Alcohol and drug misuse are associated with a wide array of negative physical and mental health outcomes that are exacerbated with advancing age, such as functional and cognitive decline, compromised immune function, and depression. Yet relatively little work has examined the correlates and consequences of substance use among older adults. Accordingly, substance misuse in later life, which encompasses alcohol and illicit, prescription, and over-the-counter drugs, has been called an "invisible epidemic" (Widlitz and Marin 2002). Epidemiological work, which has focused on younger populations, demonstrates that beginning in the mid to late 20s, overall rates of alcohol and illicit drug use begin to decline, with the majority of older adults reporting no substance use. Nevertheless, changes in demographic and cohort trends suggest that substance misuse in later life is a pressing public health matter and that older adults represent a group in growing need of specialized substance treatment programs and services (Gfroerer et al. 2003).

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FIGURE 23–1. Current, binge, and heavy alcohol use across the life span in 2006.Source. Reprinted from Office of Applied Studies: Results From the 2006 National Survey on Drug Use and Health: National Findings (DHHS Publ No SMA 07-4293, NSDUH Series H-32). Rockville, MD, Substance Abuse and Mental Health Services Administration, 2007. Available at http://www.oas.samhsa.gov/NSDUH/2k6NSDUH/2k6results.cfm#Ch3. Accessed February 5, 2008.

FIGURE 23–2. Rise in the prevalence of illicit drug use among late-middle-aged adults over the last 5 years.Source. Reprinted from Office of Applied Studies: Results From the 2006 National Survey on Drug Use and Health: National Findings (DHHS Publ No SMA 07-4293, NSDUH Series H-32). Rockville, MD, Substance Abuse and Mental Health Services Administration, 2007. Available at http://www.oas.samhsa.gov/NSDUH/2k6NSDUH/2k6Results.cfm#2.1. Accessed February 5, 2008.

FIGURE 23–3. Short Michigan Alcohol Screening Test–Geriatric Version (SMAST-G).Three or more positive responses is indicative of an alcohol abuse problem.Source. Reprinted from the University of Michigan Alcohol Research Center. Copyright 1991 The Regents of the University of Michigan. Used with permission.

FIGURE 23–4. Alcohol Use Disorders Identification Test–C (AUDIT-C) alcohol screening.Source. Adapted from Bush K, Kivlahan DR, McDonell MB, et al.: "The AUDIT Alcohol Consumption Questions (AUDIT-C): An Effective Brief Screening Test for Problem Drinking." Archives of Internal Medicine 158:1789–1795, 1998. Copyright © 1998, American Medical Association. All rights reserved. Adapted with permission.
Table Reference Number
Table 23–1. Alcohol conversion chart
Table Reference Number
Table 23–2. DSM-IV-TR criteria for substance abuse and dependence
Table Reference Number
Table 23–3. Common signs and symptoms of potential substance misuse and abuse in older adults

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When consumption of alcohol is at a level whereby adverse medical, psychological, or social consequences have occurred, older adults would be characterized as
2.
All of the following are beneficial effects of moderate alcohol consumption except
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For a number of reasons, providers may fail to identify alcohol and substance use disorders in older patients. Which of the following is not one of the reasons for failure to identify these disorders?
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