The International journal of the addictions最新文献

Recent research suggests that older adults with alcohol problems often drink in response to loneliness, depression, and poor social support networks. Although a variety of approaches such as psychodynamic, Twelve Step, social support, behavioral, and cognitive-behavioral, have been suggested, only those studies involving behavioral and cognitive-behavioral interventions have provided empirical support for treatment effectiveness. Some research also suggests that age-specific group treatment produces better outcomes than when older adults are placed in treatment with younger alcoholics.

Debates over the prevalence of elderly illicit drug addicts in the population divert our attention from this group as a viable study population. Due to their decelerated lifestyle, low crime rates, and our attitudes toward the elderly as nonstreet drug users, they are likely to remain hidden from the public eye. This paper reviews past trends in drug misuse among the elderly, the lifestyle of those addicted to drugs, the complications associated with drug misuse and aging, and the problems that the elderly face with traditional treatment programs. Given our aging society, is the study of elderly street addicts and users an important area of concern?

Alcoholism may lead to a great many physical and mental problems in individuals of any age. Elderly alcoholics often have additional problems resulting from the interaction of age related changes in physiology and "heavy" alcohol intake. Some of the more important problems are: Impairment of the immune system with decreased ability to deal with infection or cancer. Increased incidence of hypertension, cardiac arrhythmia, myocardial infarction, and cardiomyopathy. Increased incidence of stroke. Alcohol dementia. Increased incidence of esophageal and other cancers. Cirrhosis and other liver disease. Malnutrition. There seems to be no area in which even moderate alcohol intake is of definite benefit, and some areas in which even small amounts are detrimental.

The misuse of alcohol or drugs is a common and frequently neglected problem among nursing home residents. The misuse of prescription medications is particularly prevalent, but tobacco, alcohol, and illicit drugs are all subject of misuse by nursing home residents. This article reviews the epidemiologic and clinical aspects of substance misuse in nursing homes, including alcohol, illicit drugs, tobacco, and pyscho-active medications. Regulations regarding the prescription of psycho-active drugs in nursing homes is also discussed.

A literature review reveals that research is warranted to improve screening for "alcohol abuse" in older adults and women. An examination of diagnostic criteria for "alcohol abuse dependence" reveals that older adults provide unique challenges to classification systems. There is a need to evaluate the sensitivity and specificity of several new screening instruments for the identification of "alcohol abuse" in the elderly. Routine screening of elderly and women presenting in primary care settings should be a priority for researchers and clinicians.

The prevalence of alcohol use and misuse declines with age, but misuse remains an important public health problem among older people. Between 2 and 4% of the United States elderly population meet DSM-III criteria for "alcohol abuse" or dependence. Up to 10% are "heavy" or problem drinkers. Alcohol use and misuse are both more common among men than women. Since the elderly population is expanding, we will see an increase in the absolute number of older problem drinkers over the next few decades even if the prevalence of problem drinking remains constant. It is incumbent on health care providers and administrators to plan for the prevention and treatment of alcohol problems among these people.

The age of onset of alcohol-related problems is a typology that is gaining prominence among clinicians. Findings from epidemiological studies suggest that there are a significant number of older alcoholics who first begin to drink alcohol "abusively" in their later years. While few demographic differences appear between late onset and early onset alcoholics, a number of studies have reported clinical differences between these groups that may affect the natural course and treatment outcome of the illness.