Substance Use Disorders in the Elderly

2017 ◽  
Author(s):  
Michael Burgard ◽  
Robert Kohn
Keyword(s):  
Older Adults ◽  
Substance Use ◽  
Alcohol Use ◽  
Substance Use Disorders ◽  
Alcohol Use Disorder ◽  
Illicit Drugs ◽  
Nursing Home Residents ◽  
The Elderly ◽  
The United States ◽  
Driving Under The Influence

Substance use disorders in older adults remains lower than in younger adults; however, the prevalence is rising in the elderly population. In the United States, the lifetime prevalence of an alcohol use disorder among persons age 65 and older is 16.1%. Studies of Veteran’s Administration nursing home residents have found that 29% to 49% of those admitted have a lifetime diagnosis of alcohol use disorder. A sizable proportion of the elderly acknowledge driving under the influence. In 2013, 1.5% of the elderly had used illicit drugs. The number requiring treatment for substance abuse is expected to double by 2020. The populations with the fastest increase in opiate mortality are those age 55 and older, including those 65 and older. This chapter presents the epidemiology of substance use among older adults and discusses issues related to elders’ substance use, including use in nursing homes, impaired driving and arrests, use of non-prescription medications, screening for substance use, and treatment.

Effectiveness and Availability of Treatment for Substance Use Disorders

2018 ◽  
Author(s):  
Dominic Hodgkin ◽  
Hilary S. Connery
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Substance Use Disorders ◽  
Alcohol Use Disorder ◽  
The United States ◽  
Treatment Programs ◽  
Future Research ◽  
Dissemination And Implementation ◽  
Major Focus ◽  
Medication Treatment

Drug and alcohol use disorders, also called substance use disorders (SUD), are among the major health problems facing many countries, contributing a substantial burden in terms of mortality, morbidity, and economic impact. A considerable body of research is dedicated to reducing the social and individual burden of SUD. One major focus of research has been the effectiveness of treatment for SUD, with studies examining both medication and behavioral treatments using randomized, controlled clinical trials. For opioid use disorder, there is a strong evidence base for medication treatment, particularly using agonist therapies (i.e., methadone and buprenorphine), but mixed evidence regarding the use of psychosocial interventions. For alcohol use disorder, there is evidence of modest effectiveness for two medications (acamprosate and naltrexone) and for various psychosocial treatments, especially for less severe alcohol use disorder syndromes. An important area for future research is how to make treatment more appealing to clients, given that client reluctance is an important contributor to the low utilization of effective treatments. A second major focus of research has been the availability of medication treatments, building on existing theories of how innovations diffuse, and on the field of dissemination and implementation research. In the United States, this research identifies serious gaps in both the availability of SUD treatment programs and the availability of effective treatment within those programs. Key barriers include lack of on-site medical staff at many SUD treatment programs; restrictive policies of private insurers, states, and federal authorities; and widespread skepticism toward medication treatment among counseling staff and some administrators. Emerging research is promising for providing medication treatment in settings other than SUD treatment programs, such as community mental health centers, prisons, emergency departments, and homeless shelters. There is still considerable room to make SUD treatment approaches more effective, more available, and—most importantly—more acceptable to clients.

DSM-5 alcohol use disorder features among treatment-seeking older adults

2018 ◽  
Vol 64 (4) ◽  
pp. 185-196 ◽  
Author(s):  
Silke Behrendt ◽  
Barbara Braun ◽  
Randi Bilberg ◽  
Gerhard Bühringer ◽  
Michael Bogenschutz ◽  
...  
Keyword(s):  
Older Adults ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
The Elderly ◽  
Treatment Seeking ◽  
Controlled Clinical Trial ◽  
Dsm 5 ◽  
Wide Range ◽  
And Gender ◽  
International Multicenter

