Transcript Effective-Treatment-Strategies-for-Addicted-Older-Adults-and

Effective Treatment Strategies for
Addicted Older Adults and Their Families
Sharon Matthew, Clinical Supervisor-Seniors Program and
Women’s Extended Care
LPC, CCS, ACRPS, CSAT, CMAT
ASAM Disclosure of Relevant Financial
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was
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what role
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anyAny
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Sharon
Sharon Matthew
X
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Glossary of Terms
Commercial Interest - The ACCME defines a “commercial interest” as any proprietary entity
producing health care goods or services, with the exemption of non-profit or government
organizations and non-health care related companies.
Financial relationships -Financial relationships are those relationships in which the individual
benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria,
ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified
mutual funds), or other financial benefit. Financial benefits are usually associated with roles such
as employment, management position, independent contractor (including contracted research),
consulting, speaking and teaching, membership on advisory committees or review panels, board
membership, and other activities from which remuneration is received, or expected. ACCME
considers relationships of the person involved in the CME activity to include financial
relationships of a spouse or partner.
Relevant financial relationships - ACCME focuses on financial relationships with commercial
interests in the 12-month period preceding the time that the individual is being asked to assume a
role controlling content of the CME activity. ACCME has not set a minimal dollar amount for
relationships to be significant. Inherent in any amount is the incentive to maintain or increase the
value of the relationship. The ACCME defines “’relevant’ financial relationships” as financial
relationships in any amount occurring within the past 12 months that create a conflict of interest.
Conflict of Interest - Circumstances create a conflict of interest when an individual has an
opportunity to affect CME content about products or services of a commercial interest with
which he/she has a financial relationship.
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Participants will be able to:
• Talk about the fastest growing population
requiring specialized D&A levels of care
• Understand treatment components
necessary to provide a well rounded
integrated approach to senior care
• Develop and address the clinical needs
necessary to treat the entire family system
with particular focus on care giving
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An Aging Population
• By 2050, it is anticipated that Americans aged 65 or older will number
nearly 89 million people, or more than double the number of older
adults in the United States in 2010.
• Americans are living longer lives than in previous decades and, given
the post-World War II baby boom, there are proportionately more
older adults than in previous generations.
“The state of Aging and Health in America 2013” – US Centers for Disease Control and Prevention
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An Aging Population
• In 1992, the number of Americans over 50 admitted to
treatment facilities was near 6.6% of all admissions
nationwide.
• By 2008, the number of admissions from this age group
reached 12.2%.
• Statistically, alcohol addiction has remained the primary
substance abuse disorder for people age 50 and older, and
this still holds true today.
• However, seniors are now abusing more illicit substances –
such as cocaine, heroin and marijuana (with marijuana far
ahead of the rest) and legal prescription drugs than before.
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How Will Our Industry React?
• Within the next several years there will be more Boomers and
Seniors than children in America.
• Boomer and Older Adults are living with multiple chronic
disorders including the disease of addiction.
• For the next 18 years, boomers will be turning 65 at a rate of
about 10,000 a day.
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How Will Our Industry React?
• Healthcare costs related to alcohol and drug abuse among
seniors are projected to reach $100 billion by 2018.
• Most commonly abused painkillers, such as hydrocodone
and oxycodone, climbed more than 50%.
• The supply of each narcotic provided to the average
recipient grew about 15% from 2007 to 2012. (80% USA)
• This means that the ratio of the nation’s 43 million seniors
getting Medicare prescriptions to take pills like Vicodin or
Percocet are 1 in 5.
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Life Span Development
(Early Adulthood: ages 28-50)
Psychosocial Development: Erik Erikson
Stage #6: Intimacy vs. Isolation
• Develop sense of identity
• Committed relationships
• Isolation vs. loneliness vs. depression
• Intimacy (in to me I see)
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Life Span Development
(“Adulthood” ages 50-70)
Stage #7: Generativity vs. Stagnation
• Build our lives, focus on career and family.
• Those who are successful during this phase feel they have
contributed to the world as a productive member of their
home and community.
• Those who fail to attain this skill feel unproductive and
uninvolved in the world.
• Care is the “virtue” achieved when this stage is handled
successfully.
• Being proud of accomplishments, watching your children
grow into adults, and developing a sense of unity with your
life partner.
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Life Span Development
(“Older Adulthood” ages 70 and above)
Stage #8: Integrity vs. Despair
• This phase occurs during old age and is focused on
reflecting back on life.
• Those who are unsuccessful during this stage will feel their
life has been wasted and will experience regrets, left with
feelings of bitterness and despair.
