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Tip 26 Mental Health and Substance Abuse Treatment Older Adults
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Tip 26 Mental Health and Substance Abuse Treatment Older Adults

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NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at ...

NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com

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    Tip 26 Mental Health and Substance Abuse Treatment Older Adults Tip 26 Mental Health and Substance Abuse Treatment Older Adults Presentation Transcript

    • Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • Abuse of alcohol and prescription drugs among adults  60 and older is one of the fastest growing health problems facing this country. In the United States, it is estimated that 2.5 million  older adults have problems related to alcohol. Adults age 65 and older consume more prescribed and  over-the-counter (OTC) medications than any other age group. Treating older adults for substance use disorders is  worthwhile. Alcohol or substance abuse problems can be  successfully treated in older adults. Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Three age-related changes significantly affect the way an older person responds to alcohol: 1) The normal decrease in body water that comes with age means:  the same amount of alcohol that previously had little effect can now cause intoxication  increased sensitivity and decrease tolerance to alcohol 2) The decrease in the rate of metabolism of alcohol in the gastrointestinal tract means:  blood alcohol level remains raised for a longer time  an increased strain is placed on the liver Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • 3) Age-related changes, combined with alcohol consumption, can trigger or worsen serious problems including :  heart problems  risk of stroke  cirrhosis and other liver diseases  gastrointestinal bleeding  depression, anxiety, and other mental health problems Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • Many older adults’ medications can interact negatively  with alcohol Older adults can become dependent on psychoactive  medications without realizing it Older patients are more likely to misunderstand  directions for appropriate use of medicines Older adults often receive multiple prescriptions from  different doctors without coordination Unintentional misuse can progress into abuse if  medication is used for the desirable effects it provides Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • Psychoactive substance use, even at therapeutic  doses, has been associated with a variety of negative central nervous system effects. Indications of problematic psychoactive substance use:  • diminished psychomotor performance • impaired reaction time • loss of coordination • falls • excessive daytime drowsiness • confusion • aggravation of emotional state • amnesia • dependence Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Emotional and Social Problems • Bereavement and sadness • Losses  spouse, friends, family members  social status  occupation and sense of professional identity  hopes for the future  ability to function • Social isolation and loneliness • Reduced self-regard or self-esteem • Family conflict and estrangement • Problems in managing leisure time/boredom • Loss of physical attractiveness Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Medical Problems • Loss of hearing or sight • Chronic pain • Physical disabilities and handicapping conditions • Reduced mobility • Insomnia • Cognitive impairment and change  Practical Problems • Impaired self-care • Dislocation from housing • Reduced coping skills • Loss of income or increased health care costs Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Other issues to watch for • Older men when their wives die • High rates of alcoholism reported in medical settings • Substance use disorder earlier in life • Mood disorders • Family history • Psychoactive prescription drug use Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  All adults age 60 and over as part of their annual physical  If the person undergoes a major life transition  If the person develops physical symptoms not expected or explained by other medical issues Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  The following physical symptoms may alert to the development of an addiction: • Sleep-related problems • Cognitive difficulties • Seizures, malnutrition, muscle wasting • Liver function abnormalities • Persistent irritability and altered mood, depression, or anxiety • Unexplained complaints about chronic pain • Incontinence, urinary retention, difficulty urinating Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • • Poor hygiene and self-neglect • Unusual restlessness and agitation • Complaints of blurred vision or dry mouth • Unexplained nausea and vomiting • Changes in eating habits • Slurred speech • Tremors, poor motor coordination, shuffling gait • Frequent falls or unexplained bruising Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Can hamper screening by the presence of a severe cognitive impairment  Withdrawal from psychoactive drugs can induce delirium and is a medical emergency  Signs of delirium include: • Disorientation • Impaired attention, concentration, and memory • Anxiety, suspicion, and agitation • Misinterpretation, illusions, or hallucinations • Delusions, speech abnormalities Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • Dementia is generally a chronic, progressive, and  irreversible cognitive impairment. Dementia makes it more difficult to:  • monitor outcomes of drinking  clients may forget they drank • get clients into treatment • benefit from treatment Signs of dementia include :  • Impairments in short- and long-term memory, abstract thinking, and judgment • Language disorder • Personality change or alteration • Mood disturbances Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Indications inpatient hospital supervision is needed for withdrawal from a prescription drug include: 1) A high potential for developing dangerous abstinence symptoms, such as a seizure or delirium, due to:  