Substance Abuse & Older Adults

Demographics of the Elderly  35 million Americans 65 and older  People over 65 are the fastest growing age group.

Older Adults & Medications  Older adults represent only 12% of the total population yet they account for 25-30% of prescription drug expenditures.  Persons 65 and older may take 7 or more Rx meds in addition to heavy consumption of OTC drugs.  Older adults experience more than 50% of all adverse drug reactions leading to hospitalizations.

 Most common drugs abused by the elderly currently are benzodiazepines.  Widely prescribed by physicians for treatment of anxiety and insomnia, esp. to women  Benzodiazepene abuse often coexists with alcohol abuse in the elderly.

Alcohol and Its Medical Consequences  Health Effects  Lungs  Liver and kidneys  Malnutrition  Sleep problems  Circulatory System – increased risk of heart disease, hypertension, diabetes  Central Nervous System – balance, vision, brain damage, memory loss

What is “healthy” drinking?  The SAMHSA Center of Substance Abuse Treatment recommends that:  Older men consume no more than one drink/day  A maximum of two drinks on any drinking occasion  A somewhat lower limit for women

What is a standard drink?  1 can – 12 ounces of beer or ale  A single shot - 1 ½ ounces – of spirits  A glass – 5 ounces – of wine  A small glass – 4 ounces - of sherry  A small glass – 4 ounces – of an aperitif

Substance Abuse & Mental Health  Co-Existing Disorders:  One disorder may prompt the emergence of the other or exist independently  Psychiatric behaviors can mimic behaviors associated with AOD problems  Psychiatric disorders may interfere with patient’s ability and motivation to participate and be compliant with addiction treatment.

Alcohol Use and Co-Morbid Depression  High rates of concurrent depression and alcohol use among the elderly  Poorer outcomes for both disorders  Depression & other affective disorders may have contributed to alcoholic drinking behavior OR may result from addiction  Deadly triangle – the combination of suicidal ideation and depression and drinking

Among persons older than 65, moderate and heavy drinkers are 16 times more likely than non- drinkers to die of suicide.

Patterns of Alcohol Abuse Among Older Adults  Men are 2-6 times more likely to have alcohol problems than women  Older women problem drinkers tend to have later onset and be more secretive, making detection more difficult  Future projections – prevalence rates to increase – significant future health concerns

Late vs. Early Onset  Late onset - generally defined as onset after age 50  Up to 50% of elderly alcohol abusers experience the onset of problem drinking later in life  Early onset patients experience more emotional problems and drop out of treatment at a higher rate.  Late onset patients tend to be more psychologically stable, remain in treatment longer, have their problem resolve without treatment.

Risk Factors  Multiple losses: friends, family, independence, income, role, status, health  Retirement  Chronic medical conditions  Social isolation  Loneliness  Lots of free time

Barriers to Identification & Treatment  Diagnostic DSM-IV criteria may not be appropriate for older adults:  Common indicators for younger patients are not always relevant to elderly  No social problems – they live alone  No work problems – they’re retired  No DUIs – they no longer drive

Atypical Symptoms  Some signs attributed to normal aging or medication side effects (for example, falls, forgetfulness, depressed mood, incontinence, social withdrawal/isolation)

Clinician “Issues”  Lack of time and lack of current and ongoing training  Identification with the client  A belief that our clients won’t respond to treatment because of their age  Myths of aging – “this sweet little old man/woman couldn’t be….”  “Let them enjoy their last few years.”

Intervention  Stages of Change – starting where the client is  Increasing motivation for change IS critically important work we can do.  An empathic, supportive, yet directive counseling style provides conditions under which change can occur  Direct argument and aggressive confrontation tends to increase client defensiveness and reduce the likelihood of behavioral change.

Motivation  Where does motivation reside?  What is it?  How do we interfere with motivation?  How do we nurture it?

Motivational Interviewing  is a way of being with a client, not just a set of techniques  helps clients resolve their ambivalence that prevents them from realizing personal goals

 In using motivational interviewing, we serve as helpers in the change process.  In using motivational interviewing, we express acceptance of our clients.  In using motivational interviewing, we are persuasive rather than coercive. Motivational Interviewing

Labels We Don’t Use  Client is IN DENIAL  Client is UNMOTIVATED  Client is DIFFICULT  Client is MANIPULATIVE  Client is RESISTANT  Client is HOPELESS

Self identification of client as an alcoholic or addict is NOT a predictor of outcome or acceptance of a problem.

Our role is to help our clients…  Move toward envisioning desired futures and developing new lives.  Imagine a preferred future.  Focus on what could be rather than what isn’t.