Substance Use, Misuse, and Abuse among Older Adults: Implications for Clinical Mental Health Counselors

Article excerpt

Researchers project a threefold increase in substance abuse, inclusive of alcohol, prescription, and illicit drugs, for adults aged 50 or older by 2020, when an estimated 5 million older adults will need treatment for substance abuse problems (Gfroerer, Penne, Pemberton, & Folsom, 2003). This suggests a need for heightened awareness among clinical mental health counselors as they treat this population. This article (a) discusses the prevalence, vulnerabilities, and consequences of misuse and abuse of alcohol, prescription drugs, and illicit substances; lo) reviews age-specific counseling considerations and approaches to assessment, diagnosis, and intervention; and (c) calls for more attention to the subject in training and research.


It is not unusual for people to lose social and emotional support systems as they age. The aging process often results in social isolation due to the death of a spouse or partner, other family members, and close friends. Similarly, retirement, altered activity levels, disability, relocation of family and friends, and family dissonance may produce feelings of isolation and depression that exacerbate substance use and abuse in older adults (Myers, Dice, & Dew, 2000; Williams, Ballard, & Alessi, 2005). For example, older adults living alone and experiencing isolation, feelings of loneliness, and depression may be more at risk for excessive substance use as a way to manage life stressors.

Most people do adjust to these changes without abusing substances. Many aging adults discover new joys in everyday living, create new friendships in retirement communities, or explore new personal aspects in this phase of life. But unfortunately older adults who do struggle with substance abuse or dependence are often overlooked or misdiagnosed (Blow, Oslin, & Barry, 2002; Colliver, Compton, Gfroerer, & Condon, 2006; Epstein, Fischer-Elber, & Al-Otaiba, 2007; Han, Gfroerer, Colliver, & Penne, 2009).

Over the past 20 years, substance abuse in the elderly has been a vital topic of discussion (Blow, 1998; Dupree, Broskowski, & Shonfeld, 1984; Patterson & Jeste, 1999). The problem deprives older adults of their health, their quality of life, and indeed their very lives. As the population in the United States ages and the baby boomer generation progresses toward the zenith of life, it is imperative that mental health counselors understand the unique characteristics of elderly populations and the potential for debilitating problems associated with substance misuse.

Researchers project that for adults 50 and older, substance abuse, inclusive of alcohol and drug abuse, will triple by 2020. The increase reflects known predictors of substance abuse and the growth of both the baby-boom cohort born between 1946 and 1964 and the post-baby-boom cohort born between 1965 and 1970; it is estimated that ultimately 5 million older adults will then need treatment for substance abuse problems (Gfroerer et al., 2003). Although research on the need for increased learning, assessment, and treatment of substance-related problems in older adults can be found for medical, nursing, social work, and psychology (Brown et al., 2006; D'Agostino, Barry, Blow, & Podgorski, 2006; Emlet, Hawks, & Callahan, 2001; Finfgeld-Connett, 2004), our review of the Journal of Counseling & Development and three other journals (Journal of Mental Health Counseling, Journal of Addictions & Offender Counseling, and Adultspan) for 1999 to 2009 found only two articles on the subject (Myers et al., 2000; Williams et al., 2005).

There is a significant need for mental health counselors to be informed and aware as they respond to the increasing treatment needs in this population and for strategic efforts to increase training, research, and lobbying to expand access to mental health care through Medicare. This article is intended to initiate that effort by describing unrecognized and underdiagnosed substance misuse among older adults by (a) discussing the prevalence, vulnerabilities, and consequences of alcohol, prescription drugs, and misuse of illicit substances; (b) reviewing age-specific counseling considerations and approaches to assessment, diagnosis, and intervention; and (c) calling for more attention in training and research to help counselors respond to the needs of older adults. …


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