Understanding and Appropriately Treating Chemical Dependency

in Older Adults

Dale John Dyben, MA, MS, CAP, CMHP

Director of Older Adult Treatment Services Hanley Center

Learning Objectives

• Understand trends in aging, substance use disorders, and health care.

• Identify signs and symptoms of substance use

disorders in older adults.

• Recognize comorbidities in older adults.

• Improve knowledge of treatment strategies.

Defining the “Older Adult”

• Many studies include anyone over 50

• U.S. retirement age is 65-67

• World Health Organization-2 Categories:

Older adult = 65-79 Elderly = 80 and older

Group Participation

Today, we are all going to grow older…

…like it or not!

Population Trends

• By 2030, one-fifth of US population >65

• Life span expectations >85

• Longer living also means more chronic illness

• Substance abuse a major factor in this equation

Older Adult Substance Abuse

• Common problem amongst older adults

• Less likely to be recognized or addressed

• Correlates with hip fractures and dementia

• Causes and exacerbates health problems

Alcohol Abuse

Alcohol Abuse

• More than 2.5 Million older adults today

• Expected to double by 2020

• Number one drug of choice for older adults

• AGA recommends annual screenings

• A continuum of progression into addiction

Prescription Drug Abuse

Prescription Drug Abuse

• More prevalent in older adults

▫ Increased access ▫ Multiplicity of medications

• Creeping up on alcohol’s #1 spot

• Disagreements in medical community

Illicit Drugs

• Estimated 4.8 million older adults in 2010

• Marijuana by far most common illicit drug of abuse.

• The face of drug abuse is changing!

Process Addictions

• Also referred to as behavioral addictions

• Similar presentation as chemical dependency

• Continual reward seeking behavior

• Negative consequences do not cause cessation

Process Addictions • Gambling

▫ Increase from 35% in 1975 to 80% in 1998 ▫ Lottery is most common followed by casinos ▫ Excitement, socialization, money ▫ Consequences of loss harder to mitigate

Process Addictions

• Sex and Sexually Transmitted Diseases ▫ Debate over classifying as addictive ▫ Little research in OA sexual compulsivity ▫ 2010: 16.5% of new HIV diagnosed persons >50 ▫ Baby Boomers and pharma influencing trends

Screening and Assessment

• SUD under recognized in older adults

• Need for improved screening and assessment

• Patients and practitioners tend to avoid

• SUD symptoms look like other age related issues

Screening and Assessment

• Abnormalities in bloodwork

• Unexplained changes in sleep or behavior

• Unexplained injuries

• Decline in ADLs

• Fluid retention

Screening and Assessment

• CAGE ▫ Have you ever tried to Cut down on your use?

▫ Have you been Annoyed by others’ concern?

▫ Have you ever felt Guilty about use?

▫ Have you ever needed an “Eye opener”?

Screening and Assessment

• Michigan Alcohol Screening Test – Geriatric ▫ MAST-G ▫ 24 question, self-report

• Simple screening for Benzodiazepine abuse ▫ “Have you noticed decrease effectiveness?” ▫ “Have you tried to stop?”

Treatment Differentiations

• Older adults have unique treatment needs

• Private treatment centers:

▫ 18% address older adult needs in any way

▫ Roughly 0.5% have tracts ▫ Full programs so rare they are not even mentioned

Effective Treatment Models

• Tailored to address issues of aging

• Include friends, family and other support

• Respectful, non-confrontational

• Peer support

Effective Treatment Models

• Older Adult Health Living Program (HeLP) ▫ Cognitive Behavioral Therapy ▫ Motivational Interviewing

• Brief Intervention & Treatment for Elders (BRITE) ▫ 16-session relapse prevention program ▫ Psychoeducational/workbook-based/follow-up

Treatment Needs of Older Adults

Treatment Needs of Older Adults

• Physical needs ▫ More likely to have 2+ chronic medical conditions

▫ More likely to have severe physical impairment

▫ Slower metabolism

▫ Detox and treatment will take longer

Treatment Needs of Older Adults

• Psychological Needs ▫ Depression, anxiety, dementia

▫ Relevant approaches:

Practiced physical activity Cognitive Behavioral Therapy Problem Solving Therapy Interpersonal Therapy

Treatment Needs of Older Adult

• Social Needs of Older Adults

▫ Major Changes Changing social status Deaths of loved ones Changes in social support

• Social environment influences use

Treatment Needs of Older Adult

▫ Treatment should:

Support long-term social

support systems

Be age specific

Be cohort driven

• Social Needs of Older Adults

Generational Cohorts

• Groups of people born within a given time frame

• Experienced common events

• Lives shaped by formational experiences

• Effects remain through lifespan

• Relevant for cultural awareness

The Good Warriors

• Born 1908 to 1929

• World War II

• The Great Depression • Prohibition

• Institutional authority trusted

The Baby Boomers

• Born between 1946 to 1964

• Vietnam

• Civil Rights Movement

• “Sex, Drugs, & Rock and roll”

• Institutional authority feared and distrusted

Treatment Needs of Older Adult

• Spiritual Needs ▫ Socially supportive spiritual practices

▫ Reframe past and current struggles

▫ Not necessarily religious but may be

▫ Most significant predictor of healthy adjustment

Issues of Elder Abuse • Definitions

▫ “Intentional actions that cause harm or create a

serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder.” (Jogerst, Daly, Galloway, Zheng, & Xu, 2012, p. 63)

• 10% to 30% of older adult may be victims

• Substance abuse linked to elder abuse

Conclusions

• The older adult population is growing

• Substance abuse and addiction are common

• These problems are under recognized

• Screening and assessment imperative

• Treatment for this problem must be specialized

Conclusions As health professionals, you are the best line of defense for older adults who may be struggling with substance misuse, abuse or addiction.

• Screen • Prevent • Treat

• Support

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