Substance use in older adults: a review of current assessment, treatment and service provision

Changes in demography and cohort attitudes in the older adult population have meant that substance use amongst older adults is emerging as an immense challenge to mental health services. Although the prevalence of alcohol-related problems decreases with age they remain significant in older adults, whilst the use of prescription and over-the-counter drugs increases in this age group. The interplay between substance use and social, psychological and physiological difficulties associated with ageing further underscores the needs for a greater understanding of this problem. The recent insurgence of clinical and research interest in this field has revealed a discrepancy in the identification of substance use in younger and older age groups, this problem remaining frequently hidden and neglected in older adults. The present article reviews assessment and screening tools developed especially for this age group and indicates the need for systematic multidisciplinary screening in older adult services. Differences in psychological approaches to the treatment and clinical management of substance use in older adults are also reviewed. A number of treatment programmes have been adapted for this age group, although greater systematic evaluation of these interventions is required to establish their efficacy. The diverse bio-psycho-social impact of substance use in older adults also indicates the need for comprehensive clinical management. The needs of older adults with substance use problems have required greater health education and integration and liaison between older adult and substance use services.