TIP 26 Addiction Treatment in Older Adults
•
1 like•211 views
This document discusses addiction treatment in older adults. It notes that substance abuse among those aged 60 and older is a growing problem. Effective treatment requires addressing issues unique to seniors, such as medical comorbidities, cognitive decline, and social isolation. Approaches include age-specific group therapy focusing on coping skills, rebuilding social support networks, and addressing depression or grief. Treatment must be provided with sensitivity to geriatric issues by clinicians experienced in working with older populations.
Recommended
More Related Content
What's hot
What's hot (20)
Similar to TIP 26 Addiction Treatment in Older Adults
Similar to TIP 26 Addiction Treatment in Older Adults (20)
More from Dr. DawnElise Snipes ★AllCEUs★ Unlimited Counselor Training
More from Dr. DawnElise Snipes ★AllCEUs★ Unlimited Counselor Training (20)
Recently uploaded
Recently uploaded (20)
TIP 26 Addiction Treatment in Older Adults
- 1. TIP 26: Addiction Treatment in Older Adults Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 1
- 2. Objectives Review the data about substance abuse and gambling issues in older adults Review screening for substance use and mental health disorders in the elderly Identify risk factors for SA and MH issues Review placement and treatment issues specific to older adults AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 2
- 3. Introduction Abuse of alcohol and prescription drugs among adults 60 and older; growing fast Estimated 2.5 million older adults have problems related to alcohol Consume more prescribed and over-the-counter (OTC) medications 2006 New Jersey study indicated 23% of citizens over 55 were disordered gamblers (New Jersey Senior Gamblers Study) Seniors are fastest growing group of gamblers between 1974 and 1989 (Gambling Impact and Behavior Study 1999) A 2008 study reveals that they gamble for Extrinsic reasons include winning money, gaining independence, and supplementing income Intrinsic reasons include entertainment/excitement, being around other people, distraction from everyday problems such as loneliness and boredom, and escaping feelings of grief and loss associated with the death of a loved one or close friend. (Arizona Compulsive Gambling Council) http://www.socialworktoday .com/archive/031109p18.sht ml AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 3
- 4. Introduction Among adults over 65 years of age gambling is the most frequently identified social activity (McNeilly & Burke 2001) Reduced cognitive capacity can make it difficult for them to make sound decisions. Older adults living on a fixed income with limited savings can’t necessarily afford the financial drain of a gambling disorder. When you’re younger, maybe you’re $100,000 in debt, but you’ve got your spouse, you’ve got your children, your job; you still have some reason to get up in the morning,” Nower says Because older adults tend to have less contact with friends and family, gambling-related problems may go unnoticed. AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 4
- 5. Introduction Gambling should be identified as a problem when it disrupts, damages, or limits a person’s life Signs of problem gambling are spending more money on gambling than intended; feeling bad, sad, or guilty about gambling; not having enough money for food, rent, or bills; being unable to account for blocks of time; experiencing social withdrawal; and experiencing anxiety or depression. Older adults may try to hide or deny a gambling problem, they may feel hopeless or ashamed about the situation, or they may be unaware that help is available. AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 5
- 6. Alcohol and the Older Adult Age-related changes affecting the way an older person responds to alcohol: 1) Normal decrease in body water that comes with age Same amount can now cause intoxication Increased sensitivity and decrease tolerance 2) Decrease in rate of GI metabolism Blood alcohol level remains raised for a longer time Increased hepatic workload AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 6
- 7. Alcohol and the Older Adult Cont… 3) Trigger or worsen serious problems Heart problems Risk of stroke Cirrhosis and other liver diseases Gastrointestinal bleeding Depression, anxiety and other mental health problems AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 7
- 8. Prescription Drugs Medications interact negatively with alcohol Dependence on psychoactive medication Misunderstood directions Multiple prescriptions from different doctors; no coordination Unintentional misuse leading to abuse AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 8
- 9. Screening Psychoactive substance use associated with 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 AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 9
- 10. Risk Factors 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 AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 10
- 11. Risk Factors cont… Medical Problems Loss of hearing or sight Chronic pain Physical disabilities; 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 AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 11
- 12. Risk Factors cont… Other Issues Older men are at increased risk when their wives die High rates of alcoholism in medical settings Substance use disorder earlier in life Mood disorders Family history Psychoactive prescription drug use AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 12
- 13. Question What types of early intervention and prevention activities could be done, or are being done in your community, and where? AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 13
- 14. AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 14
- 15. Who and When To Screen Adult annual physical Major life transition Unexpected / unexplained physical symptoms AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 15
- 16. Physical Symptoms Potential signs of development of an addiction: Sleep-related problems Cognitive difficulties Seizures, malnutrition, muscle wasting Liver function abnormalities Persistent irritability and altered mood, depression, anxiety Unexplained complaints about chronic pain Incontinence, urinary retention, difficulty urinating AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 16
- 17. Physical Symptoms cont… Poor hygiene, self-neglect Unusual restlessness, 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 , unexplained bruising AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 17
- 18. Delirium and Dementia Presence of a severe cognitive impairment impairs screening Withdrawal-induced delirium; medical emergency Signs of delirium: Disorientation Impaired attention, concentration, memory Anxiety, suspicion, agitation Hallucinations Delusions, speech abnormalities AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 18
- 19. Dementia Chronic, progressive, irreversible cognitive impairment Complicates: Monitoring drinking outcomes Getting clients into treatment Getting benefit from treatment Signs of dementia: Impaired short- and long-term memory, abstract thinking, judgment Language disorder Personality change or alteration Mood disturbances AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 19
- 20. Detoxification Indications for inpatient hospitalization: 1) High potential for developing dangerous abstinence symptoms, seizure or delirium High or prolonged dosage of benzodiazepine, barbiturate, alcohol Abruptly discontinued Positive past history 2) Suicidal ideation or threats 3) Other major psychopathology AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 20
