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Substance Use Disorders in Late Life

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Geriatric Psychiatry

Abstract

In older populations, substance use disorders are highly prevalent, often underdiagnosed and undertreated, and are associated with significant systemic medical and psychiatric comorbidity. Diagnostic criteria for substance use disorders have changed with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, and these updated criteria are reviewed here. Furthermore, the epidemiology and proposed etiology of substance use disorders in late life are discussed. A particular focus is placed on reviewing the role of the psychiatrist in the evaluation and management of older adults with substance use disorders, especially when chronic pain is part of the clinical picture. Recommendations for evaluation and management of older adults with (or suspected to have) substance use disorders are outlined, and two case examples are provided to further solidify these concepts.

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Notes

  1. 1.

    The concept of a pain syndrome can be broadly defined and may encompass chronic pain (pain lasting over 6 months) whose genesis was rooted in an acute pain episode (e.g., hip fracture) to a somatic symptom disorder, with predominant pain. This latter diagnostic concept (previous to DSM-5 known as “pain disorder”) is defined as a somatic symptom disorder (see DSM-5) whose somatic symptoms predominantly involve pain. Oftentimes, the boundaries between these entities can be blurry and may require significant attention and effort to parse out.

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Authors and Affiliations

  1. Behavioral Health and Recovery Services, San Rafael, CA, USA

    Jeffrey DeVido MTS, MD

  2. Division of General Medicine, University of California Davis Medical Center, Sacramento, CA, USA

    Calvin H. Hirsch

  3. Medical Science Graduate Program, McMaster University, Hamilton, ON, Canada

    Nitika Sanger

  4. McMaster University, Hamilton, ON, Canada

    Tea Rosic & Zainab Samaan

  5. Baylor Scott and White Department of Psychiatry, Texas A&M University College of Medicine, Temple, TX, USA

    James A. Bourgeois

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  1. Jeffrey DeVido MTS, MD
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  2. Calvin H. Hirsch
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  3. Nitika Sanger
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  4. Tea Rosic
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  5. Zainab Samaan
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  6. James A. Bourgeois
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Correspondence to Jeffrey DeVido MTS, MD .

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Editors and Affiliations

  1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

    Ana Hategan

  2. Baylor Scott and White Department of Psychiatry, Texas A&M University College of Medicine, Temple, Texas, USA

    James A. Bourgeois

  3. Division of General Medicine, University of California Davis Medical Center, Sacramento, California, USA

    Calvin H. Hirsch

  4. Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, Sacramento, California, USA

    Caroline Giroux

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DeVido, J., Hirsch, C.H., Sanger, N., Rosic, T., Samaan, Z., Bourgeois, J.A. (2018). Substance Use Disorders in Late Life. In: Hategan, A., Bourgeois, J., Hirsch, C., Giroux, C. (eds) Geriatric Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-67555-8_16

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