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-
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