Transcript Substance Abuse & Older Adults February 2, 2010

Substance Abuse & Older Adults
February 2, 2010
Helene Bergman, LMSW. CASWCM
Mark Zilberman, LCSW
Case Study: H
The Bumpy Road to Recovery
Stumbling Blocks
Crisis-Eviction
APS
Personality Disorder
Dementia
Depression
Insurance Issues
System Failure
Collusion/neglect of professionals
Less Successful Cases- Harm
Reduction
J- the depressed concert pianist who
smokes and drinks
Mrs. K & Mrs. M- dementia and a
drinking family
Mrs. B- dementia/drinking/oxycontin
The Drinking Duo- til death do they
part
Mr. H – The Shopping Bags of Meds
What is Substance Abuse for Older
Adults?
Prescribed Medications
Benzodiazepines
Narcotics
Sleep Aids
Alcohol
Heroin, PCP, LSD, Crack
Marijuana?
The Most Abused
Prescription Meds
Older Adults- A Hidden Population:
WHY?!
Individual, family & system denial
Collusion-family/system
Physician neglect; misdiagnosis
Long Distance Caregivers
Impact more hidden (i.e, retired)
Prescription Drug Culture
Legality of supply; easy access
DSM-IV
Inapplicability of Standard Diagnostic
Criteria (303.90, 305.00)If you follow the criteria of the DSM-IV,
maybe there is no substance abuse
problem with the elderly. Here's 305,
DSM-IV, Alcohol Abuse:
DSM-IV
A maladaptive pattern of substance use leading to clinically significant
impairment or distress, as manifested by one (or more) of the
following, occurring within a 12-month period:
recurrent substance use resulting in a failure to fulfill major role
obligations at work, school, home (e.g., repeated absences or poor
work performance related to substance use; substance-related
absences, suspensions, or expulsions from school; neglect of
children or household)
recurrent substance use in situations in which it is physically
hazardous (e.g., driving an automobile or operating a machine
when impaired by substance use)
recurrent substance-related legal problems (e.g., arrests for
substance-related disorderly conduct)
continued substance use despite having persistent or recurrent social
or interpersonal problems caused or exacerbated by the effects of
the substance (e.g., arguments with spouse about consequences
of intoxication, physical fights)
Functional Assessment- the
Individual
- Assessment Tools: CAGE Questionnaire
Two "yes" responses indicate that the
respondent should be investigated further.
The questionnaire asks the following
questions:
Have you ever felt you needed to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Have you ever felt you needed a drink first thing in the morning
(Eye-opener) to steady your nerves or to get rid of a
hangover?
Functional Assessment- the
Individual
Other assessment tools (find on
Google):
1) MAST- Michigan Alcohol Screening Test
2) AUDIT-Alcohol Use Disorders
Identification Test
3) RIASI-RIA Self Inventory
4) SSI-Simple Screening Instrument
5) DAST- Drug Abuse Screening Test
Functional Assessment- the
Individual
How is the PROBLEM a PROBLEM?
Always go further than standardized
tests with mental illness to avoid over
diagnosing. Question:
• a)
b)
c)
Social impact?
Physical consequences?
Emotional effects?
System's Approach: You Can't Just
Fix The Addict.
• The Family
Role Theory: The addict, the fixer,
the overlooked, etc...
Taboos
Resistance to Change
Significant Others
Enabling
Sabotage: If he gets better, what do I
do now? Who am I?
Treatment
Models:
*Abstinence
*Harm Reduction
Survey of Structured Programs
* Detoxification
*Medical Detoxification
*Inpatient Rehabilitation
*Partial Hospitalization
*Outpatient Rehabilitation
*Individual
*Group
•
Dearth of Structured Programs for middle class
*Private Pay Facilities
*Medicare/Medicaid
Non-structured Interventions for
PGCM’s
Assess Leverage
Limit Access
Alter Substance
Limit Substance
Collaborate w/PCP (support meds)
Research/Accompany to 12 Step Groups
Function as Sponsor
System “Intervention”
Private Therapy
Medicine: antabuse, naltrexone