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Effective Treatment Strategies for Addicted Older Adults and Their Families Sharon Matthew, Clinical Supervisor-Seniors Program and Women’s Extended Care LPC, CCS, ACRPS, CSAT, CMAT ASAM Disclosure of Relevant Financial Relationships Content of Activity: Date of Activity Name Commercial Commercial Interests Interests Relevant Relevant Financial Financial Relationships: Relationships: What Was What was Received received Relevant Relevant Financial Financial Relationships: Relationships: For Role For What what role NoRelevant Relevant No Financial Financial Relationships Relationships with with anyAny Commercial Commercial Interests Interests Sharon Sharon Matthew X 800.678.2332 I www.caron.org Glossary of Terms Commercial Interest - The ACCME defines a “commercial interest” as any proprietary entity producing health care goods or services, with the exemption of non-profit or government organizations and non-health care related companies. Financial relationships -Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received, or expected. ACCME considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. Relevant financial relationships - ACCME focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CME activity. ACCME has not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship. The ACCME defines “’relevant’ financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Conflict of Interest - Circumstances create a conflict of interest when an individual has an opportunity to affect CME content about products or services of a commercial interest with which he/she has a financial relationship. 800.678.2332 I www.caron.org Participants will be able to: • Talk about the fastest growing population requiring specialized D&A levels of care • Understand treatment components necessary to provide a well rounded integrated approach to senior care • Develop and address the clinical needs necessary to treat the entire family system with particular focus on care giving 800.678.2332 I www.caron.org An Aging Population • By 2050, it is anticipated that Americans aged 65 or older will number nearly 89 million people, or more than double the number of older adults in the United States in 2010. • Americans are living longer lives than in previous decades and, given the post-World War II baby boom, there are proportionately more older adults than in previous generations. “The state of Aging and Health in America 2013” – US Centers for Disease Control and Prevention 800.678.2332 I www.caron.org An Aging Population • In 1992, the number of Americans over 50 admitted to treatment facilities was near 6.6% of all admissions nationwide. • By 2008, the number of admissions from this age group reached 12.2%. • Statistically, alcohol addiction has remained the primary substance abuse disorder for people age 50 and older, and this still holds true today. • However, seniors are now abusing more illicit substances – such as cocaine, heroin and marijuana (with marijuana far ahead of the rest) and legal prescription drugs than before. 800.678.2332 I www.caron.org How Will Our Industry React? • Within the next several years there will be more Boomers and Seniors than children in America. • Boomer and Older Adults are living with multiple chronic disorders including the disease of addiction. • For the next 18 years, boomers will be turning 65 at a rate of about 10,000 a day. 800.678.2332 I www.caron.org How Will Our Industry React? • Healthcare costs related to alcohol and drug abuse among seniors are projected to reach $100 billion by 2018. • Most commonly abused painkillers, such as hydrocodone and oxycodone, climbed more than 50%. • The supply of each narcotic provided to the average recipient grew about 15% from 2007 to 2012. (80% USA) • This means that the ratio of the nation’s 43 million seniors getting Medicare prescriptions to take pills like Vicodin or Percocet are 1 in 5. 800.678.2332 I www.caron.org Life Span Development (Early Adulthood: ages 28-50) Psychosocial Development: Erik Erikson Stage #6: Intimacy vs. Isolation • Develop sense of identity • Committed relationships • Isolation vs. loneliness vs. depression • Intimacy (in to me I see) 800.678.2332 I www.caron.org Life Span Development (“Adulthood” ages 50-70) Stage #7: Generativity vs. Stagnation • Build our lives, focus on career and family. • Those who are successful during this phase feel they have contributed to the world as a productive member of their home and community. • Those who fail to attain this skill feel unproductive and uninvolved in the world. • Care is the “virtue” achieved when this stage is handled successfully. • Being proud of accomplishments, watching your children grow into adults, and developing a sense of unity with your life partner. 