Young adults, Black adults, men, and uninsured people were less likely to receive services compared to their peers. In recent years, the number of senior citizens seeking addiction treatment in the United States has skyrocketed. The number of adults aged 55 and over who sought out addiction treatments increased by more than 50 percent between 2009 and 2020. This alarming statistic shows that substance use disorders do not discriminate and can affect any population, including older adults.

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• When considering referral for treatment, first consider the client’s thinking abilities.
• If a client marks two or more items on the SMAST-G with a “yes” response, that suggests potential alcohol misuse.332 The SMAST-G is available in the Chapter 3 Appendix.
• Working with clients in this population can certainly create a lot of frustration, burnout, and compassion fatigue.
• Are taking alcohol-interactive prescription medications, especially psychoactive prescription medications (e.g., opioid analgesics, benzodiazepines).

A full assessment of sleep should include an assessment for sleep apnea, which may involve an in-home or in-clinic overnight sleep study. Sleep problems that result from a physical condition or medication can usually be treated by addressing the medical illness and by switching medication or adjusting the dose. Consequences of substance misuse that might get clients to change (e.g., elevated blood pressure, worsening acid reflux symptoms, increased risk of falls). The most important parts of your full assessment are gathering information about the client’s substance use, mental health, physical health, and SUD treatment histories, as well as a listing of prescribed and OTC medications. Clients will feel safe sharing detailed information as their trust in you builds. Referrals to SUD treatment programs or mental health services for clients who need more indepth assessment or intervention.

Substance Use in Older Adults DrugFacts

The section on health history and the physical exam discusses disordered sleep and pain because these are common physical conditions seen in older people who misuse substances. But other health and physical assessments may be needed beyond what is listed in that section. If a cognitive screener is positive, you should refer the client for further testing by a behavioral health service provider with special training in diagnosing clients with dementia and MCI. Making such diagnoses requires additional, indepth cognitive testing.

Chapter 3 Resources

Instructions for how to give the Timed Up & Go are available online (/steadi/pdf/TUG_Test-print.pdf). If you answered “yes” to any of these questions, you may want to assess the client for fall risk. The home environment substance abuse in older adults in which a person was raised—specifically, whether the client was exposed to substance use in the household during childhood. Remember the importance of helping clients feel safe physically and emotionally.

Brief Assessments

A medical staff member may take a medical history and perform a physical exam. Nurses or occupational therapists, rather than behavioral health service providers, usually give assessments of ADLs and fall risk. If your program does not have any medical staff members, you should refer clients elsewhere for this part of the assessment. A physician, nurse, or pharmacist may be consulted to determine risk for medication misuse, whether accidental or intentional. 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). This part of the assessment also sometimes includes biological screening measures, like urine screens (for benzodiazepines and opiates), breath alcohol testing (i.e., breathalyzer), and laboratory tests.

Risk Factors for Substance Use Disorders in Older Adults

Screen all women who seek SUD treatment for intimate partner abuse, regardless of their age.512 Substance use increases the risk of abuse toward older adults,513 and experiencing elder abuse can contribute to substance misuse among older adults. If you suspect an older adult is misusing substances, screen for elder abuse. Positive screens for substance misuse require follow-up, but next steps may not be immediately clear. Decisions about follow-up care depend on how much time and effort you can expend, how much training and experience you have in drug and alcohol counseling, and your program’s treatment abilities. Also essential are the client’s agreement, engagement level, and preferences.

Substance Abuse & Seniors: How Addiction Impacts Older Adults Differently

Before sharing sensitive or personal information, make sure you’re on an official state website. If you have several of these signs and symptoms and they last for more than two weeks, talk with your doctor. If left untreated, serious depression may lead to death by suicide.

Resources for Older Adults