Treatment issues
Unlike other areas of health and social care, there are no specialist interventions and no specialist staff working with older people who have alcohol and/or drug problems (Williamson 2002).  Limited research in this area has repeatedly found a tendency among health care providers to overlook older people’s substance use in terms of diagnosis, intervention and treatment. 

Some treatment differences need to be considered.

1. Should inpatient detoxification be needed to monitor alcohol or drug withdrawal?  Withdrawal can be uncomfortable both physically and mentally and if the older person is more fragile in either of these areas potential complications could arise.
2. Attention needs to be paid to pre-existing medical conditions and other prescribed medications.
3. Is the person’s cognitive functioning able to cope with psycho-social interventions such as cognitive behavioural therapy (CBT) or motivational enhancement therapy (MET)?
4. Have underlying psychiatric problems been assessed to determine whether support is needed in tandem with the alcohol or drug treatment?

Brief interventions also need to be considered.  Giving clear messages to people about how much they are using and drinking in relation to guidelines and how their substance use interacts with and existing medication (where appropriate) is important.

Some research shows that sudden withdrawal from benzodiazepines can lead to increased confusion among older people and this needs to be done with care and under medical supervision.  Older people have different rates of physiological recovery from the substance due to the potentially slower response rates of the older person’s body.

Service provision needs to ensure that it is structured in a way that serves an older age group. For example, home visits need to be part of the service for people who are unable to physically get to the agency or alternatively transport needs to be arranged.  Literature should be produced in larger print need and should address the problems older people in particular may face in recognising and addressing their substance use.