Abstract. Background: The number of older adults with alcohol use disorder (AUD) is expected to rise. Adapted treatments for this group are lacking and information on AUD features in treatment seeking older adults is scarce. The international multicenter randomized-controlled clinical trial “ELDERLY-Study” with few exclusion criteria was conducted to investigate two outpatient AUD-treatments for adults aged 60+ with DSM-5 AUD. Aims: To add to 1) basic methodological information on the ELDERLY-Study by providing information on AUD features in ELDERLY-participants taking into account country and gender, and 2) knowledge on AUD features in older adults seeking outpatient treatment. Methods: baseline data from the German and Danish ELDERLY-sites (n=544) were used. AUD diagnoses were obtained with the Mini International Neuropsychiatric Interview, alcohol use information with Form 90. Results: Lost control, desired control, mental/physical problem, and craving were the most prevalent (> 70 %) AUD-symptoms. 54.9 % reported severe DSM-5 AUD (moderate: 28.2 %, mild: 16.9 %). Mean daily alcohol use was 6.3 drinks at 12 grams ethanol each. 93.9 % reported binging. More intense alcohol use was associated with greater AUD-severity and male gender. Country effects showed for alcohol use and AUD-severity. Conclusion: European ELDERLY-participants presented typical dependence symptoms, a wide range of severity, and intense alcohol use. This may underline the clinical significance of AUD in treatment-seeking seniors.

scholarly journals Substance Use Disorders: A Curriculum Response

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Marian Farrell
Keyword(s):  
United States ◽  
Substance Use ◽  
Nursing Education ◽  
Substance Use Disorders ◽  
Baccalaureate Nursing ◽  
Illicit Drugs ◽  
Expert Panel ◽  
Integrated Approach ◽  
The United States ◽  
Nursing Workforce

In the United States, among individuals aged 12 or older, approximately 19.7 million people experienced a substance use disorder (SUD) related to use of alcohol or illicit drugs during 2017. Current curricula in nursing education lacks sufficient content and experiences to support a nursing workforce prepared to meet the needs of individuals experiencing substance use disorders. This article describes the scope of the problem, and offers one possible solution that synthesizes essential competencies developed by an expert panel blended with an integrated approach that includes a taxonomy of significant learning. We discuss the resulting framework created for change in baccalaureate nursing education about substance use disorders.

scholarly journals Drugged Driving among Sexual Minority Older Adults in the United States, 2015-2019

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 753-753
Author(s):  
Jie Yang ◽  
Andrew Yockey
Keyword(s):  
Older Adults ◽  
Drug Use ◽  
Sexual Minority ◽  
Illicit Drugs ◽  
The United States ◽  
Emergency Department Visits ◽  
Driving Under The Influence ◽  
Pooled Data ◽  
Drugged Driving ◽  
The Life Course

Abstract Introduction Drugged driving, the act of operating vehicles under the influence of one or more illicit substances is responsible for numerous emergency department visits, deaths, and increased medical costs. Despite higher instances of drug use, older sexual minority (LGB) adults are often neglected in prevention efforts. This study assessed inequities between sexual minority older adults and their heterosexual counterparts in drugged driving across three difference substances (alcohol, marijuana, other drugs). Methods Pooled data from individuals 50 years or older (n = 43,238; 1,115 sexual minority adults) in the 2015–2019 National Survey on Drug Use and Health were analyzed. Past-year driving under the influence of alcohol, marijuana, and illicit drugs were outcome variables, and survey-weighted frequencies with 95% confidence limits and crude ORs with 95% confidence intervals (CI) were estimated. Results In the past year, 4.82% of older adults drove under the influence of alcohol, 1.33% drove under the influence of marijuana, and 1.48% drove under the influence of illicit drugs. Sexual minority adults consistently showed higher odds of drugged driving than their heterosexual counterparts, with individuals who identify as bisexual being most at risk for driving under the influence of illicit drugs (aOR:4.49, 95%CI: 2.84, 7.08) and marijuana (aOR:3.95, 95%CI: 2.39, 6.51). Discussion There are differences drugged driving by sexual orientation across the three substances we assessed. These rates of substance use among older sexual minority adults warrant ongoing concern, and it is critical to consider differences across the life course in designing and evaluating interventions to address inequities.

