The Journal of the Arkansas Medical Society Med Journal Jan 2019 Final 2 | Page 14

SCIENTIFIC ARTICLE Alcohol and Substance Use in Older Adults M. Denise Compton, PhD Clinical Psychologist/Geriatric Neuropsychologist Assistant Professor, UAMS Abstract A lcohol and substance use patterns are often over- looked in older adults in the clinic; however, the rates of use are increasing as baby boomers are ag- ing. Older adults are, unwittingly, more vulnerable to a number of physical and mental health problems associated with the use of alcohol in particular – regardless of whether they meet criteria for a diagnos- able disorder. Further, there is little com- mon understanding regarding the levels of use that are associated with increased health risks. This article is intended to increase awareness of these risks and vulnerabilities and the need for increased clinical attention to them. Alcohol and Substance Use in Older Adults H ealth care providers tend to over- look substance use disorders among older people, mistaking the symptoms for those of dementia, depression, or other problems of aging. Historically, older adults have not demonstrated high rates of alcohol or other drug use when compared with younger adults. However, evi- dence suggests that substance use among older adults has been under-identified, and the preva- lence rates of substance use disorder among baby boomers is higher than previous cohorts and continuing to grow. 1 The 2017 report of the National Epidemiologic Survey on Alcohol indicates that between 2002 and 2013 there was a 49.4% increase in alcohol use disorder – considering it a “public health cri- sis.” 2 Older adults were among the subgroups with the greatest increase. The aims of this ar- ticle are to clarify the health risks associated with substance use – particularly in older adults – and encourage increased attention to appro- priate assessment, education, and treatment. DSM-5 Substance Related Disorders The fifth edition of the Diagnostic and Sta- tistical Manual of Mental Disorders (DSM-5) 3 includes redefined substance-related disorders under the following classifications: substance use disorder, substance intoxication, substance withdrawal, and other substance-induced dis- orders. Substance use disorders are by far the most common. Table 1 outlines the diagnostic criteria. It is noteworthy that the diagnostic criteria for a substance use disorder can be made sim- ply on the basis that an individual is distressed 158 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY by a pattern of using a substance in larger amounts or over a longer period than intended, and having a persistent desire or unsuccessful efforts to cut down or control use – regardless of impairment of functioning. Other substance use disorders include intoxication and withdrawal (as a historically defined) and any cognitive, behavioral, or emo- tional disorder that is thought to be the direct result of substance use. Alcohol Use With regard to alcohol in particular, recent estimates suggest that 29% of adults will have an alcohol use disorder (AUD) in their lifetime. While the frequency and intensity of alcohol use tends to decrease with advancing age, older adults are particularly vulnerable to a number of complications associated with continued use. Specifically, withdrawal states tend to be more severe in older adults, especially those who are also dependent on other drugs (e.g. benzodiaz- VOLUME 115