Monday, August 1, 2011

Substance Abuse in the Elderly


SUBSTANCE ABUSE IN THE ELDERLY: is a 'Power Point' Training presentation by Dr. Fenny Braide, at Greater Metropolitan Healthcare Institute, Baltimore, Maryland.

In this training, my main focus will be the impact of substance abuse in the aging population. Like adults of any age, older people experience problems with addiction too. Sometimes these problems may occur when a person is older or may have been a concern for many years.

Substance abuse in the elderly can lead to disturbance thinking, poor judgment, cognitive and affective impairment, social withdrawal or fatal. Older adults are at higher risk for substance abuse for various reasons, new data from Food & Drug Administration shows that drug abuse among the elderly is increasing in the United states.

For the last two decades increasing evidence exists for the extremely high prevalence of co morbidity of psychiatric and substance Use disorders. Studies reveal that over half of diagnosed schizophrenics have a diagnosed Alcohol Dependency Disorder (Zuckoff & Daly, 1999). There is extensive documentation that the dual-diagnosed population has markedly poorer clinical outcomes and a higher utilization of inpatient services. These findings have led to the awareness of an urgent need for effective models of treatment for this co-occurring disorders population.

After working with the elderly population with substance abuse and dual diagnosis disorders for over eighteen years, and not making substantial headway in healing them with standard scientific (secular) psychotherapy (such as cognitive behavior therapy), I tried something else; I injected spirituality into the mix. And used psycho-spiritual approach and found out that the intervention yields a better result.

DEFINITION

Substance abuse can simply be defined as a pattern of harmful use of any substance for mood altering purposes. In other words, the use of illicit drugs or abuse of prescription or over-the-counter drugs for the purpose other than those for which they are indicated or in a manner or in quantities other than as directed is simply called abuse.

Generally, when most people talk about substance abuse, they are referring to the use of illegal drugs. However, most professionals in the field of drug abuse prevention argue that any use of ILLEGAL is by definition abuse. Theoretically, almost any substance can be abused---be it Alcohol, prescription drugs, over-the-counter medications, inhalants, solvent, even coffee and cigarettes and all that used to harmful excess. The fact of the matter is, any use of illegal substance is potentially addictive and can cause severe negative health problems.

CASE STUDY OF MS WILLIAMS

Substance abuse among the elderly is becoming a growing problem, Ms. Williams is not alone.
Ms Williams has had problems of substance abuse since in her late twenties. For years she denied having problem with drinking alcohol. Even though drinking binges were standard followed by period of sobriety, her inevitably returned to her addictive ways at a later age. At 65, Ms Williams is on several prescription medications, some of which should not be taken with alcohol. Her children long ago are burned out from trying to persuade her to get help but she declined. Ms. Williams was also diagnosed with Alzheimer's and depression before her 64th birthday. Ms. Williams continues to drink alcohol against doctor's advice. Her children have given-up believing that you can not "teach an old dog new trick."

This case study illustrates what has been called one of the fastest growing health problems in the aging population in the United states. As we have more and more people living longer, more and more of them are abusing drugs and alcohol in their later years. Most times caregivers often overlook substance abuse among older adults because CAREGIVERS don't know what to look for or mistakenly assume that older adults cannot be successfully treated. Again, caregivers and loved ones may give excuse for an older relatives substance abuse as a result of grief or loss or reaction to boredom. In some cases family members may not want to confront the elderly, fearing they will offend or anger them or get written off in the Will.

A Resident is a primary responsibility of the caregiver. It is very important that caregivers have full knowledge as well as medical history of their residents.

RECOGNIZE SYMPTOMS OF SUBSTANCE ABUSE IN THE ELDERLY

Elderly people who have history of substance abuse use it to alter mood and state of awareness. Sometimes detecting substance abuse in the elderly can be difficult because presenting symptoms are often those that are commonly associated with aging itself. As a caregiver, it your responsibility to observe the behavior of Residents. Residents who present with symptoms of self-neglect, falls often, socially withdrawn, and aggressive to self and others should be screened for substance abuse.

TREATMENT

Although there is no magic bullet treatment, when substance abuse is found, the elderly should be treated as aggressively as their younger counterparts, with slow careful detoxification and the use of some form of group therapy like alcohol anonymous group - AA. However, my approach to healing substance abuse disorders is didactic. I teach the client what we know about substance abuse disorder and how to treat it. I use CBT / spirituality as dual approach to empower the client with optional ideas and essentially leave the client to deal with the healing process. So far, positive feedbacks and the efficacy of this intervention is overwhelming.

REFERENCE: Substance abuse / Substance addiction of America; Zuckoff & Daly, 1999, Substance Abuse Issues.
Private practice: Evidence-based or empirically supported treatment (that is, treatment that has shown efficacy in research trials) with clients who has substance abuse problems.

For training purposes only. (c) All rights reserved.

Fenny Braide, PhD
Psychotherapist / Healthcare Consultant
Former IBHC Lead clinician