This paper reports a study of alcohol- and drug-use by older clients in relation to their health and well-being. The sample of 349 persons was drawn from adults aged 60 and over living in senior citizens apartments in Toronto. Interviews were done in several languages. The results indicated that males and those aged 60 to 65 were less happy and healthy, had fewer social supports, and more alcohol-related problems. Drug-related problems were less numerous but occurred equally for both sexes. These results indicate that new alcohol programs are needed for the elderly, and these should focus on males, especially the younger elderly in transition from work to retirement.

The misuse of alcohol or drugs is a common and frequently neglected problem among nursing home residents. The misuse of prescription medications is particularly prevalent, but tobacco, alcohol, and illicit drugs are all subject of misuse by nursing home residents. This article reviews the epidemiologic and clinical aspects of substance misuse in nursing homes, including alcohol, illicit drugs, tobacco, and pyscho-active medications. Regulations regarding the prescription of psycho-active drugs in nursing homes is also discussed.

Debates over the prevalence of elderly illicit drug addicts in the population divert our attention from this group as a viable study population. Due to their decelerated lifestyle, low crime rates, and our attitudes toward the elderly as nonstreet drug users, they are likely to remain hidden from the public eye. This paper reviews past trends in drug misuse among the elderly, the lifestyle of those addicted to drugs, the complications associated with drug misuse and aging, and the problems that the elderly face with traditional treatment programs. Given our aging society, is the study of elderly street addicts and users an important area of concern?

More than 75% of people age 65 and older use medications. Of the drugs most commonly used by older people, many have potential to interact adversely with alcohol. The absorption, distribution, metabolism, and effects of drugs or alcohol may be affected. The major adverse clinical outcomes of drug-alcohol interactions are altered blood levels of the medication or of alcohol, liver toxicity, gastrointestinal inflammation and bleeding, sedation and delirium, disulfiram-like reactions, and interference with the desired effect of medications. Since alcohol is commonly used by elderly people, educating patients about the potential for these interactions should be a routine part of health care visits.

The elderly person is at risk of drug misuse and related problems because of frequent use of prescription drugs, biologic factors, and social circumstances associated with aging. Confusion, falls, and aggravation of untoward emotional states are examples of the adverse consequences. Diagnosis of drug dependency states is difficult because of the overlap of general medical disorders and mental disorders and a lack of suitable diagnostic criteria for the aged. Two case examples of drug misuse are given, and the management of drug misuse and the treatment of drug dependence on an inpatient and outpatient basis are discussed. Future research directions are suggested.

This article reviews epidemiological, neurological, cognitive, and imaging data on alcohol-induced dementia. Recent studies indicate that "heavy alcohol use" (variously defined) is a contributing factor in 21-24% of cases of dementia. Research difficulties include lack of positive diagnostic criteria, few post-mortem studies, and no accepted pathological mechanism. Sulcal widening and ventricular enlargement (occasionally reversible) are the strongest findings in patients with alcohol-induced dementia. There is evidence for peripheral neuropathy, ataxia, sparing of language, and improved prognosis when patients with alcohol-induced dementia are compared to other dements. Case examples, etiologic theories, and recommendations for research, training, and clinical practice are included.

Recent research suggests that older adults with alcohol problems often drink in response to loneliness, depression, and poor social support networks. Although a variety of approaches such as psychodynamic, Twelve Step, social support, behavioral, and cognitive-behavioral, have been suggested, only those studies involving behavioral and cognitive-behavioral interventions have provided empirical support for treatment effectiveness. Some research also suggests that age-specific group treatment produces better outcomes than when older adults are placed in treatment with younger alcoholics.

The age of onset of alcohol-related problems is a typology that is gaining prominence among clinicians. Findings from epidemiological studies suggest that there are a significant number of older alcoholics who first begin to drink alcohol "abusively" in their later years. While few demographic differences appear between late onset and early onset alcoholics, a number of studies have reported clinical differences between these groups that may affect the natural course and treatment outcome of the illness.

Alcoholism may lead to a great many physical and mental problems in individuals of any age. Elderly alcoholics often have additional problems resulting from the interaction of age related changes in physiology and "heavy" alcohol intake. Some of the more important problems are: Impairment of the immune system with decreased ability to deal with infection or cancer. Increased incidence of hypertension, cardiac arrhythmia, myocardial infarction, and cardiomyopathy. Increased incidence of stroke. Alcohol dementia. Increased incidence of esophageal and other cancers. Cirrhosis and other liver disease. Malnutrition. There seems to be no area in which even moderate alcohol intake is of definite benefit, and some areas in which even small amounts are detrimental.

A literature review reveals that research is warranted to improve screening for "alcohol abuse" in older adults and women. An examination of diagnostic criteria for "alcohol abuse dependence" reveals that older adults provide unique challenges to classification systems. There is a need to evaluate the sensitivity and specificity of several new screening instruments for the identification of "alcohol abuse" in the elderly. Routine screening of elderly and women presenting in primary care settings should be a priority for researchers and clinicians.

The prevalence of alcohol use and misuse declines with age, but misuse remains an important public health problem among older people. Between 2 and 4% of the United States elderly population meet DSM-III criteria for "alcohol abuse" or dependence. Up to 10% are "heavy" or problem drinkers. Alcohol use and misuse are both more common among men than women. Since the elderly population is expanding, we will see an increase in the absolute number of older problem drinkers over the next few decades even if the prevalence of problem drinking remains constant. It is incumbent on health care providers and administrators to plan for the prevention and treatment of alcohol problems among these people.

Recent longitudinal studies have demonstrated that smoking cessation leads to reduced feelings of stress. This finding is not predicted by either of the two main models for smoking behavior. The nicotine resource model (Warburton) states that nicotine is used to cope with external stressors, and predicts that smokers will suffer from increased stress when they quit smoking. The deprivation reversal model (Schachter), suggests that smoking reverses the deleterious effects of deprivation; cessation will then lead to a period of increased stress, followed by a return to baseline. Although the stress/cessation data agree with neither model, they are consistent with a third explanation, namely that smoking causes stress. This model states that acute nicotine deprivation (i.e., between cigarettes) leads to increased stress. Smokers then use cigarettes to reverse these withdrawal effects and "normalize" their mood. This model explains some paradoxical aspects of the smoking/mood relationship. First, why smokers are calmed by smoking, yet report high average levels of stress. Second, why stress levels become reduced after smoking cessation; this is because the former smoker no longer suffers from the adverse mood effects of acute nicotine depletion.

This article describes reasons for abstinence of 1,066 Israeli Arab (Moslem, Druze, and Christian) adolescents in the north of Israel in winter 1994. It analyzes the results by religious group, gender, and location. "Alcohol damages health" and "Do not like the taste/smell" are the most prevalent reasons for not drinking among Christians. "Alcohol damages health" and "Religion intolerant of alcohol use" are most important among Moslems and Druze. "Do not care for it" and "Have seen bad examples of what alcohol can do" are also prominent reasons among Arab respondents. Implications of results for prevention are included.

With increased knowledge of effective prevention of adolescent smoking, there is a concomitant lack of research on effective adolescent smoking cessation. This study surveyed 77 adolescents (mean age 15.8 years) at a youth detention center in Seattle, Washington, about smoking patterns, cessation attempts, and motivations as well as withdrawal symptoms from nicotine. The results revealed that the majority of smokers had previously attempted smoking cessation (72%). The most common reasons for wanting to quit were for health concerns. Only 30.8% abstained for more than 1 month, and 35.9% abstained for less than 3 days. Nicotine craving was the most severe and most commonly reported withdrawal symptom.