Psych CASC / OSCE · Addiction psychiatry
Addiction in older adults — CASC communication station
MRCPsych/FRANZCP-style communication station: non-stigmatising engagement, explain age-related harm and falls, reject abrupt stop of zopiclone plus alcohol, negotiate screening and gradual plan, involve family constructively.
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Target exams
Station brief
Format. Communication and shared decision-making station, approximately 7–10 minutes after reading time. You are the psychiatry registrar in clinic. [1]
Candidate instructions. Engage without stigma, explain why alcohol plus zopiclone raise falls and cognitive risk in later life, refuse unsafe same-week cold turkey, outline a gradual collaborative plan (screening, sleep alternatives, possible alcohol reduction/pharmacotherapy later), involve the son as support, and safety-net. Do not invent statute numbers. [2][3]
Candidate scenario
Patient: "I am not a drug addict — wine is civilised." Son: "Stop the sleeping tablets and the wine this week or the cruise is cancelled." Two recent falls; no seizure yet. [1]
Marking domains
- Avoid moralising labels; use health and independence framing
- Link age-related sensitivity, falls, and sedative-alcohol combination
- Reject abrupt stop of continuous zopiclone after years of use
- Offer gradual plan: alcohol reduction goals, sleep strategies, education (EMPOWER-style), follow-up
- Involve son as ally for safety not police
- Safety-net: confusion, seizure, severe tremor, suicidal thoughts → urgent care
- Check understanding/teach-back
Reveal assessor key
Open. Role, privacy, agenda, acknowledge retirement stress and son's fear, ask what she already understands about the falls. [1]
Reframe. Not about being a "bad person" — ageing changes how the brain and balance respond to alcohol and sleeping tablets; falls threaten independence. [2][4]
Safety. Stopping zopiclone suddenly after years can cause severe rebound insomnia, anxiety, and rarely fits — safer is a planned slow reduction with medical review. Alcohol also needs an honest gradual plan, not a humiliating lecture. [1][3]
Plan. Shared goals (safer drinking limits, sleep skills, medication review), brief intervention style engagement, education materials, GP/psychiatry follow-up, son helping with appointments and home safety. Pharmacotherapy options can be discussed later if dependence criteria and preference align. [5][3]
Close. Three take-homes: combination of wine and zopiclone raises fall risk; do not stop sedatives suddenly; we will plan gradual changes together before the cruise if timing allows, or adjust cruise expectations for safety. Teach-back. [1][3]
References
- [1]Lehmann SW, Fingerhood M. Substance-Use Disorders in Later Life N Engl J Med, 2018.PMID 30575463
- [2]Kuerbis A, Sacco P, Blazer DG, et al. Substance abuse among older adults Clin Geriatr Med, 2014.PMID 25037298
- [3]Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial JAMA Intern Med, 2014.PMID 24733354
- [4]Glass J, Lanctôt KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits BMJ, 2005.PMID 16284208
- [5]Schonfeld L, King-Kallimanis BL, Duchene DM, et al. Screening and brief intervention for substance misuse among older adults: the Florida BRITE project Am J Public Health, 2010.PMID 19443821