Services should increase their focus on older people because of the sheer number of ‘baby boomers’ needing help for substance misuse issues, says a report from the Royal College of Psychiatrists.
Improved training is needed at all levels, including the training of more addictions psychiatrists, says Our invisible addicts, an updated version of a 2011 report from the college. With most substance problems in older people ‘going undetected’ there is an urgent need to improve diagnosis, treatment, education, training, service development and policy, it stresses.
Older people with substance issues face a ‘complex constellation of risks’, the report says, which can result in presentation to a wide range of services including drug and alcohol treatment, primary care, acute hospitals, older people’s mental health, social care, housing, criminal justice and the voluntary sector – in many cases ‘the staff in these settings have little specialist knowledge of how to deal with such complexity’, it adds.
The document calls for a multi-sector approach, improved peer support and development of a clinical workforce with the ‘appropriate knowledge, skills and attitudes’ to provide identification, assessment, referral and treatment – ‘in particular, we see a need to reverse the loss of multi-professional specialist training in addictions that has taken place in recent years’.
While older people respond well to brief advice and motivational therapy – and in some cases can have better outcomes than younger people – there is a ‘paucity of UK-based research and evidence for treatment interventions and services’ around the management of substance use disorders in older people, and the population has also traditionally been under-represented in research studies. It is also vital that people not be excluded from treatment because of their age, stresses the report, which was produced by a working group of professionals across a range of clinical specialities as well as service users.
‘In the 21st century, substance misuse is no longer confined to younger people,’ said working group chairs Professor Ilana Crome and consultant psychiatrist Dr Tony Rao. ‘The public is poorly informed about the relationship between substance misuse and health risks in older people. We need a clear and coordinated approach to address a problem that is likely to increase further over coming decades. By improving our approach to substance misuse in older people from detection to continuity of care, we can also improve both quality of life and reduce mortality in a vulnerable group that deserves better.’
Our invisible addicts 2018 at www.rcpsych.ac.uk