Older age bipolar disorder and substance use

The devastating impact of substance use disorders (SUDs) among older adults has only recently attracted the attention of researchers, clinicians, and the general public. Despite the evidence that alcohol and other SUDs affect nearly 1 in 5 older adults, there has been limited examination of these areas in the substance abuse or gerontology literature. Bearing in mind the paucity of research on the screening, assessment, and treatment protocols for older adults with bipolar disorder and coexisting SUD, in this chapter, we outline the state of current knowledge and where possible, make clinical recommendations on the assessment and management of SUDs among older adults with bipolar disorder. Adults with bipolar disorder (compared to other psychiatric disorders) have the highest rate of alcohol use disorder [3]. With the predicted dramatic growth of the aging population, as well as more geriatric patients in outpatient opioid maintenance programs both due to the aging of patients first enrolled in the 1990s and due to patients with prescription opioid misuse in later life, the need and demand for effective, comprehensive mental health services for older adults with psychiatric illness and substance use disorders will continue to grow. Other disorders, such as benzodiazepines, cannabis, and psychostimulants are also described, with future directions for research outlined.