The Severity of Personality Pathology: A Risk Factor for Concurrent Substance Use Disorders in Alcohol Use Disorder

2019 ◽  
Vol 15 (3) ◽  
pp. 159-171 ◽  
Author(s):  
Marco Cavicchioli ◽  
Francesca Prudenziati ◽  
Mariagrazia Movalli ◽  
Pietro Ramella ◽  
Cesare Maffei
Keyword(s):  
Substance Use ◽  
Risk Factor ◽  
Alcohol Use ◽  
Substance Use Disorders ◽  
Alcohol Use Disorder ◽  
Personality Pathology

Need for and Receipt of Substance Use Disorder Treatment Among Adults, by Gender, in the United States

2021 ◽  
pp. 003335492110415
Author(s):  
Caitlin E. Martin ◽  
Anna Beth Parlier-Ahmad ◽  
Lori Beck ◽  
Anna Scialli ◽  
Mishka Terplan
Keyword(s):  
United States ◽  
Substance Use ◽  
Alcohol Use ◽  
Substance Use Disorder ◽  
Alcohol Use Disorder ◽  
White Women ◽  
Unmet Need ◽  
The United States ◽  
Treatment Need ◽  
Gender Specific

Objectives Disparities in substance use disorder (SUD) treatment use persist across groups, including gender. Using a gender-informed approach to expand treatment capacity and reduce barriers to treatment engagement is vital. We examined SUD treatment need and receipt among people with SUD in the United States, by gender, and assessed gender-specific sociodemographic factors associated with unmet need for SUD treatment and reported treatment barriers. Methods We conducted an analysis of data among adults aged ≥18 with a past-year SUD from the National Survey on Drug Use and Health (2015-2018). We computed population-adjusted frequencies and proportions for SUD treatment need and receipt and assessed gender differences. Multivariate logistic regression assessed gender-specific sociodemographic variables associated with SUD treatment receipt. Results Among adults with a past-year SUD, 63.4% were men and 36.6% were women ( P < .001), only 10.6% received SUD treatment, and a greater percentage of women than men needed treatment for opioid use disorder (11.9% vs 9.9%; P = .002). Receipt of SUD treatment was lowest among women with alcohol use disorder followed by men with alcohol use disorder (7.5% vs 8.9%; P = .052). Non-Latinx Black men had fewer than half the adjusted odds of receiving SUD treatment than non-Latinx White men (adjusted odds ratio [aOR] = 0.44; 95% CI, 0.27-0.71). Latinx women (aOR = 0.37; 95% CI, 0.18-0.73) and non-Latinx Black women (aOR = 0.51; 95% CI, 0.27-0.94) had significantly lower odds of receiving SUD treatment than non-Latinx White women. Conclusions As public health efforts target expanding SUD treatment capacity and addressing disparities in use of SUD treatment, interventions informed by gender and culture should be prioritized.

Psychopharmacology for Substance Use Disorders

2021 ◽  
Author(s):  
Olapeju Simoyan ◽  
Krista Ulisse
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Alcohol Withdrawal ◽  
Alcohol Use Disorder ◽  
Maintenance Treatment ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Duration Of Symptoms ◽  
Stimulant Use

The illicit use of opioids is the fastest growing substance use problem in the United States. There are three FDA- approved medications for maintenance treatment for opioid use disorder: methadone, buprenorphine and naltrexone. Stimulants include cocaine and methamphetamines. 3,4-methylenedioxymethamphetamine (MDMA or “ecstasy”) is an amphetamine derivative that also has hallucinogenic properties. Treatment of stimulant withdrawal is primarily supportive. Psychosocial interventions for stimulant use disorder may improve adherence, but they have not been shown to improve abstinence at the end of treatment. Benzodiazepines have been shown to reduce the severity and duration of symptoms related to alcohol withdrawal, in addition to reducing the risk of seizures. The Food and Drug Administration has approved disulfiram, acamprosate and naltrexone for the treatment of alcohol use disorder. This review contains 3 tables, and 31 references. Keywords: Opioid use disorder, maintenance treatment for opioid use disorder, stimulant use disorder, stimulant withdrawal, benzodiazepine overdose, benzodiazepine withdrawal, alcohol use disorder, alcohol withdrawal

scholarly journals Intersection of Stress and Gender in Association With Transitions in Past Year DSM-5 Substance Use Disorder Diagnoses in the United States

