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

398 IV. SPECIAL POPULATIONSdrug effects, complicated by drug–drug interactions, is a major part of the problemin diagnosing alcohol dependence or abuse in elderly people (Schuckit,1979).The class of drugs most subject to misuse and abuse is the benzodiazapines.These drugs are prescribed for anxiety and depression; however, their liabilityto tolerance and dependence creates problems for patients, and demands areoften made on the prescribing physicians to give more. These drugs also causecognitive impairments and confusion that suggest dementia. It is particularlyproblematic when benzodiazepines are also used with alcohol, and by thosewith alcohol problems. Such a combination of benzodiazepines and alcohol useis common and often complicates treatment of the alcohol problem. Benzodiazepinesrepresent the most widely used psychiatric prescription drugs amongelderly patients in primary care and psychiatric settings, and can cause problemsby leading to organicity, drug interactions, and addiction. Their use, with theliabilities indicated, creates more problems than they solve and is particularlyinappropriate when other drugs, such as selective serotonin reuptake inhibitors,have been found to be safe and effective in geriatric patients with anxiety anddepression (Kennedy, 2000; Rigler, 2000; Zimberg, 1995), and their use is preferableto benzodiazepines in most cases.TYPOLOGY AND DIAGNOSIS OF ELDERLY ALCOHOLICSTypologyWork done more than two decades ago by Simon, Epstein, and Reynolds(1968) and Gaitz and Baer (1971) found distinctions between elderly alcoholics,with and without organic mental syndromes, and also typed an early- versuslate-onset typology. These authors suggested that the patients with significantorganic deficits did poorly in treatment and died at an earlier age. Simon andcolleagues also noted that in the psychiatric inpatient population of elderly personsthey studied, 23% had alcohol problems; 16% became alcoholic before age60, and 7% after age 60. Rosin and Glatt (1971) had similar findings andshowed that the early-onset group had personality characteristics similar toyounger alcoholics, whereas the late-onset group developed drinking problemsin reaction to bereavement, depression, retirement, loneliness, and physical illness.They suggested that late-onset alcoholism was related to the stresses ofaging.In my work with elderly alcoholics (Zimberg, 1974), I found this typologyto exist in the elderly patients I encountered in mental health clinics, homecare programs, nursing homes, senior citizen centers, and inpatient medical servicesin general hospitals. It was also noted that the early-onset group experiencedserious stresses of aging, and that reaction to these stresses perpetuateddrinking problems as the group aged (Schonfeld & Dupree, 1991).