The publication of Our Invisible Addicts in 2011
represented an important landmark in recognising the extent of
substance-related health problems amongst older people and that the
special service needs to deal with the complexity of such problems,
which often involve co-morbid mental and physical health problems,
polypharmacy and psychosocial adversity.
Since then, our knowledge concerning the clinical and public
mental health aspects of substance misuse in older people has
continued to advance but substance misuse amongst older people
continues to grow as the population of “baby boomers” ages,
increasing both the number of older people and the percentage of
the older population with experience of substance misuse.
Given the further experience and knowledge we now have and the
growing need, it is now timely to readdress the issue and to review
and revise the original report and build on its recommendations.
With this revision, we seek to build on the progress made over the
past six years and to emphasise anew that including older people
with substance problems in national policies is imperative and that
there is a need for organisational reform to tackle this burgeoning
The complex constellation of risks that older people with
addictions face and create can result in presentation to a variety
of services such as older people’s mental health, addictions,
primary care, acute hospital settings, social care, housing,
criminal justice and the voluntary sector. In many cases the staff
in these settings have little specialist knowledge of how to deal
with such complexity.
As a result, in this revision we consider and advocate the
further development of a clinical workforce with the appropriate
knowledge, skills and attitudes to provide identification,
assessment, treatment, and assist in recovery and referral for
substance misuse in an older population. In particular, we see a
need to reverse the loss of multi-professional specialist training
in addictions that has taken place in recent years.
We also explain how the problem can be best addressed though an
approach that is multi-professional, involving psychiatry, nursing,
pharmacy, occupational therapy, psychology, social work and the
voluntary sector (including peer support).
This report also addresses the important public mental health
aspect. The public is poorly informed about the relationship
between drinking and health risks in older people. There is also a
need to improve knowledge and awareness around the increasing use
of illicit and prescription drugs, as well as the harm caused by
novel psychoactive substances, substances acquired using the
internet, and other addictions accompanying substance misuse such
Improving health and social outcomes for older people with
substance-related disorders requires a rigorous approach and this
report collates the most up-to-date information relevant to
practising psychiatrists, their teams and other
There is a need for best practice to be implemented and extended
to all relevant settings including the criminal justice system and
end of life care. As we do so, we should continue to research the
effectiveness of the different approaches taken, using both
qualitative and quantitative measures to evaluate this.
This report, which has been developed with representation from a
patient, the Royal College of Psychiatrists, the Royal College of
General Practitioners and the British Geriatrics Society, provides
the latest milestone on the journey towards developing the best
possible response to this important problem