Alcohol and benzodiazepine abuse is so troublesome because in many situations it goes undetected until the consequences become fatal. Health care professionals often overlook the straight forward signs and symptoms of drug and alcohol abuse and attribute them to common complaints of the aging client. Family and friends may over look the abuse because it usually does not result in the socially disruptive behavior as often seen with the younger generation. The older women with substance abuse problems rarely recognize the abuse because they are taking the medications as prescribed by a trusted healthcare provider and perhaps drinking a limited amount of alcohol. Many are unaware of the serious consequences of combining alcohol and benzodiazepines or that the long term use of benzodiazepines can result in a physiological addiction. The brief intervention model by Deborah Finfgeld- Connett, 2004, recommends that patients take responsibility for their choices and initiate manageable steps towards making necessary and healthy changes. The seven elements of the model include assessment, feedback, responsibility, advice, menu, empathy and self-efficacy. Each of these elements can translate to strategies that can be implemented by the nurses to help the client recognize substance abuse problems and help them modify or change their behaviors through a series of brief interventions. Findings from a randomized controlled clinical trial of brief interventions demonstrated the effectiveness of these interventions to reduce alcohol consumption; however, similar findings on benzodiazepine abuse among older women are still lacking (Finfgeld-Connett, 2004).

      Marie Caroselli-Karinia (1985) reports there are much higher rates of prescription drug use by the older adult. Karinia reports that although people over the age of 65 represent 11% of the population, they are taking 25% of all prescribed medications. (Karinia, 1985). These numbers alone should call attention to the increased risk of misuse by this population. As the elderly patient ages there are major alterations in the environment and in relationships which make the individual more vulnerable to using drugs as a means of coping. Karinia reported three patterns of abuse and misuse to include: (1) overuse resulting in over dosage or an excessive level of medication in the bloodstream, (2) underuse as a result of the elderly forgetting to take their prescription medications and (3) the erratic use of medication which incorporates both underuse and overuse such as forgetting to take one dose and the next day taking a double dose. The most commonly abused drugs are those classified as the psychotherapeutics, such as sedatives and hypnotics. The literature also reports that physicians who care for aging clients may feel obligated to offer a cure to those who have frequent office visits for those problems which do not seem clearly defined or to have a definitive cure. Providing medications to these patients may appear to satisfy them in the short term, but little attention is paid to the fact that the prescribed medication, particularly a benzodiazepine, could possibly be harmful to them in the long term. The potential for drug abuse may be further increased in those elderly patients who may be otherwise compromised by marginal levels of mental compensation (Caroselli-Karinia, 1985).

      Many health care professionals have failed to recognize actual or potential substance abuse concerns in the older adult female. This could be the result of a lack of education related to the incidence and/or clinical manifestations, a lack of training and even biases related to the presentation of the problem in the older adult woman. It should be standard practice in acute care settings to evaluate an elderly client’s condition for the possibility that the clinical presentation could be drug induced or drug influenced. Health care professionals should teach the patient the risks associated with the long term use of benzodiazepines, the effects of combining alcohol with any prescription or over the counter medications and the possibility of dependence or reliance on certain medications when used for coping or for stress relief. The elderly should be educated that medication should only be used when absolutely necessary and they should be encouraged to periodically review all prescription medications and over the counter medications with their primary health care providers (Caroselli-Karinia, 1985).

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