Oldies but Goodies

1
Oldies but Goodies

• A brief look into the life of the elderly dealing
  with addiction

2
Baby Boomers

• In 2000, the population of adults 65 older in
  the United States was around 35 million. That
  number is expected to increase to over 86 million
  by the year 2050. (Bureau of the Census, 2004)
• In 2005, 76 of substance abuse treatment
  admissions for adults 65 and older were males,
  while 24 of admissions were females
• (SAMSHA, 2007)
• It is estimated that the number of older adults
  with substance abuse problems will increase from
  2.5 million in 1999 to 5 million in 2020.
  (Gfroerer et al. 2008)
• In 2005, older adults aged 65 to 69 made up the
  largest part of the substance abuse treatment
  population aged 65 and older (SAMSHA, 2007)

3
Age As A Factor

• 3 age groups
• Young-old (60-74)
• Old-old(75-84)
• Oldest-old(85)
• Factors that affect use in these groups
• Social Changes
• Age-related changes
• Grief Loss

4
Illicit Drug Use Among Older Adults

• In 2000, an estimated 568,000 persons aged 55 or
  older had used illicit drugs in the past month
  (1 of the population of older adults)
• Most common were psychotherapeutics used
  nonmedically and marijuana (The NHSDA Report,
  2001)
• According to Gfroerer et al. (2008)
• Rates of problematic illicit drug use have been
  shown to decline with increasing age.
• Cohorts that experience high rates of illicit
  drug use in youth have subsequently shown higher
  rates of use and associated problems as they age.

5
Alcohol Abuse

• Range of Rates in Alcohol Abuse Among Older
  Adults
• 3 to 25 for heavy alcohol use
• 2.2 to 9.6 for alcohol abuse (Straussner,
  2004)
• Alcohol abuse was the most frequently reported
  primary substance of abuse among older adults
  each year from 1995 to 2005
• (SAMHSA, 2007)

6
Recommendations

• Recommended
• 1 alcoholic drink a day is the limit for anyone
  over the age of 65 who has not been diagnosed
  with a drinking problem (12 ounces of beer, 1.5
  ounces of distilled spirits, or 5 ounces of wine)

7
Signals that may indicate an alcohol or
medication-related problem

• Memory trouble after having a drink or taking
  medicine
• Loss of coordination (walking unsteadily,
  frequent falls)
• Changes in sleeping habits
• Unexplained bruises
• Being unsure of yourself
• Irritability, sadness, depression
• Unexplained chronic pain

8
Signals that may indicate an alcohol or
medication-related problem (CONTD)

• Changes in eating habits
• Wanting to stay alone a lot of the time
• Failing to bathe or keep clean
• Having trouble finishing sentences
• Having trouble concentrating
• Difficulty staying in touch with family or
  friends
• Lack of interest in usual activities

9
Reasons for Misuse of Medications

• Difficulties reading and following prescription
• Cognitive deficits
• Cost
• Complexity of drug treatment

10
Prescription Drug Use

• Admissions into treatment facilities for abuse of
  opiates in adults 65 and older increased from 6.6
  to 10.5 between 1995 and 2005.
• (SAMSHA, 2007)
• According to Patterson, 2005
• Approximately 30 percent of prescriptions are
  consumed by adults over age 65, and 15 billion
  is spent each year by older adults on those
  prescriptions
• While we are unsure of the number of older adults
  addicted to prescription drugs, in 1999 nearly
  7.2 million older adults were medically exposed
  to prescription drugs with addictive potential.

