Dual Diagnosis in Older Adults: A Review

Abstract

Dual diagnosis is associated with frequent relapse, poor treatment engagement and overall unsatisfactory treatment outcomes. A comprehensive review of the contemporary literature examining this issue was conducted, finding a paucity of literature concerning dual diagnosis in older adults. Of the literature appraised for this review, a number of studies examined US Veteran's Affairs populations, which were largely male. Studies concerning older mental health populations were scarce. During the literature search, a number of background studies that influenced contemporary research regarding dual diagnosis in older adults were found; these studies were examined regarding their contribution to contemporary paradigms concerning older adults with co-occurring mental illness and substance use disorders. This review presents the results of the contemporary literature concerning dual diagnosis in older adults. Several recurring themes emerge from the literature, including the notion of a statistically small population that, in absolute terms, represents a sizeable number of individuals coming to the attention of aged mental health services in the future. Additionally, the potential for under-diagnosis in this cohort is highlighted, potentially creating a hidden population of older adults with dual diagnosis.

Point Prevalence and Patterns of Mental Health Comorbidity Among People Accessing Australia's First Older Adult–Specific Alcohol and Other Drug Treatment Service

“…Previous audits found 38% of patients meeting the DSM-III-R criteria for Substance Abuse also reported similar rates of depression among patients with a dual diagnosis; however, rates of dementia were higher in that population (Blixen et al, 1997). Despite other studies' methodological limitations, being younger was a common factor in people accessing psychiatric services with a dual diagnosis (Searby et al, 2015). The prevalence of dual diagnosis in Searby et al (2015) was higher than Rosen et al (2008), with participants receiving opiate replacement maintenance therapy; however, the most common diagnoses were similar.…”

“…This suggests there is the potential for the proportion of older Australians with dual diagnosis to increase. There is a need for greater understanding of dual diagnosis among older adults, in light of a paucity of research into dual diagnosis among this age group compared to others (Searby, Maude, & McGrath, 2015).…”

Addiction and Mental Health Across the Lifespan: An Overview of Some Contemporary Issues

“…It is therefore encouraging to see the development of a recovery-oriented clinical tool to plan treatment and monitor progress toward dual recovery (see Noel, Woods, Routhier, & Drake, 2016) Several reviews have also been undertaken. The following are some examples, and the list is in no way complete, but reviews include a systematic review of course and treatment of substance use disorder among people with first-episode psychosis (Wisdom, Manuel, & Drake, 2011), an extensive review of current psychosocial approaches to dual diagnosis (Drake & Mueser, 2000), a review of integrated mental health and substance abuse treatment for patients with dual disorders (Drake et al, 1998), a review of treatments for people with severe mental illnesses and co-occurring substance use disorders (Drake, Mueser, Brunette, & McHugo, 2004), an empirical, systematic and Cochrane review of psychosocial treatments for people with co-occurring severe mental illness and substance misuse (Cleary, Hunt, Matheson, & Walter, 2009;Horsfall et al, 2009;Hunt et al, 2013), a review of dual diagnosis in older adults (Searby, Maude, & McGrath, 2015).…”

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

“…Additionally, the incidental discovery of AOD use might occur as individuals are referred for other medical or mental health issues (Searby et al . ). This is particularly evident in general hospital settings, where consultation liaison nurses might receive referrals as older adults are admitted for medical problems or injuries related to AOD use (Salmon & Forester ; Weintraub et al .…”