Unhealthy Alcohol Use in Older Adults

Erin L. Woodhead, PhD; San Jose State University, San Jose, CA, USA.

Acknowledgments
1 Introduction
1.1 Defining Older Adulthood
2 Prevalence and Risk Factors
2.1 Common Terms to Describe Alcohol Use
2.2 Prevalence of Unhealthy Alcohol Use Among Older Adults
2.2.1 Prevalence of Unhealthy Alcohol Use Among Racial and Ethnic Minority
Older Adults
2.2.2 International Studies on Prevalence of Unhealthy Alcohol Use Among
Older Adults
2.2.3 Prevalence of Unhealthy Alcohol Use Among Sexual and Gender
Minority Older Adults
2.2.4 Prevalence Conclusions
2.3 Comorbid Nicotine and Other Drug Use
2.4 Conclusions: Prevalence and Risk Factors
3 Conceptualizing Unhealthy Alcohol Use Among Older Adults
3.1 Age-Related Changes in Alcohol Processing
3.2 Early Versus Late Onset
3.3 Life Transitions and Unhealthy Alcohol Use
3.4 Biopsychosocial Model
3.5 Stress and Coping Framework
3.6 Cognitive Behavioral Model
3.7 Conclusions: Conceptualizing Unhealthy Alcohol Use
4 Diagnosing Unhealthy Alcohol Use Among Older Adults
4.1 DSM-5 Criteria for Alcohol Use Disorder
4.2 Identification of Unhealthy Alcohol Use and Diagnosis
4.2.1 Common Signs of Unhealthy Alcohol Use
4.3 Differential Diagnoses to Consider
4.3.1 Cognitive Changes With Age
4.3.2 Long-Term Alcohol Use and Cognitive Impairment
4.4 Comorbid Medical and Mental Health Conditions
4.4.1 Comorbid Mental Health Conditions
4.5 Conclusions: Diagnosing Unhealthy Alcohol Use
5 Screening and Assessment
5.1 Screening Recommendations
5.2 Assessment of Unhealthy Alcohol Use
5.2.1 Assessing Medically Complex Older Adults
5.3 Choosing Appropriate Assessment Tools
5.3.1 Alcohol Use Disorders Identification Test
5.3.2 Michigan Alcoholism Screening Test - Geriatric Version - and Short
MAST-G 42
5.4 Conclusions: Screening and Assessment of Unhealthy Alcohol Use
6 Psychological Interventions
6.1 Care Coordination
6.2 Treatment Modifications for Older Adults
6.3 Harm Reduction Versus Abstinence-Based Treatments
6.4 Brief Interventions
6.5 Motivational Interviewing
6.6 Cognitive Behavioral Therapy
6.7 Mutual Help Groups
6.8 Family-Involved Treatments
6.9 Effectiveness of Treatments for Unhealthy Alcohol Use Among Older Adults
6.10 Conclusions: Psychological Interventions for Unhealthy Alcohol Use
7 Pharmacological Interventions
7.1 Disulfiram
7.2 Naltrexone
7.3 Acamprosate
7.4 Integrating Pharmacotherapy With Psychotherapy
7.5 Conclusions: Pharmacological Interventions
8 Cultural Adaptations
8.1 Cultural Adaptations to Treatment
8.2 Treatment Considerations for Sexual and Gender Minority Older Adults
8.3 Treatment Considerations for Older Women
8.4 Conclusions: Cultural Adaptations
9 General Conclusions
10 Further Reading
References
Appendix: Tools and Resources
Patient Health Questionnaire-9 (PHQ-9)
Generalized Anxiety Disorder Screener (GAD-7)
Alcohol Use Disorders Identification Test - Consumption (AUDIT-C)
Short Michigan Alcoholism Screening Test - Geriatric Version (SMAST-G)