Substance use disorders in elderly people

Roland Atkinson

AJcphpluse disorders

Clinical „features^classification,,,, screening:, and, „diagnosis

Epidemiology

Aetiology

Complications naM„como™"i.e,s Course,, and „prognosis Treatment

Benzodiazepine,, dependence Cjinic.al, „features;,, classification,, and, „diagnosis

Epidemiology Aetiology Complications Course,, a nd „prognosis Treatment

TobaccPn(nlcotine)ndependence othersubstaneeprpb.lems!n oldeLadMlt? Chapter, References

Significant substance abuse occurs in older people, although the scope of the problem has only been appreciated recently. (l,2) Alcohol, tobacco, and prescribed benzodiazepines are the substances that ageing people are most likely to use in a manner that produces dependence. Terms used in the addictions field often can be ambiguous and confusing; a glossary of definitions of terms as they are used here is presented in Boxl. Changes in pharmacodynamics and pharmacokinetics associated with ageing increase the effects of many psychoactive substances, but there is no evidence of increased dependence liability with age for alcohol, benzodiazepines, or opioids.(3) Risk factors for substance problems in later life are outlined in Table l. Screening for substance use and problems should be part of the routine evaluation of older patients. Biomedical presentation of substance abuse is more common in this population and for that reason the substance problem is more likely to remain unrecognized in elderly people.

Table 1 Risk factors for substance abuse in elderly people

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