Introduction

Author(s):  
Maria A. Sullivan ◽  
Frances R. Levin

Alcohol and substance-use disorders in late life have been under-studied. Alcohol and prescription drugs are frequently abused by older Americans, yet addictive disorders are often difficult to identify in this population because of screening instruments adapted to younger adults, stigma and shame that limit help-seeking in older adults, and co-occurring medical and psychiatric conditions that mimic or mask both acute effects and withdrawal syndromes associated with alcohol or substance-use disorders. We will review the evidence for the effectiveness of motivational brief interventions in this population, the need to modify certain pharmacotherapies, including standard detoxification regimens, as well as how to develop age-specific treatment services which tailor the content and pace of presentation toward older adults. Older patients can demonstrate equally or more successful outcomes than younger individuals. This text is intended as a practical handbook to enhance clinical skills in identifying and treating addiction in older adults.

2017 ◽  
Author(s):  
Alexander W Thompson ◽  
Timothy Ando ◽  
Emily Morse

Substance use disorders are a major source of morbidity and mortality, contributing to a significant proportion of deaths in the United States and worldwide each year. A substantial rise in deaths related to drug overdoses in recent decades has drawn increasing public attention to this issue. However, the majority of individuals struggling with substance use disorders remain untreated. The financial costs and health burden are substantial. This review provides a broad overview of substance-related and addictive disorders. The evolution of the classification system is described, and the diagnostic criteria for the various substance use disorders are reviewed. Epidemiology and etiologic considerations, including neurobiological pathways, genetics, environmental influences, and dimensional risk factors, are examined. Finally, individual substances and their related disorders are reviewed, including alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedative/hypnotics, stimulants, tobacco, and other or unknown substances. Intoxication and withdrawal syndromes are described where applicable, and clinical management concepts are discussed.  This review contains 6 figures, 5 tables, and 71 references. Key words: abuse, addiction, alcohol, caffeine, cannabis, dependence, diagnosis, DSM-5, epidemiology, hallucinogen, hypnotic, inhalant, intoxication, methamphetamine, nicotine, opioid, sedative, stimulant, substance use disorders, tobacco, tolerance, withdrawal


2018 ◽  
Author(s):  
Alexander W Thompson ◽  
Timothy Ando ◽  
Emily Morse

Substance use disorders are a major source of morbidity and mortality, contributing to a significant proportion of deaths in the United States and worldwide each year. A substantial rise in deaths related to drug overdoses in recent decades has drawn increasing public attention to this issue. However, the majority of individuals struggling with substance use disorders remain untreated. The financial costs and health burden are substantial. This review provides a broad overview of substance-related and addictive disorders. The evolution of the classification system is described, and the diagnostic criteria for the various substance use disorders are reviewed. Epidemiology and etiologic considerations, including neurobiological pathways, genetics, environmental influences, and dimensional risk factors, are examined. Finally, individual substances and their related disorders are reviewed, including alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedative/hypnotics, stimulants, tobacco, and other or unknown substances. Intoxication and withdrawal syndromes are described where applicable, and clinical management concepts are discussed.  This review contains 6 figures, 5 tables, and 71 references. Key words: abuse, addiction, alcohol, caffeine, cannabis, dependence, diagnosis, DSM-5, epidemiology, hallucinogen, hypnotic, inhalant, intoxication, methamphetamine, nicotine, opioid, sedative, stimulant, substance use disorders, tobacco, tolerance, withdrawal


2018 ◽  
Author(s):  
Alexander W Thompson ◽  
Timothy Ando ◽  
Emily Morse

Substance use disorders are a major source of morbidity and mortality, contributing to a significant proportion of deaths in the United States and worldwide each year. A substantial rise in deaths related to drug overdoses in recent decades has drawn increasing public attention to this issue. However, the majority of individuals struggling with substance use disorders remain untreated. The financial costs and health burden are substantial. This review provides a broad overview of substance-related and addictive disorders. The evolution of the classification system is described, and the diagnostic criteria for the various substance use disorders are reviewed. Epidemiology and etiologic considerations, including neurobiological pathways, genetics, environmental influences, and dimensional risk factors, are examined. Finally, individual substances and their related disorders are reviewed, including alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedative/hypnotics, stimulants, tobacco, and other or unknown substances. Intoxication and withdrawal syndromes are described where applicable, and clinical management concepts are discussed.  This review contains 6 figures, 5 tables, and 71 references. Key words: abuse, addiction, alcohol, caffeine, cannabis, dependence, diagnosis, DSM-5, epidemiology, hallucinogen, hypnotic, inhalant, intoxication, methamphetamine, nicotine, opioid, sedative, stimulant, substance use disorders, tobacco, tolerance, withdrawal


2017 ◽  
Author(s):  
Alexander W Thompson ◽  
Timothy Ando ◽  
Emily Morse

Substance use disorders are a major source of morbidity and mortality, contributing to a significant proportion of deaths in the United States and worldwide each year. A substantial rise in deaths related to drug overdoses in recent decades has drawn increasing public attention to this issue. However, the majority of individuals struggling with substance use disorders remain untreated. The financial costs and health burden are substantial. This review provides a broad overview of substance-related and addictive disorders. The evolution of the classification system is described, and the diagnostic criteria for the various substance use disorders are reviewed. Epidemiology and etiologic considerations, including neurobiological pathways, genetics, environmental influences, and dimensional risk factors, are examined. Finally, individual substances and their related disorders are reviewed, including alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedative/hypnotics, stimulants, tobacco, and other or unknown substances. Intoxication and withdrawal syndromes are described where applicable, and clinical management concepts are discussed.  This review contains 6 figures, 5 tables, and 71 references. Key words: abuse, addiction, alcohol, caffeine, cannabis, dependence, diagnosis, DSM-5, epidemiology, hallucinogen, hypnotic, inhalant, intoxication, methamphetamine, nicotine, opioid, sedative, stimulant, substance use disorders, tobacco, tolerance, withdrawal


Author(s):  
Gia Merlo

Patient safety is jeopardized when healthcare services are provided by physicians who suffer from substance use disorders (SUDs). When focusing on the problem of substance abuse and dependence among physicians, certain factors inherent in the medical field, such as long hours, the high-stress nature of the work, and the ease of access to drugs, make physicians more susceptible to abusing or becoming dependent on prescription drugs and alcohol. SUDs may differ in severity. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (Washington, DC: American Psychiatric Association, 2013) provides three severity specifiers: mild, moderate, and severe. Severe SUDs are also known as addictive disorders. To make matters worse, a culture of silence exists among colleagues, who often seek to protect the compromised physician from the legal consequences of abusing drugs. Luckily, the compromised physician can be provided with an intense and individualized treatment regime through physician health programs that aim for rehabilitation over termination of employment.


Author(s):  
Brian A. Palmer

Psychosis is a generic term used to describe altered thought and behavior in which the patient is incapable of interpreting his or her situation rationally and accurately. Psychotic symptoms can occur in various medical, neurologic, and psychiatric disorders. Many psychotic reactions seen in medical settings are associated with the use of recreational or prescription drugs. Some of these drug-induced psychotic reactions are nearly indistinguishable from schizophrenia in terms of hallucinations and paranoid delusions.


2015 ◽  
Vol 63 (11) ◽  
pp. 2317-2323 ◽  
Author(s):  
Ethan Sahker ◽  
Susan K. Schultz ◽  
Stephan Arndt

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