• Those who are proud of their accomplishments will feel a
sense of integrity successfully completing this phase –
means looking back with few regrets and a feeling of
satisfaction. These individuals attain wisdom even when
confronting death.
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Treating Older Adults
Successful Integrated Model
• Physical, Emotional, Spiritual, Medical,
Recreational, Nutritional, Social and
Systemic (Caregiver)
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Physical Signs and Symptoms
Complicated by Addiction
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•
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Sleep complications
Health complications
Decline in ADL’s
Unexplained burns/bruises
Fall risk
Medication complications
Disease concept: chronic
progressive characterized
by denial
• Memory loss, dementia,
delirium
• Malnutrition
• Incontinence
• Decline in social
interaction
• Vision problems
• Cognitive decline
• Hearing problems.
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Treatment Components
“A Successful Approach”
1.
2.
3.
4.
Environment 3 S’s: small, safe,
self-contained
Geriatric Specialists-medical and
psychiatric team (co-occurring
disorders)
Spiritual Counseling
Patient centered assessment
- nutritional
- visual impairment
- auditory impairment
- ambulatory impairment
- cognitive impairment
- fall risk
5. More tools in the clinicians
toolbox-meeting patient where they
are
6. Complicated grief
7. Stages of treatment-group vs.
individual
8. Integration of 12 Step RecoverySenior to Senior
9. Level of care
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What About Us…
The Family as Caregivers for
Senior Addicts
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The First Caregiver Group Ever!
Caregiver Support Groups
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Take Your Oxygen First
Dear Air Travel News Answer Man,
“As a mother of three, it always bothers me when I hear the emergency
announcements on airplanes telling us to grab or own oxygen masks before we
assist our children. Children seem so much more vulnerable than adults. I
believe a child would certainly stop breathing in an emergency before an
adult! Unless you can explain this to me, I don’t plan to follow the instructions
they give on airplanes.”
Sincerely,
A loyal but confused passenger
Jamie Huysman
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Symptoms of
Caregiver Burnout
• The index of the separation between what people are and what
they have to do
• It is also the greatest trigger for Caregiver and Senior Addiction
• Become chronically exhausted
• Become cynical and detached from work
• Become increasingly ineffective at work
• It represents an erosion in values, dignity, spirit and will – an
erosion of the human soil
• It is a malady that spreads gradually and continuously over
time, putting people into a downward spiral from which it’s
hard to recover
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What Causes Caregiver Burnout:
The fertile ground for addictions?
• Caregivers often are so busy caring for others that they tend to
neglect their own emotional, physical and spiritual health.
• The demands on a caregiver’s body, mind and emotions can easily
seem overwhelming, leading to fatigue and hopelessness and
ultimately, burnout. Other factors that can lead to caregiver burnout
include:
• Role confusion: many people are confused when thrust into the role of
caregiver. It can be difficult for a person to separate her role as
caregiver from her role as spouse, lover, child, friend, etc.
• Unrealistic expectations: many caregivers expect their involvement to
have a positive effect on the health and happiness of their loved one.
This may not always be realistic.
• Caregivers dying before the Senior.
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Personal Impact of Caregiving
As the Catalyst for Addictions
Caregivers in Recovery In The Rooms
TM
Prominent National Risk Factors We Understand Better
• Sandwich Generation
• Club Sandwich Generation
• Availability of Medications
• Boomer Mindset: Sex, Drugs and Rock and Roll
• Lack of Mental Health Prior to Caregiving
• Caregivers not coming for Medical Care: Dying before
their loved ones
• Replacing Program for Loved One
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Making the Difficult Decision
What Happens After Treatment?
A Continuum Approach
• Extended Care
• Outpatient Levels of
Care
• Caregiver – in home
services
• 12 Step community
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•
•
•
Wrap around care
Nursing facility
Assisted living
Primary care doctor
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Ancient Premise: CRISIS-OPPORTUNITY
• The Chinese symbol crisis is not one symbol but
two
• The symbols for crisis in Chinese are made up of
these two words
• They are pronounced wei1 ji1. wei means danger;
peril and ji means opportunity; crucial point
• So literally wei plus ji equals “danger” plus
“opportunity”
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Questions?
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About the Presenter
It is never too late to
develop an addiction
It is never too late to
intervene on an
addiction
It is never to late to have
quality of life
Sharon Matthew, LPC, CCS, ACRPS,
CSAT, CMAT
Clinical Supervisor-Seniors Program
Email: [email protected]
800.678.2332 I www.caron.org