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Older Adults with Substance Use Disorders

Providers of substance abuse services are increasingly aware that large numbers of older adults will require specialized substance abuse services as they begin moving into older age. The aging of the U.S. population and the arrival into older age of the Baby Boomers—the generation born between 1946 and 1964—are focusing attention on the “invisible epidemic” of older adults with substance use disorders.

By 2030, citizens over 65 will number 71 million, increasing to more than 20 percent of the country’s population. Of that 71 million, 16 percent (11 million people) will be in need of substance abuse services.

When substance-related problems are identified, Baby Boomers are significantly more open to seeking professional mental health assistance and substance abuse counseling than were previous cohorts. Increased demand and higher expectations will have a significant impact on the existing service delivery system.

In the older adult population, as in other age groups, substances include alcohol, street and recreational drugs, and both prescribed and over-the-counter medications. Particularly dangerous in older adults is potential interaction between alcohol and other drugs, including legitimately prescribed and appropriately used medication. The most widespread pattern of abuse among older adults, however, is the misuse of prescriptions and over-the-counter medications coupled with continued or increased consumption of alcohol.

Frequently substance abuse in older adults mimics symptoms of other health problems (e.g., confusion and agitation), or its signs are perceived as normal aspects of aging (e.g., unsteadiness and falls). It is recommended that all adults age 60 and over be screened for alcohol and prescription drug abuse as part of regular physical examinations.

Since screening, assessment, and referral to age-appropriate treatment, if warranted, are essential, providers dealing with older adults need to be aware of:

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Vulnerability of Older Adults to Misuse of Substances

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Screening Tools That Are Effective with Older Adults

The Substance Abuse and Mental Health Services Administration (SAMHSA) suggests the following screening tools:

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Evidence-based Programs (EBPs) for Older Adults with Substance Use Disorders

The Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices (NREPP) has recommended several effective programs and practices for service providers to use in working with older adults.

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Reimbursement for Services

Medicare, for which individuals 65 and older qualify, covers treatment for substance-related disorders in inpatient or outpatient settings. Coverage is available for both diagnostic and therapeutic services. Certain limits apply. To determine what kinds of coverage are provided, contact the Centers for Medicare and Medicaid Services (CMS), www.cms.gov, 1-877-267-2323.

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Special Considerations in Working with Older Adults

Because older people suffering from substance abuse are particularly stigmatized, many desiring help hesitate to discuss their problem, even with health care providers. Paradoxically, stigma against older people can result in situations in which senior services are denied due to the person’s admitted substance abuse, and substance abuse treatment is denied because the potential client is deemed “too old” to benefit from the expenditure of limited resources.

In interacting with older adults, providers should recognize the physical and mental changes that occur with aging and adjust their approaches accordingly. Older adults, for example, respond best to supportive rather than confrontational approaches. Since older adults are often uncomfortable discussing alcohol consumption or drug use, an effective screening requires privacy, safety, comfort and respect. Respect can be conveyed by actively listening to the older adult’s view of the situation and addressing concerns with empathy and encouragement.

For more information about working with older adults with substance use disorders, please contact Margaret Anne Lane (Margaret.Lane@dbhds.virginia.gov).

Resources to Provide Additional Information and Assistance

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