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The Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) issued a report on May 7 to alert health care providers that abuse of alcohol and legal drugs, both prescribed and over the counter, is a serious health problem among older Americans. This "invisible epidemic" affects up to 17 percent of adults age 60 or older, a rapidly growing segment of America's population.
The new SAMHSA publication, one of a series of Treatment Improvement Protocols (TIPs), is designed to assist the health care community to better detect and treat alcohol and medication abuse among older patients. A Consensus Panel contributing to the report recommended that clinicians consider that the DSM-IV model of alcohol abuse and dependence may not be adequate for diagnosing older adults with alcohol problems.
Some experts use the model of at-risk, heavy, and problem drinking in place of the DSM-IV model because it allows for more flexibility in characterizing drinking patterns. The substance abuse report says that the terms "heavy" and "problem" are meaningful to treatment specialists interested in differentiating severity of problems among younger alcohol abusers but are less relevant to older adults. The Consensus Panel recommends using the terms "at risk" and "problem" drinkers to differentiate older adults. The problem drinker category includes those who would otherwise fall into the heavy and problem classifications in the more traditional model as well as those who meet the DSM-IV criteria for abuse and dependence.
According to the report, it is more difficult for health care providers to diagnose alcoholism in older patients because a third of those with problems had not abused alcohol in their younger years and did not have health problems, trouble with the law, or difficulties with family relationships associated with problem drinking. These older problem drinkers typically begin abusing alcohol or medications following the death of a spouse, a divorce, retirement, or some other major life change.
Citing recent studies, the report stated that 15 percent of male alcoholics report that their first symptoms of alcoholism occurred between ages 60 and 69, and 14 percent report that their first symptoms occurred between the ages of 70 and 79. For women the percentages are even higher, with 24 percent reporting their first signs of alcoholism between ages 60 and 69. Twenty-eight percent of women report that their first signs occurred between the ages of 70 and 79.
The report also states that prescription drug misuse and abuse are prevalent among older adults because not only are more drugs prescribed to them, but also aging makes the body more vulnerable to the effects of drugs. It states, "Any use of drugs in combination with alcohol carries risk; abuse of these substances raises that risk; and multiple drug abuse raises it even further."
"As we age, there are physical changes in the body that lead to a lower tolerance for alcohol," CSAT Acting Director Camille Barry, Ph.D., R.N., explained. "Often relatives of older individuals try not to notice if they see signs of inebriation. However, that cocktail or two may be taking away a loved one's independence and health."
According to the report, which studied adults age 60 and older, the effects of aging on the body vary from person to person, and the age at which the body can no longer safely tolerate alcohol at previous rates varies as well. "Because many of the definitions, models, and classifications of alcohol-consumption levels are static and do not account for age-related physiological and social changes, they simply do not apply to older adults," the report said.
"We encourage older people, families, and service providers to understand the effect that alcohol and drug abuse can have on older people and how open discussion of this issue can benefit everyone," said James Firman, president and CEO of the National Council on Aging.
TIPs is a compendium of best practice guides produced for health care and substance abuse treatment providers. TIPs are produced by nonfederal consensus panels composed of clinical, educational, research, and administrative experts. These manuals are designed to improve treatment services available to people in need through the Substance Abuse Prevention and Treatment Block Grant and other programs. TIPs, including "Substance Abuse Among Older Adults," are available on the CSAT Web page at http://www.treatment.org/ or they can be ordered by contacting the National Clearinghouse for Alcohol and Drug Information (NCADI) at (800) 729-6686; TDD (for hearing impaired), (800) 487-4889.