Contributors xvii Foreword xxi Introduction xxiv List of Abbreviations xxvi Section 1 Legal and ethical aspects of care for older people with substance misuse 1 1 Negotiating capacity and consent in substance misuse 3 Kritika Samsi Introduction 3 Substance abuse and capacity 3 Mental capacity legislation 4 Mental Capacity Act 2005 4 Capacity assessment 5 Capacity and unwise decisions 6 Consent, barriers to decision making and substituted decision making 6 Best interest decisions 8 Independent decision makers 8 Conclusion 9 References 9 2 Elder abuse 11 Jill Manthorpe Introduction 11 Defining elder abuse 11 Main reviews 12 Alcohol and substance misuse risk factors 12 Risk factors among older people 13 The effects of elder abuse 14 Discussion 15 Conclusions and next steps 15 References 16 3 The United States perspective 18 Cynthia M.A. Geppert and Peter J. Taylor The ageing of the baby boomers and its impact on substance abuse 18 Ethical and legal aspects of substance misuse in older adults 19 Confidentiality 19 Informed consent 20 Capacity 21 Coercion 24 Conclusion 25 References 25 4 The European perspective 27 Abdi Sanati and Mohammed Abou-Saleh Introduction 27 Use and possession 28 Crime 28 European Convention of Human Rights 28 Delivering services for the elderly with substance misuse - ethical aspects 29 Research and development 30 Policy making 31 Some differences between Europe and the USA 31 Ethical issues regarding treatment 32 Stigma 32 Underprescribing controlled drugs 32 Summary 33 References 34 5 Clinical medicine and substance misuse: research, assessments and treatment 35 Amit Arora, Andrew O''Neill, Peter Crome and Finbarr C. Martin Introduction 35 Why is clinical medicine important? 36 Identification 37 The health effects of substance abuse 39 Challenges for the future 46 Research 47 Identification tools 47 Training and support 48 Conclusions 49 References 49 Section 2 Epidemiology and demography 57 6 Cigarette smoking among adults aged 45 and older in the United States, 2002-2011 59 Shanta R. Dube and Li-Tzy Wu Introduction 59 Evaluation methodology 61 Results 62 Sociodemographic characteristics of older adults: 2002 versus 2011 62 National trend in current smoking prevalence: 2002-2011 65 Current smoking prevalence by socioeconomic status: 2002 versus 2011 66 Adjusted odds ratios of correlates of current smoking: 2002 versus 2011 66 Discussion 71 Conclusion 72 References 73 7 Epidemiology and demography of alcohol and the older person 75 Stephan Arndt and Susan K. Schultz Introduction 75 Main reviews 76 Epidemiological estimates of prevalence of alcohol use 76 Estimates of alcohol problems based on amount of drinking 76 Importance of threshold selection for defining problem use 80 Estimating problem use from survey samples 80 Summary of epidemiological estimates 81 Specific problematic drinking behaviours: binge drinking 81 Diagnoses of abuse or dependence 83 Older substance abuse treatment populations 84 Special populations of older substance users 85 Demographic correlates of problem use 86 Discussion 87 Conclusions and next steps 87 References 88 8 Epidemiology and demography of illicit drug use and drug use disorders among adults aged 50 and older 91 Shawna L. Carroll Chapman and Li-Tzy Wu Introduction 91 Survey studies 92 Studies of treatment-seeking or clinical patients 101 Health implications 104 Discussion 105 Next steps 106 References 106 9 Epidemiology and demography of nonmedical prescription drug use 109 Jane Carlisle Maxwell Introduction 109 Findings 110 National surveys 110 Emergency department cases 112 Treatment admissions 113 Drug poisoning deaths 114 Discussion 116 Conclusions 118 Acknowledgement 118 References 118 Section 3 Longitudinal studies of ageing and substance abuse 121 10 Ageing and the development of alcohol use and misuse 123 Marja Aartsen Background 123 Results 124 Differences in alcohol use across cohorts 125 Developments in alcohol use within people 126 Gender differences 126 Different trajectories 126 Age and onset of problem drinking 127 Discussion 127 Explanations for age differences in alcohol use 127 Conclusions 128 References 129 11 Progression from substance use to the development of substance use disorders 133 Carla L.

