Substance Use Disorders

In older populations, substance use disorders are highly prevalent, often underdiagnosed and undertreated, and are associated with significant systemic medical and psychiatric comorbidity. Diagnostic criteria for substance use disorders are enumerated in the fifth edition, text revision, of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), and these are reviewed here. Furthermore, the epidemiology and proposed etiology of substance use disorders in late life are discussed. A particular focus is placed on reviewing the role of the psychiatrist in the evaluation and management of older adults with substance use disorders, especially when chronic pain is part of the clinical picture. Recommendations for evaluation and management of older adults with (or suspected to have) substance use disorders are outlined, and two case examples are provided to further solidify these concepts.