Understanding and Appropriately Treating Chemical Dependency in Older Adults

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1 Understanding and Appropriately Treating Chemical Dependency in Older Adults Dale John Dyben, MA, MS, CAP, CMHP Director of Older Adult Treatment Services Hanley Center

2 Learning Objectives Understand trends in aging, substance use disorders, and health care. Identify signs and symptoms of substance use disorders in older adults. Recognize comorbidities in older adults. Improve knowledge of treatment strategies.

3 Defining the Older Adult Many studies include anyone over 50 U.S. retirement age is World Health Organization-2 Categories: Older adult = Elderly = 80 and older

4 Group Participation Today, we are all going to grow older like it or not!

5 Population Trends By 2030, one-fifth of US population >65 Life span expectations >85 Longer living also means more chronic illness Substance abuse a major factor in this equation

6 Older Adult Substance Abuse Common problem amongst older adults Less likely to be recognized or addressed Correlates with hip fractures and dementia Causes and exacerbates health problems

7 Alcohol Abuse

8 Alcohol Abuse More than 2.5 Million older adults today Expected to double by 2020 Number one drug of choice for older adults AGA recommends annual screenings A continuum of progression into addiction

9 Prescription Drug Abuse

10 Prescription Drug Abuse More prevalent in older adults Increased access Multiplicity of medications Creeping up on alcohol s #1 spot Disagreements in medical community

11 Illicit Drugs Estimated 4.8 million older adults in 2010 Marijuana by far most common illicit drug of abuse. The face of drug abuse is changing!

12 Process Addictions Also referred to as behavioral addictions Similar presentation as chemical dependency Continual reward seeking behavior Negative consequences do not cause cessation

13 Process Addictions Gambling Increase from 35% in 1975 to 80% in 1998 Lottery is most common followed by casinos Excitement, socialization, money Consequences of loss harder to mitigate

14 Process Addictions Sex and Sexually Transmitted Diseases Debate over classifying as addictive Little research in OA sexual compulsivity 2010: 16.5% of new HIV diagnosed persons >50 Baby Boomers and pharma influencing trends

15 Screening and Assessment SUD under recognized in older adults Need for improved screening and assessment Patients and practitioners tend to avoid SUD symptoms look like other age related issues

16 Screening and Assessment Abnormalities in bloodwork Unexplained changes in sleep or behavior Unexplained injuries Decline in ADLs Fluid retention

17 Screening and Assessment CAGE Have you ever tried to Cut down on your use? Have you been Annoyed by others concern? Have you ever felt Guilty about use? Have you ever needed an Eye opener?

18 Screening and Assessment Michigan Alcohol Screening Test Geriatric MAST-G 24 question, self-report Simple screening for Benzodiazepine abuse Have you noticed decrease effectiveness? Have you tried to stop?

19 Treatment Differentiations Older adults have unique treatment needs Private treatment centers: 18% address older adult needs in any way Roughly 0.5% have tracts Full programs so rare they are not even mentioned

20 Effective Treatment Models Tailored to address issues of aging Include friends, family and other support Respectful, non-confrontational Peer support

21 Effective Treatment Models Older Adult Health Living Program (HeLP) Cognitive Behavioral Therapy Motivational Interviewing Brief Intervention & Treatment for Elders (BRITE) 16-session relapse prevention program Psychoeducational/workbook-based/follow-up

22 Treatment Needs of Older Adults

23 Treatment Needs of Older Adults Physical needs More likely to have 2+ chronic medical conditions More likely to have severe physical impairment Slower metabolism Detox and treatment will take longer

24 Treatment Needs of Older Adults Psychological Needs Depression, anxiety, dementia Relevant approaches: Practiced physical activity Cognitive Behavioral Therapy Problem Solving Therapy Interpersonal Therapy

25 Treatment Needs of Older Adult Social Needs of Older Adults Major Changes Changing social status Deaths of loved ones Changes in social support Social environment influences use

26 Treatment Needs of Older Adult Social Needs of Older Adults Treatment should: Support long-term social support systems Be age specific Be cohort driven

27 Generational Cohorts Groups of people born within a given time frame Experienced common events Lives shaped by formational experiences Effects remain through lifespan Relevant for cultural awareness

28 The Good Warriors Born 1908 to 1929 World War II The Great Depression Prohibition Institutional authority trusted

29 The Baby Boomers Born between 1946 to 1964 Vietnam Civil Rights Movement Sex, Drugs, & Rock and roll Institutional authority feared and distrusted

30 Treatment Needs of Older Adult Spiritual Needs Socially supportive spiritual practices Reframe past and current struggles Not necessarily religious but may be Most significant predictor of healthy adjustment

31 Issues of Elder Abuse Definitions Intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder. (Jogerst, Daly, Galloway, Zheng, & Xu, 2012, p. 63) 10% to 30% of older adult may be victims Substance abuse linked to elder abuse

32 Conclusions The older adult population is growing Substance abuse and addiction are common These problems are under recognized Screening and assessment imperative Treatment for this problem must be specialized

33 Conclusions As health professionals, you are the best line of defense for older adults who may be struggling with substance misuse, abuse or addiction. Screen Prevent Treat Support

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41 Images All images used by permission of Dollar Photo Club and downloaded from dollarpotoclub.com