2018 ◽  
Vol 2 ◽  
pp. 247054701775263 ◽  
Author(s):  
Terril L. Verplaetse ◽  
Kelly E. Moore ◽  
Brian P. Pittman ◽  
Walter Roberts ◽  
Lindsay M. Oberleitner ◽  
...  
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Life Events ◽  
Substance Use Disorders ◽  
Tobacco Use ◽  
Alcohol Use Disorder ◽  
Stressful Life Events ◽  
Stressful Life ◽  
Cannabis Use Disorder ◽  
Tobacco Use Disorder

Background Stress contributes to the development and maintenance of substance use disorders, with some research suggesting that the impact of stress on substance use disorders is greater in women. However, this has yet to be evaluated in a national dataset, across major substances of abuse. Methods Using data from the newly available U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 3; n = 36,309), we evaluated relationships among past year stressful life events (0 or 1 vs. 2+ events, range 0–16) and gender, and their association with transitions (new vs. absent cases; ongoing vs. remitted cases) in Diagnostic and Statistical Manual of Mental Disorders Fifth Edition alcohol use disorder, tobacco use disorder, cannabis use disorder, and nonmedical prescription opioid use disorder diagnoses. Results Having two or more stressful life events in the past year increased the odds of having a new alcohol use disorder, tobacco use disorder, cannabis use disorder, and opioid use disorder (OR = 3.14, 2.15, 5.52, and 3.06, respectively) or ongoing alcohol use disorder, tobacco use disorder, and cannabis use disorder (OR = 2.39, 2.62, and 2.95, respectively) compared to zero or one stressful life event. A stress by gender interaction for new vs. absent alcohol use disorder demonstrated that having two or more stressful life events was associated with increased odds of new alcohol use disorder in men (OR = 2.51) and even greater odds of new alcohol use disorder in women (OR = 3.94). Conclusions Results highlight that stress is a robust factor in both men and women with new or ongoing substance use disorders, and that effective treatments for substance use should consider the role of stress in addiction etiology and maintenance. There was little evidence for gender differences in the role of stress on transitions in substance use disorders, except for the onset of alcohol use disorders. Given that rates of alcohol use disorders are increasing in women, the impact of stress needs to be considered.

scholarly journals In our hands: responding to the IOM report on workforce needs for older adults with mental health and substance use disorders

2013 ◽  
Vol 25 (7) ◽  
pp. 1039-1040 ◽  
Author(s):  
David C. Steffens
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Substance Use ◽  
Federal Budget ◽  
The Elderly ◽  
The United States ◽  
Institute Of Medicine ◽  
Older Americans ◽  
Healthcare Needs ◽  
Medicare Costs

In the United States, there are signs that we are coming to terms with the growing healthcare needs of older Americans. Over the past decade, exploding Medicare costs and the federal budget deficit have forced medical professionals, policy-makers, and other stakeholders to consider the consequences of an aging population. The US Congress commissioned a report from the Institute of Medicine (IOM) on the physical healthcare needs of the elderly adults and the geriatric healthcare workforce required to meet them, resulting in the 2008 IOM report Retooling for an Aging America: Building the Health Care Workforce (IOM, 2008). Following this report, Congress recognized that the work was not finished and that more information was needed about mental health and substance use (MH/SU) disorders in older Americans. The IOM was commissioned by Congress to convene a committee to study and report on the workforce needed to care for this group. In 2012, the IOM released The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? (IOM, 2012).

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