Each of the instruments listed next have strengths and weaknesses related to resources required to implement them or applicability to older adults. Providing trauma-focused therapy alongside treatment for opioid use disorder [50, 58], may prove to be beneficial. Research and clinical reports describe the indirect and successful treatment of intractable and chronic pain in patients with comorbid PTSD, only after instituting behavioral therapy targeting the PTSD symptoms [60,61,62]. Cognitive-behavioral therapies with proven efficacy for the treatment of PTSD are now available to pain practitioners, and it is noteworthy that these interventions are now being tailored within comprehensive pain rehabilitation programs. Incorporating novel mindfulness and body therapy approaches to increase sensory and emotional awareness may also benefit individuals with elevated trauma symptoms and/or PTSD and co-occurring OUD, and further research is needed in this area.
Risk Factors for Substance Use Disorders in Older Adults
Our findings align with prior research showing a link between childhood trauma and chronic pain in community and SUD samples, highlighting the importance of assessing PTSD symptoms among those with chronic pain in MOUD and the potential need for psychological treatment in the context of recovery. Conduct a full assessment for any client whose screening suggests moderate-to-severe substance misuse. Full assessments gather not just substance-related information, but information about overall functioning and health (Exhibit 3.8). This information will help you differentiate among substance misuse, CODs, physical conditions common in older populations, and symptoms of normal aging.
Additional Resources
This article briefly summarizes data on the epidemiology, service use, and clinical considerations of substance use and SUDs in older adults, and suggests future directions. More middle-aged and older adults are misusing alcohol, alcohol and anxiety opioids, heroin, and marijuana. The National Institute on Drug Abuse reported in 2019 that rates of substance use had climbed in adults between 50 and 64 years old and in those 65 years and older in the previous decade.
Social Factors
Give brief education, such as reminding them of low-risk alcohol intake levels for older adults. Use positive language to urge them to continue using substances appropriately. The Elder Abuse Suspicion Index©422 is a six-item yes/no questionnaire. A “yes” response on one or more questions (other than on Question 1) is considered a positive screen. Do not ask clients to “relive” their trauma by describing it in detail. Let your clients answer questions about their trauma in the ways that are most comfortable to them.
Older adults are also more likely to take multiple medications, which means they may face dangerous and potentially fatal drug-drug interactions. Furthermore, identifying substance misuse in older adults is not simple. The signs and symptoms of substance misuse can be easily mistaken for normal aging or physical or mental disorders common in older populations. A health history and physical exam for common co-occurring physical conditions that affect mental health as well as physical conditions that suggest the client has substance misuse (e.g., sleep problems, chronic pain).
- If no providers in your program have the necessary licenses and qualifications to assess for and diagnose mental disorders, make referrals as necessary to providers who can do so.
- The twelve-month prevalence of alcohol use disorder (AUD) and drug use disorder (DUD) (the NSDUH does not publish disaggregated information on specific drugs for adults ages 65 and older), were 1.6 percent and .4 percent, respectively.
- Some people naturally feel more comfortable sharing information in writing than verbally.
- “The brain is an organ of the body, like the heart or the liver or the kidney. I had a severe, life-threatening kidney incident, but it’s treatable,” he said.
Combining drugs and alcohol with medications can be dangerous and even lead to death. Drug and alcohol use can also make certain illnesses worse and keep clients from feeling their best. Behavioral health how to detox your body while pregnant service and healthcare providers in any setting should screen older clients for substance misuse. There is no “wrong door” through which older adults can arrive at the right diagnosis and care.
There’s no “right or wrong way” for them to talk about their experiences. Developed from the AUDIT measure, it is a short version of the 20-item CUDIT screener. A score of 12 or higher means you should assess for cannabis use disorder.
The Michigan Alcohol Screening Test-Geriatric Version (MAST-G)101 is an instrument designed to identify drinking problems and was developed specifically for the elderly by modifying the Michigan Alcohol Screening Test. This screening tool contains 24 questions with yes/no responses; 5 or more positive responses indicate problematic use. The MAST is highly sensitive and specific and generally has strong ambien and alcohol: side effects and overdose risk psychometric properties.102 It is also administered in a short form, the SMAST-G, which has 10 questions, with 2 positive responses indicating a problem with alcohol. Because of the diagnostic challenges outlined earlier, the MAST-G focuses more on potential stressors and behaviors relevant to alcohol use in late life, as opposed to questions toward family, vocational, and legal consequences of use.
This tool has many of the advantages of the CAGE, such as ease of administration and low cost. It is also more specific than the CAGE in identifying problematic use. Although useful as an indicator of lifetime problem use, it lacks information about frequency, quantity, and current problems important for intervention. In this study, 41% of participants screened positive for PTSD, congruent with previously published literature [50, 51]. Given the high prevalence of many types of traumatic experiences among the participants in this sample, we could not link PTSD diagnostic status to particular types of traumatic events (i.e., whether they occurred during childhood or as an adult, whether interpersonal or non-interpersonal).