The emerging problems of alcohol and substance abuse in late life

Treatment of substance abuse among older adults will become increasingly im portant as the number of aged Americans increases. The abuse of psychoactiv e substances is a major contributor to excess morbidity, mortality, and hom elessness among persons of all ages and socioeconomic strata regardless of race or ethnicity! Alcohol and tobacco account for the majority of substanc e abuse-related death and disability in the United States; the former throu gh cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy Patterns of substance abus e irt late life are substantially different from those observed among young er adults. However treatment may be less challenging. Effective diagnosis a nd treatment requires a nonpunitive, supportive, but persistent approach. T his means the capacity to collect a substance intake history and the abilit y to formulate a treatment plan or referral strategy to a,an addiction spec ialist or residential treatment setting. It is also important for the pract itioner to manage negative feelings toward patients who decline treatment o r who are chronic abusers.