Clinical Topic

Healthy Aging, Substance Use and Abuse

Publication Date

November 1, 2022

EPIDEMIOLOGY

  • In the next 15-20 years the population of older adults will double.
    2-4% of the elderly meet current criteria for alcohol abuse or dependence.
  • An additional 10-15% of the elderly meet criteria for at-risk drinking.
  • Concurrent depression and alcohol use increases in prevalence with age.
  • Past history of addictive disorders may increase the vulnerability to central nervous system disorders such as dementia and depression in late life.

TREATMENT AND RESEARCH OPPORTUNITIES

  • While there is ample evidence that moderate drinking in healthy individuals is non-harmful and perhaps health promoting, there is pilot data about the effects of moderate to heavy drinking on common chronic medical/psychiatric disorders of late life. For instance, there are some limited data suggesting that moderate drinking in late life is associated with a poor response to standard depression care.
  • Reduced health care costs and disability can be demonstrated up to 2 years after interventions targeting at-risk and problem drinking.
  • Despite the lack of research on late-life addictions there is evidence that older adults who do seek treatment have better adherence to treatment and better treatment outcomes than younger patients. Studies examining these differences may give clues for improving outcomes in younger adults.

HEALTH SERVICES AND TRAINING CHALLENGES

  • A recent primary care study of elderly patients found that <1% of those with at-risk drinking or alcohol abuse/dependence were in formal addiction care. This study included a substantial number of veterans who should have greater access to addiction treatment.
  • Many patients especially those with depression will first seek care from their primary care provider or psychiatrist for comorbid conditions and not in an addiction treatment center. Geriatric psychiatrists often report limited training in dealing with addictions.
  • Similarly, except for a few specific programs most addiction clinics report limited expertise in caring for older adults. Many clinics have difficulty accommodating disabilities such as ambulatory problems, cognitive problems, and chronic medical problems.