Addiction in the Older Patient

This text focuses on the under-recognized and undertreated problem of addiction in later life. The widespread lack of clinical knowledge about this patient population can be traced to several sources: the systematic exclusion of older individuals from clinical trials; their reluctance to seek medical help owing to stigma and shame; the fact that additive disorders may be disguised by concurrent medical conditions; a lack of screening instruments tailored to an older population; and the low sensitivity of standard diagnostic criteria for detecting addiction in middle-aged and elderly adults who do not display the occupational and legal "red flags" seen in younger individuals. This volume provides the reader with a clear sense of the surprisingly high prevalence of alcohol and substance use disorders in older adults. For each of the major classes of addictive substances, both prescribed and illicit, this book highlights the key clinical issues that can complicate successful diagnosis. The authors describe strategies for initial engagement with the patient, including screening instruments, brief interventions which can be adapted to a primary care setting, emerging web-based and mobile technologies, and treatment strategies which are tailored to the age-appropriate needs of older adults, including older women - who have been found to be especially vulnerable to prescription drug misuse. With the aging of the baby boomers, a generation arriving in middle-age with greater exposure to alcohol and drugs than any previous cohort, the need for successful identification and effective treatment of alcohol and substance use disorders in later life has become a clinical imperative. Addiction in the Older Patient, whose editors bring more than 40 years of combined research and clinical experience in the field of addiction treatment, offers a comprehensive introduction to this underexplored and timely topic. This text synthesizes current clinical evidence to support the most effective strategies for discovering and treating addictive disorders in our older patients.

Table of Contents

1. Introduction
Maria Sullivan, Frances R. Levin
2. Recognizing Addiction in Older Patients
Anna Levesque and Edward Nunes
3. Brief Interventions for Substance Use Disorder in Older Adults
Roland C. Merchant and Francesca L. Beaudoin
4. Alcohol and Older Adults
Anna Terajewicz LaRose and John Renner
5. Abuse of Opioids and Prescription Medications
Isis Burgos-Chapman, Louis Trevisan, and Kevin Sevarino
6. Cannabis, Nicotine, and Stimulant Abuse in Older Adults
Christina A. Brezing and Frances R. Levin
7. Benzodiazepines and Other Sedative-Hypnotics in the Older Adult
Arthur Robin Williams and Olivera J. Bogunovic
8. Assessment of the Older Patient
Rahul Rao and Ilana Crome
9. Sex Differences in Late-life Substance Use Disorders
Elizabeth Evans and Maria Sullivan
10. Treatment Options for Older Adults with Substance Use Disorders
Stacy A. Cohen, Margaret M. Haglund, and Larissa J. Mooney
11. Technology-based Interventions for Late-Life Addiction
Ersa Alagoz, Kim Johnson, Andrew Quanbeck, and David Gustafson Jr.
12. Conclusion
Maria Sullivan

Edited by Dr Maria Sullivan, Associate Professor of Clinical Psychiatry, Columbia College of Physicians and Surgeons/New York State Psychiatric Institute, New York, NY, and Edited by Dr Frances Levin, Kennedy-Leavy Professor of Clinical Psychiatry, Columbia University, New York

Dr. Sullivan graduated from Harvard University, received her medical degree from George Washington University, and a doctorate in Psychology from the University of Chicago. She completed her Psychiatry Residency and Fellowship in Addiction Psychiatry at the New York State Psychiatric Institute/Columbia University. She serves as Medical Director, Clinical Research and Development, at Alkermes, Inc. and is an Associate Professor of Clinical Psychiatry at Columbia University. Dr. Sullivan has been a Principal Investigator on several NIDA-funded trials focused on the development of novel medications and therapies for opioid dependence. She has served as Scientific Review Committee member for NIAAA and NIDA, and has been a reviewer for several scientific journals. Dr. Sullivan is the former Chair, Clinical Expert Panel, Providers' Clinical Support System for Medication-assisted Treatment (PCSS-MAT), a SAMHSA-sponsored national training and mentoring initiative focused on increasing access to pharmaco

Frances R. Levin, M.D. is a board-certified psychiatrist with a subspecialty certification in Addiction Psychiatry. She is the Kennedy-Leavy Professor of Psychiatry at Columbia University Medical Center and Chief of the Division on Substance Abuse at the New York State Psychiatric Institute. Since 1998 she has served as the Director of the Addiction Psychiatry Residency program at New York Presbyterian Hospital/Columbia University Medical Center.