To set the stage for understanding medical management, we need to go back about 20 years to the inception of the landmark COMBINE Study. This study was a very large clinical trial for alcohol use disorder (AUD) that compared naltrexone, acamprosate, and their combination, and also looked at two behavioral interventions.

On May 16, 2018, the FDA announced its approval of Lucemyra (lofexidine) as a drug to help patients withdraw from opioids. Like clonidine, lofexidine is an alpha-2 agonist, but it is touted as causing less orthostatic hypotension and therefore being somewhat safer to use.

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Addiction spares no age group, but it often goes undetected in older adults age 65 or older, and its treatment poses age-specific challenges.

How should we employ pharmacotherapies for alcohol use disorder (AUD) in older adult patients? There are three FDA-approved medications (acamprosate, disulfiram, and naltrexone) and two other commonly used off-label agents (gabapentin and topiramate).

As we age, we are more vulnerable to a lot of things—the same amount of alcohol or the same amount of any of these substances is going to cause more impairment in an older person vs a younger one. As an example, our stability and gait can worsen as we get older, so any substance that affects gait or balance will have a larger effect.

How much can our older patients safely drink? And what does “safe” or “low-risk” drinking actually mean? The National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is the branch of the NIH that focuses on problems related to alcohol, has released guidelines for low-risk drinking limits in older patients.