Substance Use and Older People

Contributors xvii Foreword xxi Introduction xxiv List of Abbreviations xxvi Section 1 Legal and ethical aspects of care for older people with substance misuse 1 1 Negotiating capacity and consent in substance misuse 3 Kritika Samsi Introduction 3 Substance abuse and capacity 3 Mental capacity legislation 4 Mental Capacity Act 2005 4 Capacity assessment 5 Capacity and unwise decisions 6 Consent, barriers to decision making and substituted decision making 6 Best interest decisions 8 Independent decision makers 8 Conclusion 9 References 9 2 Elder abuse 11 Jill Manthorpe Introduction 11 Defining elder abuse 11 Main reviews 12 Alcohol and substance misuse risk factors 12 Risk factors among older people 13 The effects of elder abuse 14 Discussion 15 Conclusions and next steps 15 References 16 3 The United States perspective 18 Cynthia M.A. Geppert and Peter J. Taylor The ageing of the baby boomers and its impact on substance abuse 18 Ethical and legal aspects of substance misuse in older adults 19 Confidentiality 19 Informed consent 20 Capacity 21 Coercion 24 Conclusion 25 References 25 4 The European perspective 27 Abdi Sanati and Mohammed Abou-Saleh Introduction 27 Use and possession 28 Crime 28 European Convention of Human Rights 28 Delivering services for the elderly with substance misuse ethical aspects 29 Research and development 30 Policy making 31 Some differences between Europe and the USA 31 Ethical issues regarding treatment 32 Stigma 32 Underprescribing controlled drugs 32 Summary 33 References 34 5 Clinical medicine and substance misuse: research, assessments and treatment 35 Amit Arora, Andrew O Neill, Peter Crome and Finbarr C. Martin Introduction 35 Why is clinical medicine important? 36 Identification 37 The health effects of substance abuse 39 Challenges for the future 46 Research 47 Identification tools 47 Training and support 48 Conclusions 49 References 49 Section 2 Epidemiology and demography 57 6 Cigarette smoking among adults aged 45 and older in the United States, 2002 2011 59 Shanta R. Dube and Li-Tzy Wu Introduction 59 Evaluation methodology 61 Results 62 Sociodemographic characteristics of older adults: 2002 versus 2011 62 National trend in current smoking prevalence: 2002 2011 65 Current smoking prevalence by socioeconomic status: 2002 versus 2011 66 Adjusted odds ratios of correlates of current smoking: 2002 versus 2011 66 Discussion 71 Conclusion 72 References 73 7 Epidemiology and demography of alcohol and the older person 75 Stephan Arndt and Susan K. Schultz Introduction 75 Main reviews 76 Epidemiological estimates of prevalence of alcohol use 76 Estimates of alcohol problems based on amount of drinking 76 Importance of threshold selection for defining problem use 80 Estimating problem use from survey samples 80 Summary of epidemiological estimates 81 Specific problematic drinking behaviours: binge drinking 81 Diagnoses of abuse or dependence 83 Older substance abuse treatment populations 84 Special populations of older substance users 85 Demographic correlates of problem use 86 Discussion 87 Conclusions and next steps 87 References 88 8 Epidemiology and demography of illicit drug use and drug use disorders among adults aged 50 and older 91 Shawna L. Carroll Chapman and Li-Tzy Wu Introduction 91 Survey studies 92 Studies of treatment-seeking or clinical patients 101 Health implications 104 Discussion 105 Next steps 106 References 106 9 Epidemiology and demography of nonmedical prescription drug use 109 Jane Carlisle Maxwell Introduction 109 Findings 110 National surveys 110 Emergency department cases 112 Treatment admissions 113 Drug poisoning deaths 114 Discussion 116 Conclusions 118 Acknowledgement 118 References 118 Section 3 Longitudinal studies of ageing and substance abuse 121 10 Ageing and the development of alcohol use and misuse 123 Marja Aartsen Background 123 Results 124 Differences in alcohol use across cohorts 125 Developments in alcohol use within people 126 Gender differences 126 Different trajectories 126 Age and onset of problem drinking 127 Discussion 127 Explanations for age differences in alcohol use 127 Conclusions 128 References 129 11 Progression from substance use to the development of substance use disorders 133 Carla L. Storr and Kerry M. Green Introduction 133 Substance use progression process 134 Risk factors influencing substance use progression 