Figure 2-3: Applying DSM-IV Diagnostic Criteria to Older Adults With Alcohol Problems

Figure 2-3
Applying DSM-IV Diagnostic Criteria to Older Adults With Alcohol Problems
Diagnostic criteria for alcohol dependence are subsumed within the DSM-IV's general criteria for substance dependence. Dependence is defined as a "maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period" (American Psychiatric Association, 1994, p. 181). There are special considerations when applying DSM-IV criteria to older adults with alcohol problems.
Criteria Special Considerations for Older Adults
  1. Tolerance
May have problems with even low intake due to increased sensitivity to alcohol and higher blood alcohol levels
  1. Withdrawal
Many late onset alcoholics do not develop physiological dependence
  1. Taking larger amounts or over a longer period than was intended
Increased cognitive impairment can interfere with self-monitoring; drinking can exacerbate cognitive impairment and monitoring
  1. Unsuccessful efforts to cut down or control use
Same issues across life span
  1. Spending much time to obtain and use alcohol and to recover from effects
Negative effects can occur with relatively low use
  1. Giving up activities due to use
May have fewer activities, making detection of problems more difficult
  1. Continuing use despite physical or psychological problem caused by use
May not know or understand that problems are related to use, even after medical advice

From: Executive Summary and Recommendations

Cover of Substance Abuse Among Older Adults
Substance Abuse Among Older Adults.
Treatment Improvement Protocol (TIP) Series, No. 26.
Center for Substance Abuse Treatment.
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