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Screening and Diagnosis of Substance Use Problems

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As outlined previously, alcohol and drug problems are common in later life. However, substance misuse remains largely underrecognized and undertreated among older adults. It has been suggested that adults over the age of 60 be screened for alcohol and prescription drug use as part of their routine mental and physical health care (Blow 1998). Routine screening would enable the identification of not only those older adults who have problematic substance use, but also those who are at risk of misusing drugs and alcohol. Further, proper screening helps determine if additional assessment is needed. Nonetheless, various factors may interfere with screening and diagnostic processes.

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FIGURE 23–3. Short Michigan Alcohol Screening Test–Geriatric Version (SMAST-G).Three or more positive responses is indicative of an alcohol abuse problem.Source. Reprinted from the University of Michigan Alcohol Research Center. Copyright 1991 The Regents of the University of Michigan. Used with permission.

FIGURE 23–4. Alcohol Use Disorders Identification Test–C (AUDIT-C) alcohol screening.Source. Adapted from Bush K, Kivlahan DR, McDonell MB, et al.: "The AUDIT Alcohol Consumption Questions (AUDIT-C): An Effective Brief Screening Test for Problem Drinking." Archives of Internal Medicine 158:1789–1795, 1998. Copyright © 1998, American Medical Association. All rights reserved. Adapted with permission.
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Table 23–3. Common signs and symptoms of potential substance misuse and abuse in older adults

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