Geriatric Substance Use

Older Adults

What does it look like in older adults?

A substance use disorder (SUD) is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. The regular use of alcohol and/or other drugs produces changes in the brain which strongly reinforce the behavior of drug use, teaching the person to repeat it. These behavioral changes are also accompanied by changes in brain function, especially in the brain’s natural inhibition and reward centers.

In addition to the their high susceptibility to COVID-19 morbidity and mortality, older adults face unique complexities in their physical and mental health that make them particularly vulnerable to the effects of alcohol and drugs. When older adults use drugs or alcohol, they’re at high risk for harmful drug interactions, cognitive decline, injury, sleep problems, mental health issues, memory problems, liver disease and cardiovascular disease.

Physicians play a key role in increasing awareness in older adults about the relationship between substance use and health outcomes, including risk for COVID-19. There are a variety of elder-specific techniques and patient-centered approaches designed to be incorporated into clinical practice to help identify, refer, and/or treat substance use in older adults. In general, older adults experience better treatment outcomes with providers that understand the unique issues and complexities of older adults. 

People who are addicted to alcohol and/or other drugs have changes in their brain that affect the following areas:

  • Judgement
  • Decision-making
  • Learning
  • Memory
  • Behavioral Control
  • Relationships
  • Emotional Regulation
  • Activities of daily life (job, education, etc.)

How do I screen for it?

The most important step of recognizing a substance use disorder in older adults is considering it a possibility. Alcohol remains the most widely used and abused drug for older adults. Other drugs of concern for this population psychoactive prescription medications such as opioids or benzodiazepines (i.e. medications for sleep, pain, and anxiety). 

The Substance Use Disorder and Mental Health Administration (SAMHSA) recommends yearly screening for all adults ages 60 and older, as part of regular physical examinations, in addition to when the individual experiences changes in health status, during major life events/transitions (loss of a partner/spouse, retirement, move to new home/location), before prescribing new medications, or a decrease in cognitive or behavioral functioning.

The National Institute of Drug Abuse (NIDA) provides online and printable self- and clinician-administered Screening and Assessment Tools by substance type (alcohol, drugs) and patient age (adults, adolescents).

Screening Instruments

  • To identify at-risk patients: NIAAA Single-Item Screener 
  • For a list of adult screening instruments, click here.
  • Elder-specific screening instruments: MAST-Geriatric Version, SMAST-G

Additional Resources

COVID-19: Virtual Substance Use & Recovery Resources - U-M Addiction Center Virtual Recovery Resource Webpage provides a list of virtual online mutual support meetings, 24/7 crisis helplines, educational materials, and recovery support apps.

Training and Technical Assistance Related to COVID-19 - The Substance Abuse and Mental Health Services Administration has compiled a list of resources such as webinar and resource guides for supportive practices that providers may find useful during a public health crisis. 

COVID-19: Impact on and Implications for SUD Treatment - The Journal of Substance Abuse Treatment has created a special issue on the implications of COVID-19 for the present and future of substance use disorder (SUD) treatment. Papers are added to the Special Issue as they are published in the print edition of the journal. 

Treatment Information

  • SAMHSA Treatment Locator - The Substance Abuse and Mental Health Services Administration treatment webpage helps providers and patients locate alcohol, drug, or mental health treatment facilities.
  • U-M Addiction Treatment Services - U-M Addiction Treatment Services is staffed by psychiatrists, social workers and nurses who work together as a multidisciplinary team for the treatment of alcohol and/or drug problems.

Handouts

Select References

American Medical Association. (2020, June 30). Reports of increases in opioid- related overdose and other concerns during COVID pandemic (Issue brief). https://www.ama-assn.org/system/files/2020-07/issue-brief-increases-in-opioid-related-overdose.pdf

Clay, J. M., & Parker, M. O. (2020). Alcohol use and misuse during the COVID-19 pandemic: a potential public health crisis?. The Lancet. Public health, 5(5), e259. https://doi.org/10.1016/S2468-2667(20)30088-8

Knopf, A. (2020). Addiction telemedicine comes into its own with COVID‐19. Alcoholism & Drug Abuse Weekly, 32(13), 5-6. Retrieved from. https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.32673

Lin, L. A., Fernandez, A. C., & Bonar, E. E. (2020). Telehealth for Substance-Using Populations in the Age of Coronavirus Disease 2019: Recommendations to Enhance Adoption. JAMA psychiatry. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2767300

Marsden, J., Darke, S., Hall, W., Hickman, M., Holmes, J., Humphreys, K., ... & West, R. (2020). Mitigating and learning from the impact of COVID‐19 infection on addictive disorders. Addiction. Retrieved from http://eprints.whiterose.ac.uk/160151/

National Institute of Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction. NIH Pub No. 14-5605. https://www.drugabuse.gov/sites/default/files/soa_2014.pdf

Volkow, N. D. (2020). Collision of the COVID-19 and addiction epidemics. https://www.acpjournals.org/doi/full/10.7326/M20-1212

What are the treatment options?

Evidence shows that age-specific treatment services for older adults can reduce or stop substance use and improve health and quality of life. The American Society of Addiction Medicine Professionals (ASAM) recommends that treatment begin with the least invasive option to more intensive options.  Regardless of treatment type, older adults prefer a gentler motivational approach over a confrontational approach, as well as age-integrated treatment program.

The first step is assessing the severity of the disorder. Some older adults need low-intensity options while others require inpatient clinical supervision.  Unless there’s significant impairment, active suicidal ideation, or other acute health concerns, older adults must be able to exercise their free choice to choose their preferred method of treatment and to participate in treatment. The different levels of SUD treatment for older adults include:

  • Outpatient care (i.e. weekly individual or group counseling)
  • Intensive Outpatient Care  (i.e. daily individual or group counseling for a number of weeks/months)
  • Residential care (i.e. 24-hour supervision and clinical monitoring)
  • Medically Managed Inpatient Care (i.e. treatment services in a medical or psychiatric hospital setting).

Additional Resources

Select References

  • The ASAM criteria: treatment for addictive, substance-related, and co-occurring conditions

Handouts

Select References

American Medical Association. (2020, June 30). Reports of increases in opioid- related overdose and other concerns during COVID pandemic (Issue brief). Retrieved July 3, 2020, from American Medical Association website: https://www.ama-assn.org/system/files/2020-07/issue-brief-increases-in-opioid-related-overdose.pdf

Clay, J. M., & Parker, M. O. (2020). Alcohol use and misuse during the COVID-19 pandemic: a potential public health crisis?. The Lancet. Public health, 5(5), e259. https://doi.org/10.1016/S2468-2667(20)30088-8

Knopf, A. (2020). Addiction telemedicine comes into its own with COVID‐19. Alcoholism & Drug Abuse Weekly, 32(13), 5-6. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.32673

Marsden, J., Darke, S., Hall, W., Hickman, M., Holmes, J., Humphreys, K., ... & West, R. (2020). Mitigating and learning from the impact of COVID‐19 infection on addictive disorders. Addiction. Retrieved from http://eprints.whiterose.ac.uk/160151/

National Institute of Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction. NIH Pub No. 14-5605. Retrieved from https://www.drugabuse.gov/sites/default/files/soa_2014.pdf

Volkow, N. D. (2020). Collision of the COVID-19 and addiction epidemics. Retrieved from https://www.acpjournals.org/doi/full/10.7326/M20-1212