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Drug, Alcohol Use on the Upswing in Older Adults: What’s the Clinician’s Role?
posted 02.22.2012

By Kristen Barry

As the older adult cohort increases rapidly in America, promoting healthy lifestyles is critical, to prevent or manage the many acute and chronic medical and mental health problems influenced by lifestyle choices. In the past, older adults were much less likely than younger adults to use illicit drugs, but still likely to use alcohol. Now, the use and abuse of psychoactive prescription medications has increased, and it’s a more challenging issue to identify than alcohol misuse.

A psychoactive drug is a chemical substance that crosses the blood-brain barrier and acts primarily upon the central nervous system, where it affects brain function, resulting in changes in perception, pain, mood, consciousness, cognition and behavior. This class of drugs includes many medications for pain, anxiety and sleep.

Despite high rates of such medication use among older adults, few studies have examined the prevalence and nature of their misuse and abuse in this population. But new national data show an elevated risk for binge drinking and nonmedical use of prescription drugs in elders.

Studies show that up to 18 percent of older adults are at-risk drinkers; as many as one in four take medications with abuse potential; and 11 percent of women older than 60 misuse prescription drugs.

Heavier alcohol use and psychoactive prescription medication use are associated with a number of adverse health effects in this population, including a greater risk for harmful drug interactions, injury, depression, memory problems, liver disease, cardiovascular disease, cognitive changes and sleep problems. Plus, older adults are more vulnerable than younger adults to the effects of psychoactive prescription medications and alcohol.As the baby boom generation reaches later life, clinicians and researchers are beginning to see even greater alcohol use and larger numbers of individuals misusing psychoactive prescription medications than ever before. In 2004, there were an estimated 115,803 emergency department visits involving medication misuse and abuse by adults ages 50 or older. In 2008, there were 256,097 such visits, representing an increase of 121.1 percent, according to the 2010 Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network.

Researchers and clinicians have been working to develop and refine caring, nonjudgmental approaches to identify and intervene with older adults who engage in these risky behaviors.

We now have reliable and valid screening techniques that help determine the extent of the problem:

  • Ask direct questions;
  • Preface questions with a link to medical-health conditions and quality of life;
  • Imbed questions on alcohol and psychoactive prescription medications with other health screening questions (exercise, nutrition, medical conditions, smoking);
  • Use questions during registration, intake, assessment for services, wellness programs, yearly check-ups, and during major life events (retirement, loss of partner or spouse, dramatic change in health or cognitive functioning).

We also have techniques, such as brief interventions, that can be used by physicians, social workers and other health professionals who work with this population. These interventions are often workbook-driven and have been shown to be effective in a number of settings. Brief interventions use motivational techniques, are non-confrontational and educational. And they have been well-tested in large randomized trials and in community settings. 

Screening and brief interventions that focus on lifestyle factors, including the use of alcohol and misuse of psychoactive prescription medications, may be the most appropriate way to maximize health outcomes and minimize healthcare costs among older adults. Therefore, systematic substance-use screening and intervention methods are particularly relevant to providing high-quality healthcare to older adults.

Older individuals with at-risk drinking are an especially vulnerable population that requires elder-specific screening and intervention procedures focused on later-life alcohol use. Preventing alcohol and psychoactive prescription medication misuse and abuse can potentially reduce or eliminate negative health and social outcomes in this population.

We should take advantage of this unique opportunity to assist aging Americans with these minimal screening and intervention strategies for maximum positive outcomes in this large and growing group of older adults.


Kristen Barry, Ph.D., is a research professor at the University of Michigan Department of Psychiatry.

This article was brought you by the editorial board of ASA’s Mental Health & Aging Network (MHAN).

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