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Trends in Treatment: Substance Abuse in Older Adults

Substance abuse researchers and treatment providers are beginning to address addiction among older adults in the United States.

Diagnosing, treating, and managing addiction among older adults places special demands on treatment systems. Age-specific diagnostic criteria need to be developed and validated; treatments need to be tailored to the specific physical, emotional, and psychological needs of older adults; and collaboration between physical healthcare providers and substance abuse treatment professionals must be made a priority.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that addiction treatment programs incorporate features designed to address the specific needs of older adults. In a SAMHSA publication titled "Substance Abuse and Mental Health Among Older Americans: The State of the Knowledge and Future Directions," the organization also advocates the implementation of protective factors designed to empower older individuals to address and manage their addictions, as well as assist them in their efforts to cope with life events.

DIAGNOSIS

Recovery professionals are developing diagnostic criteria and tools to address situations specific to substance abuse among older adults. For example, because older adults metabolize substances differently than do people in other age groups, they may experience intoxication after consuming a smaller quantity of a given substance (particularly alcohol) than a younger person would need to ingest.

In addition, some signs of addiction - such as memory loss, confusion, and various physical ailments - are often confused with symptoms of other age-related conditions. New diagnostics are being developed to help providers more accurately discern addictive behaviors in older patients.

TREATMENT

The initial treatment of older addicted adults often requires more intensive medical support than is necessary in younger patients. Because withdrawal is typically more difficult and dangerous for older adults, detoxification facilities are learning to be prepared for the particular challenges that elderly patients face when they are being weaned from substances to which they were previously addicted. Also, social and psychological withdrawal, as well as behavior modification, can also be more strenuous for older patients.

Treating older adults can also be complicated by a number of additional issues, including the difficulty of changing long-time habits; the patient's reluctance to admit to the existence of a problem; concurrent psychological issues of loss, depression, and isolation; and the resistance of support persons (family members and caretakers) to address the situation. In addition, certain aspects of old age, such as forgetfulness or dementia, can negatively affect a patient's ability to properly utilize prescription medications.

Addressing co-occurring mental health and substance abuse disorders in elderly adults is becoming a key treatment component, and programs that treat addiction among older adults are encouraged to increase access to mental services and support systems. SAMHSA estimates that one in four older adults has a significant mental disorder - a prevalence that is strongly associated with the incidence of substance abuse among elderly individuals.

PROGRAM FEATURES & PROTECTIVE FACTORS

Many health care providers are beginning to offer specialized treatment "tracks" for older adults who are struggling with addiction. These tracks are typically designed to comply with SAMHSA's mandate to include the following six program features:

  1. Age-specific group treatment that is non-confrontational and aims to build or rebuild the patient's self-esteem.
  2. A focus on coping with depression, loneliness, and loss.
  3. A focus on rebuilding or establishing a social support network.
  4. A pace and content of treatment appropriate for the older person.
  5. Staff members who are interested and experienced in working with older adults.
  6. Linkages with medical services and other supportive services.

In addition to these six features, SAMHSA promotes the inclusion of the following protective factors specifically designed to help recovering older adults manage their addiction and cope with other issues in their lives:

  1. Access to resources, such as housing and health care.
  2. Availability of support networks and social bonds.
  3. Involvement in community activities.
  4. Supportive relationships.
  5. Education (for example, instruction in the wise use of medications) and skills.
  6. Sense of purpose and identity.
  7. Ability to live independently.

With improved diagnosis, treatment, and management, aging individuals can receive more timely attention and more effective treatment. Research into the nature of older adult substance abuse promises to continue this improvement in the services and programs available to the members of this high-risk age group.

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