- 21. Inpatient Detoxification cont… 4) Unstable or uncontrolled co-morbid medical conditions requiring 24-hour care or parenterally administered medications renal disease diabetes HBP 5) Mixed addictions, including alcohol 6) Lack of social supports in the living situation; living alone 7) Continued access to the abused drug(s) AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 21
- 22. FRAMES Approach 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 AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 22
- 23. Brief Interventions Non-confrontational, supportive Shame issues Provide customized feedback Provide information Based on age, health, medications Explore reasons for drinking/gambling Explore consequences of drinking/gambling Physical, psychological, social functioning AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 23
- 24. Brief Interventions cont… Discuss key motivators to cut down or quit Maintaining independence Physical health Financial security Mental capacity Identify sensible ways to cut down or quit Develop sober social opportunities Get reacquainted with hobbies and interests Pursue volunteer activities Develop a drinking agreement prescription AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 24
- 25. Brief Interventions cont… What types of coping methods could be used to deal with… Social isolation Boredom Negative family interactions AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 25
- 26. AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 26
- 27. Treatment Settings Inpatient 24-hour, primary medical/psychiatric/nursing care Medically managed, monitored, intensive setting Indicators: Brittle, frail, acutely suicidal, medically unstable Need constant one-on-one monitoring Older people dependent on psychoactive prescription drugs need flexible, community-oriented programs with case management services AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 27
- 28. Treatment Approaches 1) Age-specific group treatment Supportive, non-confrontational Builds or rebuilds patient's self-esteem 2) Focus Coping with depression, loneliness and loss from death of a spouse, retirement 3) Focus Rebuilding client's social support network 4) Pace and content Appropriate for the older person AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 28
- 29. Treatment Approaches cont… 5) Staff Interested and experienced with older adults 6) Provide Medical services, services for the aging Institutional settings for referral into and out of treatment Case management AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 29
- 30. Treatment Approaches cont… 5 Principles 1) Treat older people in age-specific settings 2) Create a culture of respect for older clients 3) Take a broad, holistic approach to treatment; emphasize age-specific psychological, social and health problems 4) Flexible treatment program 5) Adapt treatment to client’s gender AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 30
- 31. General Approaches To Treatment Cognitive-Behavioral/Motivational Approach Identify negative consequences of use Shift perceptions about the impact of use Empower client to generate insights and solutions Express belief in their capacity for change Help offset the denial, resentment and shame Focus on: Rebuilding social support network Self-management approaches for overcoming depression, grief or loneliness General problem solving AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 31
- 32. General Approaches cont… Group-Based Approach Two components: Educational/theoretical Personal/practical application Clearly state goal and purpose of sessions; outline content Topics sequential; “building block” style Begin with a review of previously presented materials Incorporate all 5 senses About 55 minutes Well lit without glare, interruptions and noise Superfluous material kept to a minimum AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 32
- 33. General Approaches cont… Individual counseling Medical/psychiatric approaches Marital and family involvement/family therapy Case management/community-linked services and outreach AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 33
- 34. Staffing Gerontology training Enjoy working with older adults Provide training to all staff who will interact with these clients Empirically demonstrated principles Effective with older adults AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 34
- 35. Summary Many issues unique to treating elders Substance abuse treatment in this population Necessary Worthwhile Ease clients by providing treatment: In peer settings By persons sensitive to gerontological issues By clinicians of similar ages Withdrawal from psychoactive drugs can induce delirium and is a medical emergency. AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 35
- 36. 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 AllCEUs.com Unlimited CEUs $59 | Addiction Counselor Certification Training $149 | Webinars $5 36
Editor's Notes
- 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.
- 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.
- 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.
- 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
- 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
- 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
- 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
- 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
- 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
- Other issues to watch for Other Issues 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
- 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
- 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, anxiety Unexplained complaints about chronic pain Incontinence, urinary retention, difficulty urinating …
- Poor hygiene, self-neglect Unusual restlessness, 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 , unexplained bruising
- 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
- 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
- Indications inpatient hospital supervision is needed for withdrawal from a prescription drug include: 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 Suicidal ideation or threats 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)
- 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
- 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
- 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
- Brainstorm methods for coping with risky situations social isolation boredom negative family interactions Should end with a summary of the session
- 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
- 6 Features 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 (e.g., death of a spouse, retirement) Focus on rebuilding the client's social support network Pace and content of treatment appropriate for the older person
- Staff Interested and experienced in working with older adults Provide Medical services, services for the aging Institutional settings for referral into and out of treatment Case management
- 5 Principles Treat older people in age-specific settings where feasible Create a culture of respect for older clients Take a broad, holistic approach to treatment that emphasizes age-specific psychological, social and health problems Keep the treatment program flexible Adapt treatment as needed in response to client’s gender
- Cognitive-Behavioral/ Motivational Approach 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
- Group-Based Approach 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
- Individual counseling Medical/psychiatric approaches Marital and family involvement/family therapy Case management/community-linked services and outreach
- 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
- 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