Substance misuse and dependence: older people deserve better services

1999 ◽  
Vol 9 (4) ◽  
pp. 327-342 ◽  
Author(s):  
Ilana B Crome ◽  
Ed Day
Keyword(s):  
Older People ◽  
Large Scale ◽  
Substance Misuse ◽  
Drug Misuse ◽  
Definition Of ◽  
The Uk ◽  
Available Information

It is not easy to establish with any confidence the prevalence of drug misuse in older people. The issue is confounded by variations in definition of what constitutes ‘elderly’ and ‘drug misuse’, and by the types of sample used (Tables 1 and 2). There are few large-scale studies in the UK, and much of the information has been extrapolated from the American findings. The available information can be organized into four main areas:

scholarly journals Drug misuse in older people: old problems and new challenges

2010 ◽  
Vol 16 (6) ◽  
pp. 421-429 ◽  
Author(s):  
Vellingiri Raja Badrakalimuthu ◽  
Daphne Rumball ◽  
Ajay Wagle
Keyword(s):  
Older People ◽  
Substance Misuse ◽  
Psychiatric Morbidity ◽  
Drug Misuse ◽  
Diagnostic Ability ◽  
The People ◽  
New Challenges ◽  
The Uk ◽  
And Training ◽  
The Invisible

SummaryVery little attention has been paid to the invisible epidemic of substance misuse among older people in the UK. This article looks at the prevalence of substance misuse in the people over the age of 60. The reasons for difficulty in diagnosing substance misuse are explored and ways to improve diagnostic ability are discussed. Substance misuse leads to severe physical and psychiatric morbidity that is being managed by meagre resources. The article provides recommendations on specific issues related to interventions, biological and psychosocial, and training of psychiatrists.

scholarly journals Commentary

2000 ◽  
Vol 6 (1) ◽  
pp. 39-40
Author(s):  
Roch Cantwell
Keyword(s):  
Illicit Drugs ◽  
Substance Misuse ◽  
Illicit Drug ◽  
Information Gathering ◽  
Drug Misuse ◽  
High Prevalence ◽  
The Rich ◽  
The Uk ◽  
Tabloid Journalism ◽  
Timely Reminder

In the sometimes sensational world of illicit drug reportage, there is one unsung villain. While heroin misuse remains the bête noir of tabloid journalism, ecstasy the demon of the dance floors and cocaine caricatured as the choice of the rich and famous, amphetamine misuse has lurked the shadows. Its use defies such simple categorisation and spans several groups in society. Bruce has provided a timely reminder of this neglected area in substance misuse literature and, in the process, has highlighted the relevance of basic information gathering as the most important tool in the armamentorium of drug misuse workers. The lack of prominence given to what they describe as a “hidden epidemic” is striking. Could this be because amphetamine misuse is a less prevalent problem than that of other illicit drugs? Evidence suggests otherwise. Amphetamine is the second most common illicit drug seized in the UK (after cannabis). It is easily produced and used in a variety of modes, and recent research confirms a high prevalence of misuse in this country reflecting that found in North American and Australian literature.

Problems due to use of alcohol and other psychoactive substances

Psychiatry ◽  
2019 ◽  
Author(s):  
Rebecca McKnight ◽  
Jonathan Price ◽  
John Geddes
Keyword(s):  
Illicit Drugs ◽  
Substance Misuse ◽  
Classification Systems ◽  
Drug Misuse ◽  
Psychoactive Substances ◽  
Victorian England ◽  
True Incidence ◽  
Medicinal Use ◽  
The Individual ◽  
The Uk

Archaeological evidence has demonstrated that for at least the past 10,000 years humans have been using psychoactive substances. From the chewing of coca leaves in Ancient Peru (c.4000– 3000 bce) to the popular use of laudanum in Victorian England, the recreational, cultural, and medicinal use of ‘mind- altering’ substances has been widespread. As of 2016, alcohol and other psychoactive substances remain a leading cause of medical and social problems world­wide: humans are clearly vulnerable to their attrac­tion. Although a myriad of substances are available, only a few are commonly used, and all tend to produce similar harms upon the individual and society. This chapter will provide a general approach to managing a patient presenting with a problem stemming from substance misuse. It is extremely difficult to gather accurate data on the use of substances in the general population, especially if they are illegal. It is therefore likely that most figures are underestimations of the true incidence. The WHO estimates that tobacco, alcohol, and illicit drugs are a factor in 12.4 per cent of all deaths worldwide. This is a stark reminder of the severity that problems associated with substance usage can reach, but the morbidity sur­rounding them affects a much wider section of society. In the UK, 80 per cent of adults drink alcohol, 19 per cent smoke tobacco, and 30 per cent admit to having used an illegal drug at least once in their lifetime. Worldwide, the highest prevalence of drug misuse is found in the 16- to 30- year age group, with males outnumbering females at a ratio of 4 to 1. Table 29.1 shows a selection of epidemiological figures associ­ated with commonly used substances. Substance misuse is associated with an array of con­fusing terminology, the majority describing different disorders that may occur due to use of any substance. The following terms are internationally agreed and ap­pear in major classification systems:… ● Intoxication is the direct psychological and physical effects of the substance that are dose dependent and time limited. They are individual to the substance and typically include both pleasurable and unpleasant symptoms.

