Download Surviving War and Woodstock

Surviving War and
Woodstock:
Substance Use and
Older Adults
2017 ICB Spring Conference
March 23, 2017
Nina J. Henry, LCPC, CADC
Jewish Center for
Addiction
Surviving World War II
Surviving Korea
Surviving Vietnam
Surviving Woodstock
"Turn on, tune in, drop out"
Surviving Hippies
...Just Surviving!
Surviving Sex, Drugs, & Rock ‘n Roll
Keith
Richards
Aging Population
Who Are Older Adults?
Americans Older
than age 55
Increase in Older Americans:
2000-2030
25
20
15
2000
2030
10
5
0
Age
65+
75+
85+
Increase in Clients 50+ Years Old
Who Need Treatment: 2001 - 2020
Number in Millions
6
5
4
3
Number in Millions
2
1
0
2001
2020
Two Distinct Populations
 Pre-Baby
 Baby
Boomers (1930 – 1946)
Boomers (1947 – 1964)
 1947: Pre-hippie
 1950: Hippie
Baby Boomers vs. Pre-Baby Boomers
Pre-Baby Boomers
Baby Boomers
Team work
Save
Stay with Tradition
Marriage First
Marriage (forever)
Drug use the exception
Drink at 18 – 21
Go to war
Cultural Status Quo
Individualism
Spend
Break with Tradition
Sex First
Marriage (disposable)
Drug use the norm
Drink at 14 – 16
Protest war
Cultural Revolution
Understanding Substance
Use Disorders in Older Adults
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An estimated 1 in 5 older adults may be adversely affected
by a combination of alcohol and medication misuse.
Approximately 25% of older adults use prescription
psychoactive medications that have a potential to be
misused or abused.
Misuse of prescription medications among older adults,
which is estimated to increase 100% between 2001
and 2020, can cause serious adverse drug events including
falls, confusion, and delirium that is associated with a high
rate of emergency hospitalizations and mortality.
As the baby boom generation ages, experts predict that past
year marijuana use will almost triple between 2001 and 2020
among persons aged 50+.
Barriers to Treatment for Older Adults
 Lack
of age specific programs
 Complications with overall health
 Medication Management
 Co-occurring disorders (medical &
mental)
 Transportation
 Support systems (family & self-help)
 Not a “sexy issue”
What Do We Think About Grandma
& Grandpa?
Common Misconceptions about Older
Adults (75+)

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Most elderly people are sick.
Elderly people don't pull their own weight in society.
Elderly people are set in their ways (you can't teach an
old dog new tricks).
Elderly people aren't mentally or physically sharp and
alert.
Ailments caused by poor lifestyle choices, such as
substance use or misuse, can't be improved upon or
undone.
Physical aging is primarily predetermined by genetics.
Older Adults don’t have sex.
What You Might Hear...
 “I’m
not going to take away one of Dad’s
last pleasures in life.”
 “There isn’t much for her to enjoy
anymore, so why shouldn’t she spend her
time drinking. She’s not hurting anyone.”
 “He’s worked hard his whole life. He
deserves to reward himself now.”
What is Medication Misuse, Abuse, and
Dependence?
Misuse by Patient





Dose level more than
prescribed
Longer duration than
prescribed
Used for purposes other
than prescribed
Used in conjunction with
other meds/alcohol
Skipping/hoarding doses
Misuse by Practitioner



Prescription for
inappropriate indication
Unnecessary high dose
Failure to monitor/fully
explain appropriate use
Assessing Older Adults
Problems Identifying Substance Use in
Older Adults
Hard to detect under routine circumstances
 Symptoms of substance use mimic those of
other health problems
 Symptoms of substance use may be perceived
as part of normal aging
 Shame, guilt, stigma
 Family and others ignore or enable
 Absence of previous consequences

Age-related Changes That Intensify the
Impact of Substance Use

Decrease in Body Water

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Decrease in Liver Function

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Slower metabolism of alcohol makes it easier to become intoxicated
Some medications accumulate in the body because they are
metabolized too slowly
Decrease in Kidney Function


May result in quicker intoxication from alcohol
Certain medications are more concentrated and potent
Alcohol and medications stay in the body longer, so its effects are
prolonged
Increase in body fat

Medications are less immediate and more prolonged effect
ASAM: Acute Intoxication and/or
Withdrawal Potential



Tolerance
Increased sensitivity to low intake
Withdrawal
Physiological dependence may not have developed
Taking larger amounts or over a longer period than was
intended
Cognitive impairment may interfere with selfmonitoring
Drinking/drug use can worsen cognitive impairment
ASAM: Biomedical Conditions and
Complications

