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The existence of comorbid medical and psychiatric disorders will influence treatment choice and priorities and will affect treatment outcome. Frail or medically compromised alcohol abusers, for example, may require more intensive monitoring during the detoxification period of treatment than their more robust peers. When disorders such as uncontrolled hypertension or depression are detected, reducing alcohol consumption becomes a priority; until drinking is curbed, medication prescribed for those conditions will not work effectively. In contrast, for older adults suffering from chronic pain, the priority would be to identify an effective painkiller, then taper the amount of alcohol consumed. Psychiatric comorbidities Data from the Epidemiologic Catchment Area (ECA) study have strengthened support for a possible link between alcohol use and abuse and the development of other psychiatric illnesses (Regier et al., 1990). Adults with a lifetime diagnosis of alcohol abuse or dependence had nearly three times the risk of being diagnosed with another mental disorder. Comorbid disorders associated with alcohol use include anxiety disorders, affective illness, cognitive impairment, schizophrenia, and antisocial personality disorder (Finlayson et al., 1988; Blow et al., 1992b; Blazer and Williams, 1980; Saunders et al., 1991; Oslin and Liberto, 1995; Wagman et al., 1977). According to one study, older alcohol abusers are more likely to have triple diagnoses - alcohol, depression, and personality disorders - whereas younger substance abusers are more likely to have diagnoses of schizophrenia (Speer and Bates, 1992). Cognitive impairments Figure 4-5: Comparison of Dementia and Delirium: Characteristics and Causes
Figure 4-5 Comparison of Dementia and Delirium: Characteristics and Causes Dementia
Delirium  Impairments
in
 Inability
to
Characterist
short- and
appreciate and
ics
long-term
respond