scholarly journals A gradual separation from the world: a qualitative exploration of existential loneliness in old age

2020 ◽  
Author(s):  
Sam Carr ◽  
Chao Fang
Keyword(s):  
Older People ◽  
Large Scale ◽  
Later Life ◽  
Retirement Communities ◽  
Structured Interviews ◽  
Existential Loneliness ◽  
The World ◽  
Physical Touch ◽  
The Uk ◽  
Qualitative Exploration

This study sought to qualitatively explore experiences of existential loneliness (EL) in 80 older people living in retirement communities across the UK and Australia. Qualitative semi-structured interviews permitted in-depth exploration of issues such as biographical narrative, close relationships, loss, feelings of loneliness, and retirement living. It was our intention to conduct a large-scale, deep listening exercise that would provide further clues about existential loneliness in older people and the circumstances that give rise to such feelings. Data provided rich insight into older people’s inner lives. Core themes identified loss of close attachments, lack of physical touch and intimacy, deterioration of health and body, and lack of an emotional language through which to express EL as central to older people’s experiences. Furthermore, there was a suggestion that the move to retirement living was for many people inextricably connected to their experience of EL. Our data further support and extend the notion that EL can be thought of as a gradual sense of separation from the world and that ageing intensifies a myriad of social, emotional, and physical circumstances that prompt its emergence. This sense of existential isolation need not be thought of as exclusive to those experiencing extreme frailty or who face death imminently – our data pointed to a clear and gradual emergence of EL throughout later life.

scholarly journals The Destructive Capacity of Drug Abuse: An Overview Exploring the Harmful Potential of Drug Abuse Both to the Individual and to Society

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Thomas Peter Fox ◽  
Govind Oliver ◽  
Sophie Marie Ellis
Keyword(s):  
Drug Abuse ◽  
Substance Misuse ◽  
Crack Cocaine ◽  
Illegal Drug ◽  
Drug Misuse ◽  
Western World ◽  
Public Health Perspective ◽  
Published Evidence ◽  
The Individual ◽  
The Uk

From a public health perspective, substance abuse has long been a source of major concern, both for the individual’s health and for wider society as a whole. The UK has the highest rates of recorded illegal drug misuse in the western world. In particular, it has comparatively high rates of heroin and crack cocaine use. Substances that are considered harmful are strictly regulated according to a classification system that takes into account the harms and risks of taking each drug (see the tables) (Nutt et al. (2007)). The adverse effects of drug abuse can be thought of in three parts that together determine the overall harm in taking it: (1) the direct physical harm of the substance to the individual user, (2) the tendency of the drug to induce dependence, and (3) the effect of abuse of the drug on families, communities, and society (Gable (2004, 1993)). In this report, we discuss published evidence relating to the harm of substance misuse and consider the neuropsychopharmacological mechanisms behind addiction in an attempt to gain an improved picture of the potential devastation that abuse of these substances may evoke.

scholarly journals No pets allowed? Companion animals, older people and residential care

2019 ◽  
Vol 45 (2) ◽  
pp. 211-222 ◽  
Author(s):  
Marie Fox ◽  
Mo Ray
Keyword(s):  
Older People ◽  
Care Home ◽  
Companion Animals ◽  
Well Being ◽  
Animal Companionship ◽  
Environment Control ◽  
Vulnerability Theory ◽  
Adequate Provision ◽  
Definition Of ◽  
The Uk

This article is concerned with a particular site of inter-species relationships. Using the lens of liminality, it examines forced separation of older people from their companion animals when they move to a residential or nursing home in the UK. Such residential spaces frequently either exclude companion animals or fail to make adequate provision for them to accompany their human caretakers. We see such separation as a major bereavement for an older person at a stage of life when they experience significant other losses, and suggest it is often experienced as akin to the loss of a family member. We deploy vulnerability theory to argue that exclusion of companion animals from care spaces exemplifies a failure to understand the relational vulnerabilities of older age and the significance of animal companionship in mitigating those vulnerabilities. Equally, such separation fails to recognise the implications for excluded animals who can end up in unsuitable homes, being signed over to already over-stretched animal rescues or euthanised. Vulnerability theory highlights how companion species are always already vulnerable, given their liminal position between person and property, while older people are rendered particularly vulnerable in the ‘liminal zone’ of the care home, denied the ability to shape their environment, control their private space or form/sustain relationships of their own choosing. This article explores the potential of law to respond to and mitigate these shared vulnerabilities, suggesting that human rights arguments grounded in shared vulnerability may be invoked to argue for a re-definition of the family to recognise the significance of the human–animal relationship. We draw on the reasoning in a recent Court of Protection case which hints at law’s ability to recognise the value of interspecies relations and their role in sustaining health and well-being, and the ability to live well in old age.

