1. Mental Health, Substance Abuse, and Older Adults Funded by Master’s Advanced Curriculum Project University of Texas at Arlington The development of this learning module was made possible through a Gero Innovations Grant from the CSWE Gero-Ed Center’s Master’s Advanced Curriculum (MAC) Project and the John A. Hartford Foundation.

2. Mental Health, Substance Abuse, and Older Adults

3. Test Your Knowledge

4. Question #1: Substance abuse among the elderly is only a minor problem.  False

5. Question #2: Most elderly with substance-related disorders get treatment.  False

6. Question #3: Most elderly with substance–related disorders abuse alcohol followed by marijuana.  False

7. Question #4: Older women are more depressed and therefore drink more than older men.  False

8. Question #5: The elderly can tolerate higher levels of alcohol compared to younger drinkers.  False

9. Question #6: Most elderly individuals can easily tolerate recommended adult doses of most medications.  False

10. Question #7: Illicit drug use particularly involving substances such as marijuana, heroin, or cocaine is quite rare among the elderly.  True

11. Question #8: Tranquilizers and sleeping pills are the prescription drugs most abused by elderly individuals.  True

12. Question #9: Abuse of prescription drugs is more common among older women than men.  True

13. 3 types of elderly drinkers:  Early onset problem drinkers  Early intermittent drinkers  Later-onset problem drinkers

14. Misuse of Prescription Medications  30% of all prescriptions and 40% of all over the counter medications sold to older adults.  10% to 15% of the elderly intentionally misuse prescription medications.  17% to 23% of drugs prescribed to older adults are benzodiazepines.

15. Factors that Contribute to Substance Abuse among the Elderly  Substance use disorder earlier in life  Genetics  Major life changes  Disengagement  Deterioration of health  Dangerous health care prescribing practices

16. Mental Health Comorbidity  Alcohol Dependence with Comorbid Major Depressive Disorder  Alcohol Dependence with Comorbid Cognitive Impairment  Alcohol Dependence with Comorbid Anxiety Disorders

17. Assessment and Diagnosis  Problems With DSM for Diagnosis  Older adults who consume smaller amounts go undetected as having a substance abuse problem.  Older adults less likely that substance use interferes with social or occupational functioning.

18. Screening Tools

19. CAGE  Have you ever felt you should Cut down on your drinking?  Have people Annoyed you by criticizing your drinking?  Have you felt Guilty about your drinking?  Have you Ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

20. Michigan Alcoholism Screening Test- Geriatric (MAST-G)  Internet Site: http://pathwayscourses.samhsa.gov/elab /pdfs_elab/elab_supps_pg8.pdf

21. The Alcohol Use Disorders Identification Test (AUDIT)  Internet Site: http://whqlibdoc.who.int/hq/2001/WHO_ MSD_MSB_01.6a.pdf

22. The Alcohol Related Problems Survey (ARPS)  Internet Site: afink@mednet.ucla.edu

23. The Impressions of Medication, Alcohol, and Drug Use in Seniors (IMADUS)  pp. 199-200 in the book Geropsychiatric and Mental Health Nursing by Karen Melillo & Susan Houde published by Jones and Bartlett.

24. Intervention and Treatment  Least Intensive Treatment Option  Traditional confrontational interventions do not work  Brief interventions and motivational methods are recommended as the first mode of intervention.  Hospitalization

25. Brief Interventions & Motivational Counseling  Give feedback on screening  Discuss reasons for drinking  Discuss consequences of drinking  Discuss reasons to cut down or quit  Develop strategies for achieving goal  Develop an agreement in the form of a written contract.  Identify obstacles to achieving goal.  Discuss strategies to overcome obstacles  Summarize session.

26. Cognitive-Behavioral Approaches

27. Additional Considerations for Intervention & Treatment  Age-appropriate components  Group-based approaches  Involvement of family or significant others  Case management services  Inpatient treatment Facilities  12 Step programs

28. Case Example for Discussion and Application  Mr. G. had recently lost his wife. She had been ill for several years and he had taken care of her. After she died, he did not have many ways to fill his time. He was unable to drive and depend on his daughter to grocery shop for him. Once in a while he added a six-pack of beer to the weekly list. Indeed, since his wife’s death, Mr. G had put beer on the list every week. Over the past month, Mr. G. had fallen and became incontinent. His doctor recognized the roll alcohol played in these symptoms, asked about it, and referred him to a community mental health clinic where he encountered a social work practitioner.