Substance Use Disorder in Elderly

Question 1

what is sensitivity?

Answer 1

• ability of test to correctly identify those with a disease of condition
• how many of those who have the disease are “caught” by the test?

Question 2

what does it mean if sensitivity is high?

Answer 2

• neg test likely to be a true neg
• low likelihood of missing someone with condition
• false positives are possible

Question 3

what is specificity?

Answer 3

• probability that a person w/o a disease or condition will have a negative test
• how many of those w/o the disease are “cleared” by the test?

Question 4

what does it mean if specificity is high?

Answer 4

• positive test likely to be a true positive
• low likelihood of falsely labeling someone with a condition
• false negatives are possible

Question 5

AUDIT-C

Answer 5

1. how often
2. how many in one night
3. how many nights 6+
   3+ for women, 4+ for men

Question 6

CAGE

Answer 6

cut down
annoyed
guilty
eye opener
2+
best for identifying alcohol use disorder, less sensitive for problem drinking

Question 7

AUDIT

Answer 7

8+
most widely validated
10 questions

Question 8

for what substance abuse disorder is there a specific, validated best tx?

Answer 8

opioid use disorder - MAT

Question 9

withdrawal from what 2 substances can be life-threatening?

Answer 9

ETOH and benzos

opioids not bad

Question 10

what meds are approved for older adults in withdrawal from opioids?

Answer 10

• anti-emetics = GI disturbance
• trazadone = sleep disturbance
• acetaminophen = body aches

Question 11

1st line medical therapy for AUD

Answer 11

• naltrexone - can still be drinking when start but must be opioid free, oral and injectable, caution liver and renal, adverse effects diminish with time
• acamprosate - must be alcohol free at start, ok liver, caution renal, few adverse effects, most effective in maintaining abstinence
• disulfram - neg reinforcement, no alcohol 12 hrs prior to start, no alcohol even in meds or mouthwash, caution liver/cardiac
• topiramate - off label, titrate and taper, caution renal, many adverse effects, caution elderly - inc risk falls

Question 12

2nd line medical therapy for AUD

Answer 12

• gabapentin - 1800mg/day, caution elderly risk of falls
  ? baclofen
  ? SSRIs
  ? ondansetron

Question 13

best tx opioid use dx

Answer 13

MAT

• methadone - caution QTc prolongation
• buprenorphine - not as effective as methadone but safer and more convenient (can be dispensed monthly rather than daily)
• naltrexone - only use after withdrawal sx have resolved