11
Types of Misuse

• Over dose
• Under dose
• Use for other than prescribed
• Drug combinations

12
Factors associated with abuse

• Genetics
• Stress
• Depression
• Co-morbidities
• Metabolism
• Structural Problems
• Research not consider aged
• Dosage one size fits all

13
Onset Patterns of Substance Abuse

• Early onset
• People who have lived with substance abuse
  problems throughout adulthood
• Late onset
• History of substance abuse after midlife
• Intermittent substance abuse
• Problems with abuse occurred earlier in life and
  ended in recover, however, the abuse is present
  again in late life

14
Treatment Issues

• Ageism
• Stigma
• Misdiagnosis
• Lack of Inquiry by the helping professional
• Indicators of abuse differ in this population

15
Screening

• Prescription Misuse
• The Solano County Senior Medication Education
  Project Noncompliance Screening Form
• 21 Question Screening form that covers a variety
  of issues that may lead to problems of
  overmedication or undermedication in elderly
  people. (Straussner, 2004)

16
Screening (CONTD)

• Alcohol Abuse
• CAGE
• Cut down, Annoyed, Guilt, Eye Opener
• HEAT
• Asks open-ended questions that promote discussion
  of reasons behind use
• CHARMM
• Pattern of use, role of alcohol, problem
  interactions with Meds
• MAST-G
• Inquires about alcohol use as a coping mechanism
  for loneliness and lack of sleep

17
Therapeutic Implications

• Inquire about the older adults feelings regarding
  substance use and abuse
• Build rapport
• Clear and concise, Non stigmatizing questions
• Provide a safe, private environment
• Client education on substance abuse
• Consideration of spirituality
• 2 Cs Competence Caring

18
Assessment

• Assessment that considers age related health and
  mental health problems
• Consideration of factor such as Alzheimers
  Disease, Dementia, or depression
• Consideration of past experiences that could have
  affected abuse
• Family history
• Support systems
• Etc.

19
Community Resources

• Substance Abuse
• http//dasis3.samhsa.gov/PrxInput.aspx?STATEGeorg
  ia
• Opioid Dependency Treatment
• http//dpt2.samhsa.gov/treatment/

20
References

• Substance Abuse and Mental Health Services
  Administration (2008, April    8). Find
  Treatment. Retrieved July 10, 2008 from SAMHSA, 
    U.S. Department of Health and Human Services
  Web site    http//www.samhsa.gov/treatment/inde
  x.aspxsa
• Benshoff, J.J., Harrawood, L.K., Koch, D.S.
  (2003). Substance abuse and    the elderly
  unique issues and concerns. Journal of
  Rehabilitation
• Drug and Alcohol Services Information System
  (2007, May 31). Adults    Aged 65 or Older in
  Substance Abuse Treatment 2005. Retrieved   
  July 10, 2008 from SAMHSA, Office of Applied
  Studies Web site    http//www.drugabusestatisti
  cs.samhsa.gov/2k7/olderTX/olderTX.pd
• Gfroerer, J.C., Penne M.A., Pemberton, M.R.,
  Folson, R.E. (2008, June    16). The Aging Baby
  Boom Cohort and Future Prevalence of   
  Substance Abuse. Retrieved July 9, 2008 from
  SAMHSA, U.S.    Department of Health and Human
  Services Web site  http//www.drugabusestatistic
  s.samhsa.gov/aging/chap5.htm  

21
References CONTD

• Patterson, T.L., PhD (2005, March 9).
  Prescription Drugs and Drug    Interactions.
  Retrieved July 8, 2008 from , National
  Institute    on Drug Abuse Web site   
  http//www.drugabuse.gov/whatsnew/meetings/bbsr/pr
  escription.html
• Substance Abuse and Mental Health Services
  Administration (2008, April    8). Find
  Treatment. Retrieved July 10, 2008 from SAMHSA, 
    U.S. Department of Health and Human Services
  Web site    http//www.samhsa.gov/treatment/inde
  x.aspxsa
• SAMHSA (2001, November 3). Substance Use Among
  Older Adults.    Retrieved July 9, 2008 from
  Office of Applied Studies Web site   
  http//www.oas.samhsa.gov/2k1/olderadults/olderadu
  lts.htm
• Straussner, L.A. (2004). Clinical Work with
  Substance-Abusing    Clients (Second Edition).
  New York, NY The Guilford Press.
• U.S. Census Bureau (2004, March 18). U.S. Interim
  projections by    Age, Sex, Race, and Hispanic
  Origin. Retrieved July 9, 2008    from , U.S.
  Census Bureau Web site http//www.census.gov/ip
  c/www/usinterimproj/natprojtab02a.pdf