800.678.2332 I www.caron.org Life Span Development (“Older Adulthood” ages 70 and above) Stage #8: Integrity vs. Despair • This phase occurs during old age and is focused on reflecting back on life. • Those who are unsuccessful during this stage will feel their life has been wasted and will experience regrets, left with feelings of bitterness and despair. • Those who are proud of their accomplishments will feel a sense of integrity successfully completing this phase – means looking back with few regrets and a feeling of satisfaction. These individuals attain wisdom even when confronting death. 800.678.2332 I www.caron.org Treating Older Adults Successful Integrated Model • Physical, Emotional, Spiritual, Medical, Recreational, Nutritional, Social and Systemic (Caregiver) 800.678.2332 I www.caron.org Physical Signs and Symptoms Complicated by Addiction • • • • • • • Sleep complications Health complications Decline in ADL’s Unexplained burns/bruises Fall risk Medication complications Disease concept: chronic progressive characterized by denial • Memory loss, dementia, delirium • Malnutrition • Incontinence • Decline in social interaction • Vision problems • Cognitive decline • Hearing problems. 800.678.2332 I www.caron.org Treatment Components “A Successful Approach” 1. 2. 3. 4. Environment 3 S’s: small, safe, self-contained Geriatric Specialists-medical and psychiatric team (co-occurring disorders) Spiritual Counseling Patient centered assessment - nutritional - visual impairment - auditory impairment - ambulatory impairment - cognitive impairment - fall risk 5. More tools in the clinicians toolbox-meeting patient where they are 6. Complicated grief 7. Stages of treatment-group vs. individual 8. Integration of 12 Step RecoverySenior to Senior 9. Level of care 800.678.2332 I www.caron.org What About Us… The Family as Caregivers for Senior Addicts 800.678.2332 I www.caron.org The First Caregiver Group Ever! Caregiver Support Groups 800.678.2332 I www.caron.org Take Your Oxygen First Dear Air Travel News Answer Man, “As a mother of three, it always bothers me when I hear the emergency announcements on airplanes telling us to grab or own oxygen masks before we assist our children. Children seem so much more vulnerable than adults. I believe a child would certainly stop breathing in an emergency before an adult! Unless you can explain this to me, I don’t plan to follow the instructions they give on airplanes.” Sincerely, A loyal but confused passenger Jamie Huysman 800.678.2332 I www.caron.org Symptoms of Caregiver Burnout • The index of the separation between what people are and what they have to do • It is also the greatest trigger for Caregiver and Senior Addiction • Become chronically exhausted • Become cynical and detached from work • Become increasingly ineffective at work • It represents an erosion in values, dignity, spirit and will – an erosion of the human soil • It is a malady that spreads gradually and continuously over time, putting people into a downward spiral from which it’s hard to recover 800.678.2332 I www.caron.org What Causes Caregiver Burnout: The fertile ground for addictions? • Caregivers often are so busy caring for others that they tend to neglect their own emotional, physical and spiritual health. • The demands on a caregiver’s body, mind and emotions can easily seem overwhelming, leading to fatigue and hopelessness and ultimately, burnout. Other factors that can lead to caregiver burnout include: • Role confusion: many people are confused when thrust into the role of caregiver. It can be difficult for a person to separate her role as caregiver from her role as spouse, lover, child, friend, etc. • Unrealistic expectations: many caregivers expect their involvement to have a positive effect on the health and happiness of their loved one. This may not always be realistic. • Caregivers dying before the Senior. 800.678.2332 I www.caron.org Personal Impact of Caregiving As the Catalyst for Addictions Caregivers in Recovery In The Rooms TM Prominent National Risk Factors We Understand Better • Sandwich Generation • Club Sandwich Generation • Availability of Medications • Boomer Mindset: Sex, Drugs and Rock and Roll • Lack of Mental Health Prior to Caregiving • Caregivers not coming for Medical Care: Dying before their loved ones • Replacing Program for Loved One 800.678.2332 I www.caron.org 800.678.2332 I www.caron.org Making the Difficult Decision What Happens After Treatment? A Continuum Approach • Extended Care • Outpatient Levels of Care • Caregiver – in home services • 12 Step community • • • • Wrap around care Nursing facility Assisted living Primary care doctor 800.678.2332 I www.caron.org Ancient Premise: CRISIS-OPPORTUNITY • The Chinese symbol crisis is not one symbol but two • The symbols for crisis in Chinese are made up of these two words • They are pronounced wei1 ji1. wei means danger; peril and ji means opportunity; crucial point • So literally wei plus ji equals “danger” plus “opportunity” 800.678.2332 I www.caron.org Questions? 800.678.2332 I www.caron.org About the Presenter It is never too late to develop an addiction It is never too late to intervene on an addiction It is never to late to have quality of life Sharon Matthew, LPC, CCS, ACRPS, CSAT, CMAT Clinical Supervisor-Seniors Program Email: [email protected] 800.678.2332 I www.caron.org