Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

18. Alcoholism and Substance Abuse in Older Adults 397(Zimberg, 1996). The availability of treatment services is further complicatedby the lack of knowledge of addictive disorders among primary care physiciansand geriatric specialists, and the reciprocal lack of knowledge of aging-relatedproblems among addiction specialists.In this chapter, I discuss the prevalence of alcoholism and prescriptiondrug abuse among elderly persons, diagnostic approaches, and therapy directedat the maladaptations to aging that often lead to alcohol and prescription drugmisuse. In addition, I present a section on the recognition and treatment ofelderly alcoholics admitted to general hospitals, since so many such patients areoften not diagnosed and not treated or are inappropriately treated.PREVALENCE OF ALCOHOLISM AND PRESCRIPTION DRUGMISUSE IN ELDERLY PEOPLEPrevalence studies of alcoholism in elderly people in the community have beenreported in the range from 4 to 20% (Atkinson, Ganzini, & Bernstein, 1992;Bridgewater, Leigh, James, & Potter, 1987; Cahalan, Cisin, & Crossley, 1969).A study in the Washington Heights area in Manhattan indicated an alcoholismrate of 105/1000 residents among elderly widowers (Bailey, Haberman, &Alksne, 1965). The researchers asked questions about problems associated withdrinking rather than quantity–frequency questions, which often give unreliableinformation. The elderly widowers had the highest rates of alcohol problemsfound. Another community-based study of United Automobile Workers in Baltimorefound that 10% of men and 20% of women over age 60 were heavyescape drinkers and considered to be alcoholics (Siassi, Crocetti, & Spiro,1973).In studies in primary care settings, outpatient treatment, medical and psychiatricinpatient treatment, and emergency rooms, elderly patients show ratesof alcoholism in the 15 to 20% range (Adams, Barry, & Fleming, 1996; Adams,Magruder-Habid, Trued, & Broome, 1992; Adams, Zhung, Barhoriak, & Rimm,1993; McCusker, Cherubin, & Zimberg, 1971; Moore, 1972; Zimberg, 1969). Aparticularly significant study of hospital admissions under Medicare showedthat elderly patients with alcoholism or alcohol-related medical conditionswere admitted at a rate of 48 per 10,000 population, similar to the rates ofadmission for myocardial infarction for this age group (Adams et al., 1993).As indicated previously, illicit drug use of heroin, cocaine, marijuana, andother substances is relatively rare. The major concern, however, is with prescriptionand over-the-counter drug misuse and abuse. Many elderly individualsare on multiple prescription drugs, at times supplemented by over-the-counteranalgesics, antihistamines, laxatives, cold preparations, and sedatives. Thesemultiple drugs can produce side effects through interactions and can causeproblems for elderly people who are using and abusing alcohol. Confusion with