Dual Diagnosis Among Older Adults: Co-Occurring Substance Abuse and Psychiatric Illness

ABSTRACT

Objectives: The goal of this article is to provide a comprehensive critical review of studies reporting the prevalence, characteristics, outcomes, and service utilization associated with comorbid substance abuse and mental illness in older age.

Methods: We searched the Medline and PsycINFO databases using combinations of the keywords ‘Dual diagnosis,’ ‘Elderly,’ and ‘Older.’ We included English-language reports presenting quantitative data on the prevalence and/or any descriptive information about older adults with dual diagnosis.

Findings: The prevalence of older adults with comorbid substance abuse and mental disorders varies by population, and ranges from 7% to 38% of those with psychiatric illness and from 21% to 66% of those with substance abuse. Depression and alcohol use are the most commonly cited co-occurring disorders in older adults. Dual diagnosis in older adults is associated with increased suicidality and greater inpatient and outpatient service utilization. Data on treatment are limited. However, recommendations have been adapted from evidence-based treatment of younger adults with dual diagnosis, older adults with substance abuse, and older adults with mental health problems.

Conclusions: Dual diagnosis among older adults is a growing public health problem. Well-designed prevention, early intervention, and treatment studies are needed that specifically address co-occurring disorders in older adult populations.

KEYWORDS:

• Dual diagnosis
• co-occurring
• mental illness
• depression
• psychiatric
• substance abuse
• alcohol
• older adult
• geriatric