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• W332000714 abstract "The misuse and abuse of alcohol are common among older adults and have become a significant public health concem (see Blow, 1998, for a more complete discussion). Misuse of psychoactive medications and use of illicit drugs also cause problems among older people, but to a lesser extent. All of these substances have particular effects on older people, who are especially vulnerable to them. Thus, clinicians and researchers must change the way they think about the risks of use of these substances by this segment of the population. Compared to younger adults, older individuals have an increased sensitivity to alcohol and a heightened response to over-the-counter and prescription medications. For example, an agerelated decrease in lean body mass versus total volume of fat, and the resultant decrease in total body volume, increases the total distribution of alcohol and other mood-altering chemicals in the body (Vestal et al., 1976). Liver enzymes that metabolize alcohol and certain other drugs are less efficient with age, and central nervous system sensitivity increases with age. Typically, substance-use problems are thought to occur only in those people who use substances in high quantities and at regular intervals. However, for some patients, any alcohol use, coupled with the use of specific over-thecounter or prescription medications, can be problematic. Many of the acute and chronic medical and psychiatric conditions in older people that lead to high rates of healthcare utilization (Fuchs,1999; Krop et al.,1998) are influenced by use of medications and other drugs and the consumption of alcohol. With the increasing awareness that older adults have specific risks when using these substances have come newer and more effective interventions and treatments that can lead to both reduced use and improvements in overall health. It is, therefore, timely and imperative that older adults with problems related to alcohol, medication, or illegal drugs be identified and have appropriate treatments provided. SCOPE OF THE PROBLEM The scope of the problem varies for different substances. Alcohol abuse or dependence. Although studies in this area are limited, prevalence estimates and typical characteristics of older problem drinkers have been reported (e.g., Adams, Barry, and Fleming, 1996; Blow et al., 1992; Blow et al., 1992). Prevalence estimates using community surveys of problem drinking in older adults have ranged from i percent to 15 percent (e.g., Adams, Barry, and Fleming,1996). These rates vary widely depending on the definitions of risky and problem drinking or alcohol abuse or dependence and the methodology used in obtaining samples. Among clinical populations, however, estimates of alcohol abuse or dependence are substantially higher because problem drinkers of all ages are more likely to be identified in healthcare settings (Institute of Medicine, 1990). Still, despite the high prevalence of alcohol problems, most older patients with alcohol problems go unidentified by healthcare personnel. Use of Illicit Drugs. In older people, little is known about the epidemiology of substance-- use disorders other than alcohol abuse and dependence. The general belief is that most older adults who use or are dependent on illegal drugs have early-onset disorders. As a group, the current cohort of adults age 65 and older is less likely than younger cohorts to use illicit drugs. Drinking problems are by far the largest class of substance-use problem seen in older adults today and are the primary focus of this paper. However, as the baby boom generation reaches later life, clinicians may see a greater use of illicit drugs in that age group. The Epidemiologic Catchment Area (ECA) study provides perhaps the only community examination of the prevalence of drug abuse and dependence among older adults (Regier et al., 1988). Using the Diagnostic Interview Schedule to determine prevalence rates for psychiatric diagnoses as defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), the study found the lifetime prevalence rates of drug abuse and dependence to be O. …" @default.
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• W332000714 date "2002-04-01" @default.
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• W332000714 title "Misuse and Abuse of Alcohol, Illicit Drugs, and Psychoactive Medication among Older People" @default.
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