Drug misuse in older people: old problems and new challenges

Abstract

SummaryVery little attention has been paid to the invisible epidemic of substance misuse among older people in the UK. This article looks at the prevalence of substance misuse in the people over the age of 60. The reasons for difficulty in diagnosing substance misuse are explored and ways to improve diagnostic ability are discussed. Substance misuse leads to severe physical and psychiatric morbidity that is being managed by meagre resources. The article provides recommendations on specific issues related to interventions, biological and psychosocial, and training of psychiatrists.

Older-adult marijuana users and ex-users: Comparisons of sociodemographic characteristics and mental and substance use disorders

“…(3) Past-year users also had extremely high rates of past-year other drug, alcohol, and tobacco/nicotine use disorders, demonstrating that a significant proportion of older marijuana users engage in and are at risk for a variety of substance use problems that can compromise their physical as well as their mental health. Polysubstance use/misuse among older marijuana users is a serious concern as it increases risks for health problems, such as respiratory/pulmonary disease from smoking both tobacco and marijuana as well as drug, including prescription drug, interactions (Badrakalimuthu et al, 2010;Gordon et al, 2013;Tan et al, 2009).…”

Maturing out, natural recovery, and dual diagnosis: What are the implications for older adult mental health services?

“…As discussed earlier in this paper, the under‐diagnosis of substance use disorders in older adults is rife in health care (Badrakalimuthu et al . ). It is essential that, as clinicians, we move towards a default position of screening every individual, particularly in older adult mental health services, where the incidental discovery of psychiatric problems could occur in other settings (Loukissa ).…”

“…This situation has led not only to a lack of contemporary research regarding older adults with a dual diagnosis, but arguably a shortage of clinical skills in mental health nurses who are required to care for this population; very few older adult‐specific AOD treatment services exist, and the screening and detection of substance use in this population is demonstrated to be poor (Badrakalimuthu et al . ; Bright et al . ).…”

“…Arguments for the lack of treatment options typically revolve around the perceived insignificance of the older population in regards to numbers presenting to health services, a belief that long‐term substance use leads to early mortality, and a general opinion that screening older adults for AOD use is pejorative (Badrakalimuthu et al . ; Bartels & Naslund ; Benshoff et al . ; Crome et al .…”

Cannabis matters? Treatment responses to increasing cannabis presentations in addiction services in England

“…These individuals are often younger and are more likely to be working and in stable housing. We need to ensure that provision for these individuals is tailored and responsive (HM Government, 2010:6) There has been growing interest in the demographic changes in drug use, and the potential impact this will have on successful treatment outcomes (Badrakalimuthu et al 2010, Gowing et al 2015. The Royal College of Psychiatrists (2011) recently examined this issue making a number of recommendations including the need for the 'examination of trends in the extent, nature and predictors of substance use problems in older people'.…”