dosage of a benzodiazepine or barbiturate has been particularly high or prolonged  dosage has been discontinued abruptly  patient has experienced these serious symptoms at any time previously Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • Indications for inpatient withdrawal cont…  2) Suicidal ideation or threats 3) The presence of other major psychopathology 4) Unstable or uncontrolled co-morbid medical conditions requiring 24-hour care or parenterally administered medications (e.g., renal disease, diabetes) 5) Mixed addictions, including alcohol 6) A lack of social supports in the living situation or living alone with continued access to the abused drug(s) Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • Should be non-confrontational and supportive  because of shame issues Provide customized feedback on drinking patterns  and other health habits Provide information about sensible drinking limits  based on age, health, medications Explore reasons for drinking  Explore consequences of drinking:  physical, psychological, or social functioning Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • Discuss key motivators to cut down or quit  drinking • Maintaining independence • physical health • financial security • mental capacity Identify sensible ways to cut down or quit  • Developing social opportunities that do not involve alcohol • Getting reacquainted with hobbies and interests from earlier in life • Pursuing volunteer activities Develop a drinking agreement in the form of a  prescription Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Brainstorm methods for coping with risky situations • Social isolation • Boredom • Negative family interactions  Should end with a summary of the session Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Feedback of personal risk or impairment as derived from the screening  Responsibility for change  Advice to change  Menu of options  Empathic counseling style  Support self-efficacy and ongoing follow-up Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Inpatient • 24-hour, primary medical/psychiatric/nursing inpatient care in • medically managed and monitored intensive treatment settings  Patients who need this level of care: • brittle, frail, acutely suicidal, medically unstable or • need constant one-on-one monitoring • older people who are dependent on psychoactive prescription drugs should be served in flexible, community-oriented programs with case management services Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  6 Features 1) Age-specific group treatment that is supportive and non-confrontational; aims to build or rebuild the patient's self-esteem Focus on coping with depression, loneliness and loss 2) (e.g., death of a spouse, retirement) Focus on rebuilding the client's social support 3) network Pace and content of treatment appropriate for the 4) older person Staff members who are interested and experienced in 5) working with older adults Linkages with medical services, services for the aging 6) and institutional settings for referral into and out of treatment; as well as case management Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • 5 Principles 1) Treat older people in age-specific settings where feasible Create a culture of respect for older clients 2) Take a broad, holistic approach to treatment that 3) emphasizes age-specific psychological, social and health problems Keep the treatment program flexible 4) Adapt treatment as needed in response to 5) client’s gender Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Cognitive-behavioral/ Motivational Approaches • Help to identify the negative consequences of use • Help to shift perceptions about the impact of use • Empower the client to generate insights and solutions • Express belief in the person's capacity for change • Help offset the denial, resentment and shame • Focus on:  rebuilding the social support network  self-management approaches for overcoming depression, grief or loneliness  general problem solving Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • Group-based Approaches  • Contain both an educational/theoretical component and a personal/practical application component • Provide a clear statement of the goal and purpose of the session; outline the content to be covered Cover topics sequentially ; “building block” style • • Begin sessions with a review of previously presented materials • Groups should use as many of the clients' senses as possible • Group sessions should last no longer than about 55 minutes • Area should be well lit without glare, interruptions and noise • Superfluous material should be kept to a minimum Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Individualcounseling  Medical/psychiatric approaches  Marital and family involvement/family therapy  Case management/community-linked services and outreach Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  Whenever possible, employ staff who have completed training in gerontology  Employ staff who like working with older adults  Provide training in empirically demonstrated principles effective with older adults to all staff who will interact with these clients Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    •  There are many issues unique to treating elders  Substance abuse treatment is both necessary and worthwhile in this population  Treatment in peer settings, by persons sensitive to gerontological issues and by clinicians of similar ages may help clients feel more at ease Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
    • RESOURCES AARP  • 601 E Street, NW • Washington, DC 20049 • (202) 424-2277 • (202) 434-2562 (fax) • www.aarp.org National Center on Addiction and Substance Abuse at Columbia University  • 152 West 57th Street • New York, NY 10019 • (212) 841-5200 • (212) 956-8020 (fax) • www.casacolumbia.org Join Together  • 441 Stuart Street • Boston, MA 02116 • (617) 437-1500 • (617) 437-9394 (fax) • www.jointogether.org National Aging Information Center, U.S. Administration on Aging  • 330 Independence Avenue, SW, Room 4656 • Washington, DC 20201 • (202) 619-7501 • (202) 401-7620 (fax) • http://www.aoa.gov/naic Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC