“Dual diagnosis” refers to the presence of coexisting medical disorders. It is a term most often used when referring to people who have both a substance use disorder and a mental health condition. The incidence of dual diagnosis in older adults is increasing.
Implications of Dual Diagnosis in Older Adults
People with mental health disorders are more likely to self-harm or commit suicide than any other demographic. When people with mental health disorders are also suffering from a substance use disorder, their risk level increases. When addressing dual diagnosis in older adults, this increased risk level should be taken into account. Suicide rates are highest in the 45-64-year-old age bracket. In 2014, more than twice as many people in this age range committed suicide than those in the 15-24 age range.1
If people who suffer from depression also abuse alcohol, they are more likely to self-harm or commit suicide than those who abuse alcohol but have no other medical issues. This is thought to be a result of the way alcohol lowers inhibitions and the ability to control impulses. Additionally, alcohol acts as a depressant in the brain, exacerbating the effects of clinical depression. Misuse of other drugs such as benzodiazepines also poses an increased risk of self-harm or suicide.
Older Adults Are More Likely to Have a Dual Diagnosis
Specific age-related factors can lead to substance use disorders. Older adults are more likely to undergo traumatic experiences like bereavement. Many people struggle to cope with retirement. Loneliness following the loss of a spouse is common. Reduced mobility and the need to rely on others to carry out routine tasks can undermine self-confidence. Any of these can prompt people to turn to drugs or alcohol for relief.
Health disorders tend to accumulate in people as they age. Older adults are more likely to be on prescription drugs such as painkillers, anti-depressants and sedatives. Almost all of these drugs are addictive, so the risk of older adults developing a substance use disorder is higher.
Treatment for Dual Diagnosis in Older Adults
Once an older adult has received a dual diagnosis, it is important for them to seek professional help. When older adults receive appropriate treatment, the outcome is just as good as, if not better than, the success rates of younger people.2
Ideally, dual diagnosis in older adults should be addressed through treatment in an inpatient facility. There are several reasons why this approach is best. Alcohol withdrawal symptoms for older adults tend to be more severe than those in younger people. Medical intervention is more often required, and temporary dementia or hallucinations during withdrawal are more common. Withdrawal from other substances can pose additional problems for older people.
Once detox is complete, treatment can focus on relapse prevention. Therapies that work well with younger people may need to be modified; for example, older people may regard standard techniques like group therapy as intimidating. Other forms of group therapy, such as creative arts therapy, may produce better results.
Many older adults make successful recoveries from substance use disorders and remain sober after treatment. Those with dual diagnosis may need to continue treatment for their mental health, but they can still enjoy happy and fulfilling lives.