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

Motivational Interviewing 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.

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.