Storr and Kerry M. Green Introduction 133 Substance use progression process 134 Risk factors influencing substance use progression 137 Individual factors 137 Substance properties 139 Environmental influences 140 Future direction 141 Conclusions 143 Acknowledgement 144 References 144 12 Psychopharmacology and the consequences of alcohol and drug interactions 149 Vijay A. Ramchandani, Patricia W. Slattum, Ashwin A. Patkar, Li-Tzy Wu, Jonathan C. Lee, Maitreyee Mohanty, Marion Coe and Ting-Kai Li The extent of alcohol and drug misuse among older adults 149 Substance misuse in the general population 149 Substance misuse or addiction in clinical settings 150 Co-morbidities among older substance misusers 151 Psychopharmacology of alcohol and drug misuse in older people 152 Neurocircuitry of abused substances 152 Alcohol-drug interactions in older adults 155 Mechanisms of alcohol-medication interactions 156 Significance of the problem 156 Concurrent use of alcohol and potentially interacting medications 157 Consequences of concurrent use of alcohol and medications 158 Clinical presentation and evaluation of substance use disorders in the elderly 158 Clinical presentations (case vignettes) 159 Medical co-morbidities 161 Screening for substance use disorders 161 Evaluation of substance use disorders 162 Cognitive impairment in the elderly with substance use disorders 163 Safety assessment of the elderly with substance use disorders 164 Medications for individuals with substance use disorders 164 Conclusions 166 References 166 Section 4 Comprehensive geriatric assessment and special needs of older people 171 13 Comprehensive geriatric assessment and the special needs of older people 173 Dan Wilson, Stephen Jackson, Ilana B. Crome, Rahul (Tony) Rao and Peter Crome Background 173 Assessment 175 Setting 176 Barriers to assessment 176 High-risk groups 177 Presenting problems 177 Collateral information 178 General principles of assessment 179 Screening 182 Psychiatric assessment 183 Case presentations 184 Driving and substance misuse 184 Older women and alcohol misuse 184 Polysubstance misuse 185 The frequent attender 185 Alcohol and cognitive impairment 186 Pain and substance misuse 187 Discussion 187 Conclusion 187 References 188 Section 5 Screening and intervention in health care settings 193 14 Screening and brief intervention in the psychiatric setting 195 M. Shafi Siddiqui and Michael Fleming Overview 195 Screening and assessment for alcohol use disorders 197 Single question screen for an alcohol use disorder 197 Quantity and frequency questions 198 Proxy questions such as CAGE 198 Symptoms of abuse or dependence 199 Alcohol biomarkers 199 Illicit drugs 202 Rationale for screening older adults for marijuana, cocaine and other illicit drugs 202 Screening for illegal drugs in the psychiatric setting 202 Recommended screening questions to detect drug use 202 Screening for drug abuse/dependence 203 Screening for illicit drug use with toxicology screening 203 Prescription drug abuse 204 Rationale for screening older adults 204 Screening for prescription drug abuse 205 Brief intervention for alcohol, prescription drug abuse and illegal drug use 206 Summary 208 References 209 15 Tobacco use cessation 212 Daniel J.

Pilowsky and Li-Tzy Wu Introduction 212 Smoking cessation interventions among older adults 214 Multimodal interventions 214 Medication-based interventions 216 Counselling and behavioural interventions 217 Physician-delivered interventions 217 Other interventions 218 Conclusions 218 References 219 Section 6 Use of substance abuse treatment services among older adults 223 16 Epidemiology of use of treatment services for substance use problems 225 Shawna L. Carroll Chapman and Li-Tzy Wu Introduction 225 Tobacco cessation service use and characteristics 225 Alcohol treatment use and characteristics 230 Trend in substance abuse treatm.