137 Individual factors 137 Substance properties 139 Environmental influences 140 Future direction 141 Conclusions 143 Acknowledgement 144 References 144 12 Psychopharmacology and the consequences of alcohol and drug interactions 149 Vijay A. Ramchandani, Patricia W. Slattum, Ashwin A. Patkar, Li-Tzy Wu, Jonathan C. Lee, Maitreyee Mohanty, Marion Coe and Ting-Kai Li The extent of alcohol and drug misuse among older adults 149 Substance misuse in the general population 149 Substance misuse or addiction in clinical settings 150 Co-morbidities among older substance misusers 151 Psychopharmacology of alcohol and drug misuse in older people 152 Neurocircuitry of abused substances 152 Alcohol drug interactions in older adults 155 Mechanisms of alcohol medication interactions 156 Significance of the problem 156 Concurrent use of alcohol and potentially interacting medications 157 Consequences of concurrent use of alcohol and medications 158 Clinical presentation and evaluation of substance use disorders in the elderly 158 Clinical presentations (case vignettes) 159 Medical co-morbidities 161 Screening for substance use disorders 161 Evaluation of substance use disorders 162 Cognitive impairment in the elderly with substance use disorders 163 Safety assessment of the elderly with substance use disorders 164 Medications for individuals with substance use disorders 164 Conclusions 166 References 166 Section 4 Comprehensive geriatric assessment and special needs of older people 171 13 Comprehensive geriatric assessment and the special needs of older people 173 Dan Wilson, Stephen Jackson, Ilana B. Crome, Rahul (Tony) Rao and Peter Crome Background 173 Assessment 175 Setting 176 Barriers to assessment 176 High-risk groups 177 Presenting problems 177 Collateral information 178 General principles of assessment 179 Screening 182 Psychiatric assessment 183 Case presentations 184 Driving and substance misuse 184 Older women and alcohol misuse 184 Polysubstance misuse 185 The frequent attender 185 Alcohol and cognitive impairment 186 Pain and substance misuse 187 Discussion 187 Conclusion 187 References 188 Section 5 Screening and intervention in health care settings 193 14 Screening and brief intervention in the psychiatric setting 195 M. Shafi Siddiqui and Michael Fleming Overview 195 Screening and assessment for alcohol use disorders 197 Single question screen for an alcohol use disorder 197 Quantity and frequency questions 198 Proxy questions such as CAGE 198 Symptoms of abuse or dependence 199 Alcohol biomarkers 199 Illicit drugs 202 Rationale for screening older adults for marijuana, cocaine and other illicit drugs 202 Screening for illegal drugs in the psychiatric setting 202 Recommended screening questions to detect drug use 202 Screening for drug abuse/dependence 203 Screening for illicit drug use with toxicology screening 203 Prescription drug abuse 204 Rationale for screening older adults 204 Screening for prescription drug abuse 205 Brief intervention for alcohol, prescription drug abuse and illegal drug use 206 Summary 208 References 209 15 Tobacco use cessation 212 Daniel J. Pilowsky and Li-Tzy Wu Introduction 212 Smoking cessation interventions among older adults 214 Multimodal interventions 214 Medication-based interventions 216 Counselling and behavioural interventions 217 Physician-delivered interventions 217 Other interventions 218 Conclusions 218 References 219 Section 6 Use of substance abuse treatment services among older adults 223 16 Epidemiology of use of treatment services for substance use problems 225 Shawna L. Carroll Chapman and Li-Tzy Wu Introduction 225 Tobacco cessation service use and characteristics 225 Alcohol treatment use and characteristics 230 Trend in substance abuse treatment admissions 238 Drug abuse treatment use and outcomes 243 Substance abuse treatment in general health care settings 245 Discussion and conclusion 246 References 247 17 Implications for primary care 249 Devoshree Chatterjee and Steve Iliffe Background 249 Implications for primary care 249 Different populations at risk 250 Screening in primary care 251 Scale of benefit 252 Co-morbidities and social context 252 Conclusions 253 References 253 18 Addiction liaison services 255 Roger Bloor and Derrett Watts Introduction 255 Organizing an addiction liaison service to a general hospital 256 Case vignette 1 256 Addiction liaison services for older