Young people and substance misuse

2018 ◽  
Vol 11 (11) ◽  
pp. 601-607
Author(s):  
Irene Hernandez Sanchez
Keyword(s):  
Substance Misuse ◽  
Warning Signs ◽  
Assessment Tools ◽  
Drug Misuse ◽  
Mental Performance ◽  
Illegal Drug Use ◽  
And Performance ◽  
The Uk ◽  
Drunk Alcohol

In the UK in 2017, 9% of pupils aged 11–15 reported having drunk alcohol in the previous week, which is the lowest rate since the 1980s. Illegal drug use in the previous year reported by 15-year olds halved between 2001 and 2014. Despite these promising figures, adolescence is deemed to be decisive for future biopsychosocial development and performance. Initiation during adolescence may therefore have long-term implications, affecting mental performance and educational outcomes. This article focuses on patterns of drug misuse in teenagers. The warning signs of drug misuse and useful assessment tools are also introduced. For the purposes of this article, alcohol will be defined as a drug.

Multiple Exclusion Homelessness in the UK: Key Patterns and Intersections

2011 ◽  
Vol 10 (4) ◽  
pp. 501-512 ◽  
Author(s):  
Suzanne Fitzpatrick ◽  
Sarah Johnsen ◽  
Michael White
Keyword(s):  
Substance Misuse ◽  
Institutional Care ◽  
Drug Misuse ◽  
Multi Stage ◽  
Low Threshold ◽  
The Uk ◽  
High Degree ◽  
Personal Trauma ◽  
Very High ◽  
Prevalent Form

This article presents preliminary results from a multi-stage quantitative study of ‘multiple exclusion homelessness’ (MEH) in seven urban locations across the UK. It demonstrates a very high degree of overlap between a range of experiences associated with ‘deep social exclusion’ – namely, homelessness, substance misuse, institutional care and ‘street culture’ activities (such as begging and street drinking). It also provides evidence to support the contention that homelessness is a particularly prevalent form of exclusion, with its experience reported as widespread by those accessing low threshold support services targeted at other dimensions of deep exclusion, such as drug misuse. Further, the analysis presented indicates that the nature of MEH varies geographically, with the profile of the population affected looking quite different in Westminster (London) than in the other urban locations. The main explanation for this appears to be the exceptionally high proportion of migrants in the MEH population in Westminster, who tend to report lower overall levels of personal trauma and vulnerability than the indigenous MEH population.

Alcohol and substance misuse

2020 ◽  
pp. 713-734
Author(s):  
Tony Rao ◽  
Katy A. Jones
Keyword(s):  
Older People ◽  
Workforce Development ◽  
Prescription Drugs ◽  
Substance Misuse ◽  
Treatment Options ◽  
Evidence Base ◽  
Drug Misuse ◽  
Prescription Drug Misuse ◽  
Physical Disorders ◽  
To Come

Older people now represent a group at highest risk of rising substance misuse. This applies to alcohol as well as both illicit and prescription drugs. It is a trend that is likely to continue for decades to come, during which time we expect to see further increases in rates of illicit and prescription drug misuse. These problems are likely to pose a considerable burden on public health and clinical services, the problems being compounded by comorbid mental and physical disorders, polypharmacy and psychosocial problems such as retirement, loneliness, and bereavement. There is considerable scope for education and workforce development to improve screening and assessment, as well as exploring barriers to entering treatment, treatment options, and factors to promote recovery. Given the limited evidence base for treatment of substance misuse in older people, there is a pressing need for further research through both observational and analytical studies.

Commercial property retrofitting

2014 ◽  
Vol 32 (4) ◽  
pp. 443-452 ◽  
Author(s):  
Tim Dixon
Keyword(s):  
Large Scale ◽  
Scale Up ◽  
Energy Performance ◽  
Policy And Practice ◽  
Content Type ◽  
Commercial Property ◽  
Definition Of ◽  
The Uk ◽  
New Research ◽  
Measurement Verification

Purpose – Progress in retrofitting the UK's commercial properties continues to be slow and fragmented. New research from the UK and USA suggests that radical changes are needed to drive large-scale retrofitting, and that new and innovative models of financing can create new opportunities. The purpose of this paper is to offer insights into the terminology of retrofit and the changes in UK policy and practice that are needed to scale up activity in the sector. Design/methodology/approach – The paper reviews and synthesises key published research into commercial property retrofitting in the UK and USA and also draws on policy and practice from the EU and Australia. Findings – The paper provides a definition of “retrofit”, and compares and contrasts this with “refurbishment” and “renovation” in an international context. The paper summarises key findings from recent research and suggests that there are a number of policy and practice measures which need to be implemented in the UK for commercial retrofitting to succeed at scale. These include improved funding vehicles for retrofit; better transparency in actual energy performance; and consistency in measurement, verification and assessment standards. Practical implications – Policy and practice in the UK needs to change if large-scale commercial property retrofit is to be rolled out successfully. This requires mandatory legislation underpinned by incentives and penalties for non-compliance. Originality/value – This paper synthesises recent research to provide a set of policy and practice recommendations which draw on international experience, and can assist on implementation in the UK.

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