Book Review: Old and High

Old and High: A Guide to Understanding the Neuroscience and Psychotherapeutic Treatment of Baby Boom Adults’ Substance Use, Abuse, and Misuse, by Robert Youdin, Oxford University Press, ISBN 0190672897, 2019, 296 pages, $55.00.

    Robert Youdin’s book Old and High is a ground-breaking guide to understanding Baby Boomers’ use, misuse, and abuse of psychotropic drugs. The book is broken into three distinct parts.

    Part I addresses who Baby Boomers are, as well as the unique characteristics of this generation related to documented substance use and abuse. The medical model and the Person-in-Environment (PIE) perspective are discussed side by side to highlight the differences in the two theoretical models and the impact the two frameworks have had, and continue to have, on how society views addiction. Basic genetic and psychophysiological concepts are explained in an easy-to-understand manner. In addition, the impact and intersection of racism, classism, and the criminalization of psychotropic substances are discussed poignantly.

    Part II discusses the psychotropic substances most used and abused by Baby Boomers (alcohol, benzodiazepines, cannabis, opioids, psychostimulants, tobacco) and presents research related to each.  

    Part III presents therapeutic interventions and techniques for treating substance-using older adults (i.e., Boomers). Case scenarios are used throughout to illustrate points, techniques, and issues.

    In my opinion, Youdin’s book is really a seminal guide for any social work practitioner and/or social work student’s bookshelf. With the significant growth and diversity of the aging population, along with the economy’s negative impact (physically and mentally) on seniors’ human rights, dignity, and quality of life, I suspect that social workers in any field of practice will run into substance abuse issues among older adults (most of whom will be Baby Boomers). From access to affordable housing, and healthcare, to loneliness, poverty, and the emotional/physical strain of grandparents raising grandchildren, numerous stress-related variables can lead to self-medication among this marginalized group. Consequently, having access to a guide that not only acknowledges the diversity and unique characteristics of Boomers, but discusses past and present research on the phenomenon, as well as evidence-based practices and interventions that are illustrated in relevant case scenarios, is really invaluable. In addition, Youdin does a fantastic job of presenting extensive, detailed research in a way that directly ties it to clinical practice.

    What I found particularly impressive was the way in which the author took into consideration looking at this phenomenon from a social justice perspective. Youdin may not be a social worker, but he addresses the impact of diversity on this phenomenon and acknowledges how policy intersects with social variables in regard to diagnosis and treatment, and what that means for the consumer.

    Although I wish the book included more discussion on dimensions of diversity (sexual orientation, gender identity, cultural differences are addressed, but not thoroughly enough for me), I highly recommend this book to any social worker or social work student because of its relevance, guided interventions, and overall discussion of addiction and Baby Boomers from a PIE perspective. As a macro social worker, I found myself more prepared to advocate for this population after reading this book.  This text coupled with a book specific to LGBTQ seniors would be a powerful asset to social workers.

Reviewed by Satara Armstrong-Charlson, PhD, MSW, Professor of Social Work, Brandman University, Irvine, CA.