Substance abuse in older adults. An overview.

Substance abuse among older adults, including abuse of alcohol and prescription and over-the-counter drugs, has been called an invisible epidemic. Signs and symptoms of abuse in older adults vary from those presented in younger persons and this variation can complicate the diagnosis. Validated screening tools, such as CAGE and MAST-G, can aid diagnosis, but primary care physicians also need to be alert to suspicious medical conditions often associated with substance use disorders. Treatment goal is almost always abstinence; although efficacy remains uncertain, brief interventions by primary care physicians are recommended when patients are identified as at-risk. Pharmacotherapies may be used, but caution is advised due to associated side effects. Physicians may even be able to prevent the development of benzodiazepine dependence by prescribing alternative treatments for anxiety and depression in this population.