Early onset substance abuse disorders and addictive diseases in old age

During the past 20 years substance-related and addictive disorders in old age have markedly increased and this increase is going to continue. It is quite common to make a distinction between early onset (EO) and late onset (LO) of these disorders. EO-addicts are in a more disadvantageous position due to constitutional and psychosocial burdens and the cumulating harmful medical, mental and social consequences of addiction place them at a further disadvantage during the course of the disorder. In old age they are at a disadvantage compared to others of the same age with LO addiction problems because of more and more severe chronic medical conditions, psychiatric comorbidity, less personal and social resources, dysfunctional coping style, and social problems. They present with lower treatment adherence and the treatment is difficult due to the combination of typical addictive behavior, psychiatric comorbidity, somatic diseases and in many cases also cognitive impairment. Treatment goals must be mostly individually defined and abstinence is rarely a realistic goal. Even the treatment has to be carried out mostly individually and often unconventionally. This article gives a review of the characteristic features of the course, presentation and adverse consequences of addictive disorders in EO addicts who have reached old age. The article covers alcohol, prescription drugs, illicit drugs and smoking as well as behavioral addictions.