Chapter 1: Older Adults and Substance Misuse: Understanding the Issue
This chapter lays the foundation for understanding the scope and importance of substance misuse as a problem among older aged populations.

• Substance misuse is not something that only occurs in younger people.
• Substance misuse among older individuals is very dangerous and can increase their risk of death and other physical harms.
• Not only are rates of illicit drug use among older adults growing, rates of co-occurring mental disorders are also high.
• Older adults with SUDs are more likely to misuse alcohol than any other substance.
• Most older adults take at least one medication, and many take more than one.
• Providers and professionals may struggle to identify SUDs in older clients because symptoms can be hard to recognize and do not necessarily mirror diagnostic criteria.
• Although the idea that older adults are unwilling to seek treatment or services for substance misuse is false, certain barriers can make this population less likely to seek treatment.
• Multiple treatment approaches for SUDs exist that are effective for older adults.

Chapter 2: Principles of Care for Older Adults
This chapter describes guiding principles for evidence-based, effective, and safe treatments and services for older adults with substance misuse.
• To give older clients the best opportunities to access and beneft from substance use treatment and services, you must acknowledge, respect, and respond to differences among populations of older individuals.
• Organizations should create a treatment/ service environment that gives older clients the best chances for successful recovery.
• As a provider, you should learn the signs and symptoms of SUDs in older adults and be prepared to respond appropriately when they appear.
• Person-centered care is the preferred approach for this population
• Investing time and money in developing an age-sensitive workforce throughout your organization is important.
• Older adults with substance misuse can beneft greatly from social support and community resources.
• Including caregivers throughout treatment and services (as appropriate) and providing them with education and resources (including access to case managers) can improve older clients’ recovery chances.

Chapter 3: Identifying, Screening for, and Assessing Substance Misuse in Older Adults
This chapter addresses how, when, and why to use screening and assessment for substance misuse in older clients.
• By learning the steps to accurate and effective screening and assessment, you increase the chances of older adults receiving timely and appropriate care.
• To ensure proper and timely identifcation of problems, you should learn how to recognize and overcome these challenges.
• As a provider, you should regularly screen your older clients for substance misuse, at least annually.
• When communicating screening results, you should praise clients for fndings that indicate abstinence, and follow up on fndings that indicate substance-related problems.
• You should follow up on screening that indicates a potential substance-related problem by conducting an assessment.
• Not all clients who screen positive will need formal substance use treatment. For older clients with or at risk for mild or moderate substance misuse, a brief intervention may be suffcient (e.g., education, motivational interviewing). For older adults with moderate-to-severe SUDs, formal treatment may be necessary.