Larry Schonfeld, Ph'D', Professor

1
Policy Issues

• Larry Schonfeld, Ph.D., Professor
• Dept. of Aging Mental Health
• Florida Mental Health Institute

Presented at the National Conference on Older
Adults and Substance Abuse June 18, 2004
2
Working with Older Substance Abusers is a
difficult process.
3
Policy Issues Recognize the Barriers

• Were not prepared for the rapidly aging
  population.
• Elders disproportionally are currently
  under-represented in treatment, and the numbers
  will only increase
• Best practice models and recommendations have
  been proposed by SAMHSA but rarely implemented
• Treatment and funding priorities for elder
  behavioral health are still lagging
• Referral networks not well established
• Despite high medical costs associated with
  substance abuse, prevention are rare
• Prevention efforts are rare

4
An Aging Populationfrom Korper and Raskin (2002)
Substance Use by Older AdultsEstimates of
Future Impact on the Treatment System

5
November 23, 2001
6
Baby Boomers

• The rate of lifetime illicit drug use was
  significantly higher among persons aged 35 to 54
  (50 percent) in 2000 (birth cohorts of the "baby
  boom" generation) than among older adults (13
  percent)
• The higher prevalence of illicit drug use among
  the younger age group (those aged 35 to 54),
  combined with the generation's overall large
  population size, suggests that the number of
  illicit drug users among older adults will
  increase in the coming years as this younger
  group enters older adulthood.

7
The DASIS ReportDrug and Alcohol Services
Information SystemDecember 7, 2001

• In 1999, 50,700 persons aged 55 or older were
  admitted to publicly funded substance abuse
  treatment
• Alcohol was the primary substance of abuse among
  older adults
• Alcohol abuse admissions among older adults
  declined between 1994 and 1999, but illicit drug
  admissions increased

8
Source 1999 Treatment Episode Data System (TEDS)
9
States with Largest Numbers and Highest Ranks of
Admissions Aged 55 in 1999 (source DASIS
Report 2001)
Florida not even among the top 15 in rate
10
Research on Older Adults and Substance Abuse

• Few older adults enter traditional forms of
  substance abuse services
• Minorities and low-income even more
  under-represented in the treatment population
• Older adults have greater needs regarding
• Physical ailments, frailty
• Cognitive impairment
• Overcoming losses and depression
• Elder specific treatment is recommended but
  rarely available
• Brief interventions, brief therapies, in-home
  services and other innovations should be
  considered
• Little evaluation of prevention efforts.
  Progress beyond talking to available audiences
  of elders

11
Percentage of Adults Aged 18 or Older Reporting
Past Month Use of Any Illicit Drug or Alcohol by
Age Group 2000 (source NHSDA, 2001)
Percent Reporting Use in Past Month
12
(No Transcript)
13
Medication Misuse

• Often is unintentional
• Requires education of the consumer
• Increase awareness of their own meds
• Increase awareness of interactions with alcohol
  and with other meds
• How they can be better prepared to speak with
  their physician in a short amount of time?
• How can family members learn more about the
  effects of meds as well as how to help their
  loved ones cope?

14
(No Transcript)
15
Older Floridians Rarely Receive Treatment

• There are 3.5 million Floridians ages 60
• Using estimates of 2 -10 of alcohol abuse in
  community based elders
• There would be between 70,000 and 350,000 elders
  in Florida abusing alcohol
• Yet in Florida about 2 of adults admitted to
  substance abuse treatment are age 60 or older
• Thus, 1 to 9 out of every 1,000 older Floridians
  in need of treatment for alcohol problems
  actually receive treatment.

16
The Proportion of Older Adults Treated in
Publicly Funded Substance Abuse Treatment
Services in FloridaFiscal Year 2001-2002
Ages 60 and Older 2
Ages 18-59 98
Source Policy Services Research Data Center
(2003) Louis de la Parte Florida Mental Health
Institute
17
Healthcare Financing IssuesKorper and Raskin
(2002)

• Managed care plans are increasingly limiting the
  provision of services to Medicare patients
• Medicare requires a 50 percent co-payment from
  patients for the treatment of substance abuse and
  mental health problems
• Health care practitioners limit the number of
  Medicare patents in their practices (older adults
  with complex and consuming psychosocial and
  medical disorders)

18
Healthcare Financing IssuesKorper and Raskin
(2002)

• Reduced time for doctor-patient interactions
  makes it difficult to identify patient problems
  with substances drug interactions
• Healthcare system Reduced hospital lengths of
  stay, increased reliance on primary care
  physicians, dwindling outpatient resources, and
  reduced nursing home beds.
• Fewer options for older adults with chronic
  mental illness (and other medical and social
  covariates of alcohol and drug abuse)

19
So. What can we do about this?

• Before we ask for funds .
• We need data!
• How can we convince our legislators that this is
  a problem?
• Can we demonstrate there is a need?
• We need advocacy!
• Even if we can demonstrate need, how do we raise
  such priorities?
• We need collaboration of service providers

20
So. How can we do this?

• Conduct a community based needs assessments
• Determine priorities and service needs
• Target populations different from current state
  priorities?
• Pilot screening data
• Difficult to convince legislators policy makers
• Use best practices - SAMHSA TIPs
• Evaluate your efforts
• Demonstrate that you are in fact identifying the
  target populations that the state or local levels
  have prioritized
• Build or join the coalitions focused on improving
  services for older adults

21
Changing Policy by Changing Service Systems

• How can we work with geriatricians, geriatric
  psychiatrists, other healthcare providers to
  offer screening and referral services?
• Work with nurses, ARNPs
• Determine the best method for grooming referral
  systems
• Link with Aging Services, Health Clinics
• Establish gatekeepers, sentinels
• Link with universities to offer training and
  internship experiences for students in
• Social work
• Psychology
• Counseling
• Nursing
• Gerontology/Aging Studies

22
Legislation and Policy Change

• State-wide coalitions joining forces with local
  coalitions
• Collective advocacy
• Setting aside rivalries, territorialism
• Work with individuals who have written
  legislation to work with the coalition leaders
• Partnerships of Academicians, Substance Abuse
  Agencies, Service Providers, Policy makers to
• Seek Grants
• Evaluate programs and Provide better data