Substance misuse in older people

aaIn this blog, Professor Ilana Crome offers an introduction to the Royal College of Psychiatrists’ new information guide on substance misuse in older people; an editorial about the guide  by Prof. Crome appears in the July issue of Age and Ageing.

In 2015 the Royal College of Psychiatrists produced an Information Guide on the management of older substance misusers. This is in recognition of the rising numbers of older people in our communities and the increase in their use of substances. Older people appear as motivated to reduce or abstain – if not more so – than their younger counterparts. The health care system is unprepared for this problem partly because it is an invisible epidemic.

The basic premise of the Guide is that age should not be a barrier to treatment, and older people should be offered treatment of proven effectiveness in the adult population, but adapted to their needs and monitored by a multidisciplinary team expert at the management of addiction and older people. It aims to outline the key practical components for intervention.  All substances are considered, as well as the comorbid conditions that may require treatment in addition to that for substance misuse. Thus it provides an overview of general and specialist clinical guidance in the assessment, treatment and care for older people with substance problems. It includes assessment, psychosocial interventions, supporting families and carers, as well as legal and ethical considerations.

Specialist approaches to substance misuser are outlined, including the physical and psychiatric presentations, management of withdrawal in the community and support for those with alcohol related brain injury. Alcohol misuse in older women, driving in older people with substance misuse and recovery are discussed.

Recommendations for greater enrolment of older people in treatment studies which are long term are made so that coordinated service developments can offer a choice of acceptable and effective interventions. This topic is of relevance to addiction specialists and specialists in the needs of older people as well as generalists: doctors, geriatricians, psychiatrists, psychologists, nurses, pharmacists, commissioners, policy makers, educators and researchers.

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