Transcript Slides on Substance Abuse and Older Adults

The development of this learning module was made possible
through a Gero Innovations Grant from the CSWE Gero-Ed
Center’s Master’s Advanced Curriculum (MAC) Project and the
John A. Hartford Foundation.
Mental Health,
Substance Abuse, and
Older Adults
Funded by Master’s Advanced Curriculum
Project
University of Texas at Arlington
Mental Health, Substance
Abuse, and Older Adults
Test Your Knowledge
Question #1: Substance abuse among
the elderly is only a minor problem.
 False
Question #2: Most elderly with
substance-related disorders get
treatment.
 False
Question #3: Most elderly with
substance–related disorders abuse
alcohol followed by marijuana.
 False
Question #4: Older women are
more depressed and therefore
drink more than older men.
 False
Question #5: The elderly can
tolerate higher levels of alcohol
compared to younger drinkers.
 False
Question #6: Most elderly individuals
can easily tolerate recommended adult
doses of most medications.
 False
Question #7: Illicit drug use particularly
involving substances such as marijuana, heroin,
or cocaine is quite rare among the elderly.
 True
Question #8: Tranquilizers and sleeping
pills are the prescription drugs most
abused by elderly individuals.
 True
Question #9: Abuse of prescription
drugs is more common among older
women than men.
 True
3 types of elderly drinkers:
 Early onset problem
drinkers
 Early intermittent
drinkers
 Later-onset problem
drinkers
Misuse of
Prescription Medications
 30% of all prescriptions and
40% of all over the counter
medications sold to older adults.
 10% to 15% of the elderly
intentionally misuse prescription
medications.
 17% to 23% of drugs
prescribed to older adults are
benzodiazepines.
Factors that Contribute to Substance
Abuse among the Elderly
 Substance use disorder earlier in life
 Genetics
 Major life changes
 Disengagement
 Deterioration of health
 Dangerous health care prescribing
practices
Mental Health Comorbidity
 Alcohol Dependence with Comorbid
Major Depressive Disorder
 Alcohol Dependence with Comorbid
Cognitive Impairment
 Alcohol Dependence with Comorbid
Anxiety Disorders
Assessment and Diagnosis
 Problems With DSM for Diagnosis
 Older adults who consume smaller
amounts go undetected as having a
substance abuse problem.
 Older adults less likely that
substance use interferes with social
or occupational functioning.
Screening Tools
CAGE
 Have you ever felt you should Cut
down on your drinking?
 Have people Annoyed you by
criticizing your drinking?
 Have you felt Guilty about your
drinking?
 Have you Ever had a drink first
thing in the morning to steady
your nerves or to get rid of a
hangover?
Michigan Alcoholism Screening TestGeriatric (MAST-G)
 Internet Site:
http://pathwayscourses.samhsa.gov/elab
/pdfs_elab/elab_supps_pg8.pdf
The Alcohol Use Disorders
Identification Test (AUDIT)
 Internet Site:
http://whqlibdoc.who.int/hq/2001/WHO_
MSD_MSB_01.6a.pdf
The Alcohol Related Problems Survey
(ARPS)
 Internet Site: [email protected]
The Impressions of Medication, Alcohol,
and Drug Use in Seniors (IMADUS)
 pp. 199-200 in the book Geropsychiatric
and Mental Health Nursing by Karen Melillo
& Susan Houde published by Jones and
Bartlett.
Intervention and Treatment
 Least Intensive Treatment Option
 Traditional confrontational interventions
do not work
 Brief interventions and motivational
methods are recommended as the first
mode of intervention.
 Hospitalization
Brief Interventions &
Motivational Counseling
 Give feedback on screening
 Discuss reasons for drinking
 Discuss consequences of drinking
 Discuss reasons to cut down or quit
 Develop strategies for achieving goal
 Develop an agreement in the form of a written contract.
 Identify obstacles to achieving goal.
 Discuss strategies to overcome obstacles
 Summarize session.
Cognitive-Behavioral Approaches
Additional Considerations for
Intervention & Treatment
 Age-appropriate components
 Group-based approaches
 Involvement of family or significant
others
 Case management services
 Inpatient treatment Facilities
 12 Step programs
Case Example for Discussion
and Application
 Mr. G. had recently lost his wife. She had
been ill for several years and he had taken
care of her. After she died, he did not have
many ways to fill his time. He was unable to
drive and depend on his daughter to grocery
shop for him. Once in a while he added a
six-pack of beer to the weekly list. Indeed,
since his wife’s death, Mr. G had put beer on
the list every week. Over the past month,
Mr. G. had fallen and became incontinent.
His doctor recognized the roll alcohol played
in these symptoms, asked about it, and
referred him to a community mental health
clinic where he encountered a social work
practitioner.