There is increasing recognition of both the extent and seriousness of substance use disorders comorbid with other psychiatric disorders. There is now ample proof that treating these conditions as they occur together improves outcome because each psychiatric illness influences the course of any coexisting psychiatric illnesses. In older adults there is limited knowledge about substance use and even less about comorbid states. To identify, evaluate, and treat older adults with comorbid illnesses, one must piece together a coherent understanding from sources not primarily focused on comorbid states. Epidemiological findings suggest substance use patterns in older adults differ from younger patients with a greater “misuse” of medications. Prevalence reports indicate that as baby boomers become older adults the extent of substance use will be much greater. Useful screens for older adult substance use are limited at present making it difficult to identify the problem. Central definitions of drug use disorders criteria are often not applicable to older people and the pertinent definitions are not clearly identified. Drug metabolic changes occurring with aging may make the effects of both licit and illicit drugs different than those seen in younger patients. This affects the manifestations of intoxications and dependence as well as the therapeutic effects of psychotropic medications. Because of the density of the knowledge haze overlying comorbid substance use and other psychiatric disorders in older adults, specific factors affecting course and treatment must be inferred. This presentation will review the evidence for the importance of comorbid conditions in the aged, review factors pertinent to the evaluation and treatment of comorbid illnesses, and identify areas most needing empiric research.
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