What are the challenges to an effective interview for an older adult diagnosed with SUD?

Older people may under-report their substance misuse due to perceived stigma. Ageism may distract clinicians from signs of substance misuse, such as low energy and mood changes, which may instead be misattributed to general physical illness or depression. Stereotyping may blind detection of symptoms, for instance, ignoring substance use in older women due to the misnomer that substance use is an uncommon occurrence for this population. In addition, when performing an interview, it is crucial to identify the psychosocial factors that may make substance misuse more likely in older adults, for instance, issues such as bereavement, retirement, or physical immobility. SAMHSA (2011) also highlighted the complexities in assessing older adult SUDs and related psychiatric conditions such as major and mild depression and dysthymia. For example, older adults may demonstrate depression-like symptoms such as hopelessness, worry, and loss of interest in tasks deemed once pleasurable. Furthermore, there are no established older adult DSM diagnostic guidelines .
The SMAST-G identifies problems common for older adults, such as drinking after a significant loss. Other alcohol measures designed specifically for the older adult population include an adaptation of the AUDIT (SAMHSA, 2001), with sensitivity and specificity shown for a cutoff score of 5 for older men and 3 for older women.