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316 Substance Use in Older Adults

RESOURCES FOR CLINICIANS

American Psychiatric Association

Best Practice Highlights for Treating Diverse Patient Populations

(www.psychiatry.org/psychiatrists/diversity/education/bestpractice-highlights): These web pages and videos provide clinicians information on w (e.g., African American/Black patients, Muslim patients, indigenous patients), including addressing stigma and disparities.

Lewis-Fernández R, Aggarwal NK, Hinton L, et al: DSM-5

book on the Cultural Formulation Interview. Washington, DC, American Psychiatric Publishing, 2016: This book helps clinicians learn to use the 1 and Case Example 11–1.

Cultural Formulation Interview, referenced in Table 11–

American Medical Association

Creating an LGBTQ-Friendly Practice: This Web page provides cli-

nicians with practical tips for creating an environment that is welcoming of LGBTQ patients (www.ama-assn.org/delivering-care/ creating-LGBTQ-friendly-practice).

orking with patients of various backgrounds

Hand-

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INDEX

Page numbers printed in boldface type refer to tables and boxes.

5 A’s tool, 167, 168, 177 5 R’s, 170, 171 12-step programs, 67, 79, 140, 146–

148, 192, 254–256

42 CFR Part 2, 64–65

AA (Alcoholics Anonymous), 67,

131, 140, 146–148, 298–299 ABCs of substance use, 66 Acamprosate, 141, 142, 262 Acetaldehyde, 129, 142 Activities of daily living (ADLs), 36,

310 Acupuncture, 231 Addiction

nicotine, 169 opioid, 198–199 stages, 5–6, 15 stimulant, 254 terminology, 2, 16

Addiction stages, 5–6, 15

binge/intoxication, 6 preoccupation/anticipation, 6

withdrawal/negative affect, 6 ADHD, 112–113, 260 Adverse childhood experiences

(ACEs), 8, 15, 72 Ageism, 2, 4, 15–16, 27, 28 Agency for Healthcare Research and

Quality, 100 Aging, physiological changes related

to, 38, 87–88, 89–90, 129–130 Agitation

antipsychotics for, 113, 252

, 116

benzodiazepines, 102 cannabis, 280, 282 cocaine, 246–247 in intoxication, 62 methamphetamine,

withdrawal, 165, 223, 312 Al-Anon, 149, 265 Alcohol, Smoking, and Substance

Involvement Screening Test

(ASSIST), 32, 225 Alcohol dehydrogenase genes, 7 Alcohol use, 125–150

at-risk drinking, 137 binge drinking, 10, 40, 61, 70, 127,

129, 137, 147 cannabis use with, 276 cardiovascular disease, 133 clinical symptoms and signs,

130–131 cognition, 133 comorbidities, 13 dementia risk, 14 detoxification, 63, 138–139, 142,

144 effects on older adults, 129–133 epidemiology, 128–129 hazardous/problem drinking,

127 heavy drinking, 126–128, 132–

133, 140, 143, 146, 262 introduction, 126–128 laboratory investigations, 37 medication interactions, 40 metabolism, 129–130

252

323

324 Substance Use in Older Adults

Alcohol use (continued)

moderate alcohol consumption,

127–128, 133 opioid use comorbidity, 194 overview of interventions, 59 physiological changes with

aging, 129–130 recommendations for safe use,

127–128 standard drink, 126, 127 terminology, 126–128 use among older adults, 126 withdrawal, 63, 132, 134, 139, 143

Alcohol use disorder (AUD)

assessment, 135–138

challenges, 137–138 comprehensive evaluation,

135–136, 136

screening, 136–137

benzodiazepine use, 112 case example, 130–131 clinical symptoms and signs,

130–131 comorbidities, 131–132 definition, 133 diagnostic criteria, 133–134, 134–

135

epidemiology, 10, 129 management, 138–147

detoxification, 139 key characteristics of age-sen-

sitive, 138 overview, 138 pharmacotherapy, 139–144, 141 psychosocial interventions,

144–147

mutual-help groups, 67 pharmacotherapy, 139–144, 141

acamprosate, 141, 142 baclofen, 141, 144 disulfiram, 141, 142–143 gabapentin, 141, 143 naltrexone, 140, 141, 142 overview, 139–140 topiramate, 141, 143

psychosocial interventions, 144–

147

brief interventions, 144–145 cognitive-behavioral therapy

(CBT), 145

motivational interviewing,

145 mutual-help groups, 146 in patient treatment, 144 virtual interventions, 146–147

resources, 148–150 SBIRT (screening, brief

intervention, and referral to treatment),

Alcohol Use Disorders Identification

Test (AUDIT), 31

Alcohol withdrawal syndrome

(AWS), 63, 139, 143

Alcoholics Anonymous (AA), 67,

131, 140, 146–148, 298–299

Alprazolam, 103, 112

in case examples, 193, 223–224 misuse, 99, 215

Alzheimer’s disease, 114, 133, 165,

219, 249

American Association of Geriatric

Psychiatry, 315 American Medical Association, 316 American Psychiatric Association,

316

Position Statement on Substance Use

Disorders in Older Adults, 5

on tobacco use disorder, 178

American Society of Addiction

Medicine (ASAM), 64, 169, 234,

253 Amnesia, 43, 132, 219 Amphetamine, 241, 243–245, 249,

252, 255, 257–260