adults 257 Essential elements of liaison service provision for older adults 258 Screening for alcohol problems in older adults 259 Screening for drug use problems 260 Case vignette 2 260 Summary 261 References 262 19 Current healthcare models and clinical practices 265 Rahul (Tony) Rao, Ilana B. Crome, Peter Crome and Finbarr C. Martin Introduction 265 An ageing population 265 Service development and provision 266 Integrated care and workforce development 267 Conclusions and recommendations 269 References 269 Section 7 Age-specific treatment interventions and outcomes 271 20 Pharmacological and integrated treatments in older adults with substance use disorders 273 Paolo Mannelli, Li-Tzy Wu and Kathleen T. Brady Introduction 273 Tobacco 274 Alcohol 275 Opioids 277 Benzodiazepines 278 Other substances of abuse 280 Stimulants 280 Cannabis 281 Integrated treatments 281 Conclusion and future directions 284 References 285 21 The assessment and prevention of potentially inappropriate prescribing 295 Denis O Mahony Introduction 295 Inappropriate psychotropic use in elderly patients 296 Implicit IP criteria 297 Explicit IP criteria 298 Applying STOPP/START criteria as an intervention 299 Other methods of detection and prevention of IP in older people 307 Comprehensive Geriatric Assessment (CGA) 307 Pharmacist review and intervention 308 Prescriber education, audit and feedback 308 Computerized provider order entry with clinical decision support 309 Conclusions 309 References 310 22 Age-sensitive psychosocial treatment for older adults with substance abuse 314 Kathleen Schutte, Sonne Lemke, Rudolf H. Moos and Penny L. Brennan Introduction 314 Seven characteristics of age-sensitive treatment 316 1 Supportive and nonconfrontational 316 2 Flexible 316 3 Sensitive to gender differences 317 4 Sensitive to cultural differences 317 5 Focus on client functioning 318 6 Holistic 319 7 Focus on coping and social skills 319 Six components of age-sensitive psychosocial treatment 320 1 Biopsychosocial assessment 320 2 Treatment planning 321 3 Attention to co-occurring conditions 322 4 Referrals and care coordination 325 5 Empirically-supported psychosocial interventions 325 6 Adjuncts to psychosocial interventions 328 Age-segregated or mixed-age treatment 329 Future directions 330 Acknowledgements 331 References 332 23 Integrated treatment models for co-morbid disorders 340 Rahul (Tony) Rao Introduction 340 Methodological approach to examining SMCD in older people 341 A. Current systems of care for substance misuse and mental disorders 341 B. Service implications 342 C. Principles underlying integrated treatment models for SMCD in older people 342 D. Developing integrated treatment models for older people with substance misuse and co-morbid psychiatric disorders 344 E. Research evidence for integrated treatment models 346 Future direction and challenges 347 References 347 Section 8 Policy: proposals for development 351 24 Proposals for policy development: drugs 353 Susanne MacGregor Introduction 353 Recognition of a need or problem and arguments made to justify the development of policy 354 Policy options 356 Policy design and implementation 359 Conclusion 360 References 360 25 Proposals for alcohol-related policy development United States 364 Ralph Hingson and Ting-Kai Li Recommended low-risk alcohol consumption levels 364 Traffic crash risks among the elderly 365 Driving policy questions 365 Factors to consider when contemplating legal policies 365 Summary and conclusions 369 References 370 26 Proposals for policy development: tobacco 372 Michael Givel Introduction 372 Past and present approaches to reduce tobacco consumption 372 Phase three anti-tobacco efforts 373 Legal approach 373 Regulatory and tobacco tax approaches 374 Anti-tobacco counter-marketing campaigns 376 Recent anti-tobacco proposals 376 Product modification and safer cigarettes 376 Harm reduction 377 Cigarette neo-prohibitionism 377 Smoke-free movies 377 Policy proposals to further reduce tobacco prevalence 378 References 378 27 Recommendations 383 Ilana B. Crome, Peter Crome, Rahul (Tony) Rao and Li-Tzy Wu Background 383 Epidemiology 384 Clinical presentations 384 Education and training 385 Who gets treatment treatment interventions 386 Concluding remarks 386 Index 388

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• Doença e dependência: aspectos sociais
• Grupos etários: idosos