The Silver Tsunami: Understanding Substance Use Disorders in Later Life

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1 The Silver Tsunami: Understanding Substance Use Disorders in Later Life Dr. John Dyben DHSc, CAP, CMHP

2 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

3 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

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

5 Alcohol Abuse

6 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

7 Prescription Drug Abuse

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

9 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!

10 Treatment Differentiations Older adults have unique treatment needs Private treatment centers: 18% address older adult needs in any way Roughly 5% have tracts Full programs so rare they are not even mentioned

11 Treatment Needs of Older Adults

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

13 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

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

15 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

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

17 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

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

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

20 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

21 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

22 References Anetzberger, G. J. (2012). An update on the nature and scope of elder abuse. Generations, 36(3), Arean, P. (2012). Psychotherapy for late-life depression. Psychiatric Times, 29(8), Ariyabuddhiphongs, V. (2012). Older adults and gambling: A review. International Journal of Mental Health & Addiction, 10(2), Berkowitz, E. N., & Schewe, C. D. (2011). Generational cohorts hold the key to understanding patients and health care providers: Coming-of-age experiences influence health care behaviors for a lifetime. Health Marketing Quarterly, 28(2), doi: / Blazer, D. G., & Li-Tzy, W. (2011). The epidemiology of alcohol use disorders and subthreshold dependence in a middle-aged and elderly community sample. American Journal of Geriatric Psychiatry, 19(8), Bogunovic, O. (2012). Substance abuse in aging and elderly adults. Psychiatric Times, 29(8),

23 References Borok, J., Galier, P., Dinolfo, M., Welgreen, S., Hoffing, M., Davis, J., &... Moore, A. (2013). Why do older unhealthy drinkers decide to make changes or not in their alcohol Brooks, J., Buchacz, K., Gebo, K., & Mermin, J. (2012). HIV infection and older Americans: The public health perspective. American Journal of Public Health, 102(8), Cairney, J., Faulkner, G., Veldhuizen, S., & Wade, T. J. (2009). Changes over time in physical activity and psychological distress among older adults. Canadian Journal of Psychiatry, 54(3), Carlson, E. (2009). 20th-century US generations. Population Reference Bureau. Retrieved from Cooper, L. (2012). Combined motivational interviewing and cognitivebehavioral therapy with older adult drug and alcohol abusers. Health & Social Work, 37(3), Diaz, N., Horton, E., Green, D., McIlveen, J., Weiner, M., & Mullaney, D. (2011). Relationship between spirituality and depressive symptoms among inpatient individuals who abuse substances. Counseling & Values, 56(1/2),

24 References Draper, B. (2014). Preparing for the graying of the world: Meeting the needs of older adults. Psychiatric Times, 31(2), 1-5. Elmstahl, S., & Linder, H. (2013). Polypharmacy and inappropriate drug use among older people-a systematic review. Healthy Aging & Clinical Care in the Elderly, (5), 1-8. doi: /hacce.s11173 Flood, M., & Buckwalter, K. (2009). Recommendations for mental health care of older adults: Part 2 an overview of dementia, delirium, and substance abuse. Journal of Gerontological Nursing, 35(2), Gallagher, R. (2009). Methadone: An effective, safe drug of first choice for pain management in frail older adults. Pain Medicine, 10(2), Han, B., Gfroerer, J., Colliver, J., & Penne, M. (2009). Substance use disorder among older adults in the United States in Addiction, 104(1), doi: /j x Hagedorn, W. (2009). The call for a new Diagnostic and Statistical Manual of Mental Disorders diagnosis: Addictive disorders. Journal of Addictions & Offender Counseling, 29(2),

25 References Holbert, K. R., & Tueth, M. J. (2004). Alcohol abuse and dependence. A clinical update on alcoholism in the older population. Geriatrics, 59(9), 38. Ismail, Z., Arenovich, T., Grieve, C., Willett, P., Sajeev, G., Mamo, D.,... Mulsant, B. (2012). Predicting hospital length of stay for geriatric patients with mood disorders. Canadian Journal of Psychiatry, 57(11), Jogerst, G. J., Daly, J. M., Galloway, L. J., Zheng, S., & Xu, Y. (2012). Substance abuse associated with elder abuse in the United States. American Journal of Drug & Alcohol Abuse, 38(1), Lawton, P., & La Porte, A. (2013). Beyond Traditional Art Education: Transformative Lifelong Learning in Community-Based Settings With Older Adults. Studies In Art Education, 54(4), Li-Tzy, W., & Blazer, D. G. (2011). Illicit and nonmedical drug use among older adults: A review. Journal of Aging & Health, 23(3), Lin, W., Zhang, J., Leung, G. Y., & Clark, R. E. (2011). Chronic physical conditions in older adults with mental illness and/ or substance use disorders. Journal of the American Geriatrics Society, 59(10),

26 References Morgan, M. L., Brosi, W. A., & Brosi, M. W. (2011). Restorying older adults' narratives about self and substance abuse. American Journal of Family Therapy, 39(5), Najavits, L., Lung, J., Froias, A., Paull, N., & Bailey, G. (2014). A study of multiple behavioral addictions in a substance abuse sample. Substance Use & Misuse, 49(4), Powell, J. (2011). Alcohol and drug abuse issues in older persons as revealed through the comprehensive drug, alcohol, and mental health treatment systems. (2011). Care Management Journals, 12(3), doi: / Rothrauff, T., Abraham, A., Bride, B., & Roman, P. (2011). Substance abuse treatment for older adults in private centers. Substance Abuse, 32(1), doi: / Seitz, D., Vigod, S., Lin, E., Gruneir, A., Newman, A., Anderson, G.,... Herrmann, N. (2012). Characteristics of older adults hospitalized in acute psychiatric units in Ontario: A population-based study. Canadian Journal of Psychiatry, 57(9),

27 References Schonfeld, L., King-Kallimanis, B. L., & Duchene, D. M. (2010). Screening and brief intervention for substance misuse among older adults: The Florida BRITE project. American Journal of Public Health, 100(1), Song-Iee, H., Sacco, P., & Cunningham-Williams, R. M. (2009). An empirical typology of lifetime and current gambling behaviors: Association with health status of older adults. Aging and Mental Health, 13(2), Spitzer, W. J., & Davidson, K. W. (2013). Future trends in health and health care: Implications for social work practice in an aging society. Social Work in Health Care, 52(10), doi: / Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2011). The NSDUH report: Illicit drug use among older adults. Rockville, MD: Author. Tew, J. (2012). Care transitions and the dementia patient: A model intervention builds communication, trust And better care. Generations, 36(4),

28 References Trevisan, L. (2014). Elderly alcohol use disorders: Epidemiology, screening, and assessment issues. Psychiatric Times, 31(5), 1-4. Von Humboldt, S., Leal, I., & Pimenta, F. (2014). What predicts older adults adjustment to aging in later life? The impact of sense of coherence, subjective well-being, and sociodemographic, lifestyle, and health-related factors. Educational Gerontology, 40(9), Voyer, P. P., Roussel, M.., Berbiche, D. D., & Preville, M. M. (2010). Effectively detect dependence on benzodiazepines among communitydwelling seniors by asking only two questions. Journal Of Psychiatric & Mental Health Nursing, 17(4), doi: /j x

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

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