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
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Fatigue
Insomnia
Chronic Pain
Impotence
Seizures
Malnutrition; Muscle wasting
Liver function abnormalities
Incontinence, urinary retention
Blurred vision; dry mouth
Gastrointestinal complaints – nausea; vomiting
Tremors
Frequent falls and unexplained bruising
Heart rate changes
ASAM: Emotional, Behavioral, or Cognitive
Conditions or Complications
 Cognitive
Impairment
 Dementia
 Delirium
 Affective Disorders
 Sleep Disorders
 Psychotic Disorders
ASAM: Readiness to Change
Shame
Denial
Resistance
Members
of Family
ASAM: Relapse, Continued Use, or
Continued Problem Potential
Relapse Rates Do
Not Vary With Age
of Onset
ASAM: Recovery/Living Environment
 Finances
 Employment; Volunteering
 Social
Support – Family; Friends
 Living – Independent Living;
Assisted Living
 Transportation; Mobility
Screening and Assessment
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SBIRT
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CAGE
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Screening, Brief Intervention, and Referral to Treatment
1. Have you ever felt you should Cut down on drinking/drug
use?
2. Have people Annoyed you by criticizing your drinking/ drug
use?
3. Have you ever felt Guilty about your drinking/or drug use?
4. Have you ever taken a drink and/or used drugs even in the
morning to steady your nerves or get rid of a hangover (“Eye
opener”)?
AUDIT

Alcohol Use Disorders Identification Test
Short – Michigan Alcoholism Screening Test
Geriatric Version (SMAST-G)
1.
2.
3.
4.
When talking with others, do you ever
underestimate how much you actually drink?
After a few drinks, have you sometimes not
eaten or been able to skip a meal because
you didn’t feel hungry?
Does having a few drinks help decrease your
shakiness or tremors?
Does alcohol sometimes make it hard for
you to remember parts of the day or night?
SMAST-G (cont.)
5.
6.
7.
8.
9.
Do you usually take a drink to relax or calm your
nerves?
Do you drink to take your mind off your problems?
Have you ever increased your drinking after
experiencing a loss in your life?
Has a doctor or nurse ever said they were worried
or concerned about your drinking?
Have you ever made rules to manage your drinking?
Moving the Older Adult into Treatment
Motivation for Treatment for Older
Adults
 Physical
Health
 Loss of Independence; Maintaining
Independence
 Financial Insecurity
 Self-Determination
 Family Involvement (respecting
confidentiality)
Brief Intervention Strategy
Customized Feedback
Evaluating Response to Screening
Reasons for Drinking
The clinician must learn the “pay off” for
drinking or using drugs
Consequences of drinking/misusing
prescribed drugs
Education about how alcohol and drugs
effect older adults differently
Reasons to cut down or quit
drinking
Maintaining independence, improved
physical health, improved cognitive
function
Sensible drinking limits and
strategies for cutting down or
quitting
Develop social opportunities that do not
involve alcohol, reintroduce lost hobbies
and interests, volunteerism
Developing Behavioral Contracts
Agreed upon plan, signed by client
Relapse Prevention Planning
Isolation, Boredom, Family conflict
Summary of the Session
Characteristics of Substance Use Treatment
for Older Adults
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Age-specific group treatment – non-confrontational;
aimed at (re)building self-esteem, with peers
Focus on coping with depression, loneliness, and loss
Focus on rebuilding the client’s social support network
A pace and content of treatment appropriate for older
person
Staff members motivated to work with older adults
Linkage agreements with medical providers, services for
the aging, case management, and institutional settings for
referral into and out of treatment
Preserving the elder’s dignity is a goal
Treatment Approaches
Cognitive-behavioral approaches
 Group-based approaches
 Individual counseling
 Medical/psychiatric approaches
 Marital and family involvement/family therapy
(including grandchildren)
 Case management/community-linked services
and outreach
 Recommended Treatment Model: Motivational
Interviewing

Linkage Considerations
Medical/health care agencies
 Physicians
 Dentists
 Gerontologists
 Visual and hearing impairment resources
 Senior Centers
 Retirement Communities
 Animal Welfare Organizations
 Transportation resources
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Preparing Your Client
for a Doctor’s Visit
What is the purpose of the visit?
 More than one reason for the visit?
 Write down questions for the doctor
 Don’t let the doctor rush exam
 Prepare a list of medications, dosages, and
instructions
 Take in Rx bottles
 Have the names and contact information for
other prescribers

Packing Med’s Is Life-Saving!
Wrap-Up & Questions
Resources/Bibliography
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Artisan Entertainment, Requiem for a Dream, 2000
Blow, Frederic C., Ph.D. (Consensus Panel Chair), Substance
Abuse Among Older Adults, US Department of Health and
Human Services, SAMHSA, Treatment Improvement Protocol
(TIP) Series, Rockville, MD, 1998
Colleran, Carol; Jay, Debra, Aging and Addiction, Helping Older
Adults Overcome Alcohol or Medication Dependence,
Hazelden, Center City, MN, 2002
Mental Health Association of Maryland, Missouri Department
of Mental Health, and National Council for Behavioral Health,
Mental Health First Aid USA for Older Adults and Those
Dealing with Later-Life Issues, 2015