Summary: TIP 26: Addiction Treatment in Older Adults Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives ~ Review the data about substance abuse and gambling issues in older adults ~ Review screening for substance use and mental health disorders in the elderly ~ Identify risk factors for SA and MH issues ~ Review placement and treatment issues specific to older adults Introduction ~ Abuse of alcohol and prescription drugs among adults 60 and older; growing fast ~ Estimated 2.5 million older adults have problems related to alcohol ~ Consume more prescribed and over-the-counter (OTC) medications ~ 2006 New Jersey study indicated 23% of citizens over 55 were disordered gamblers (New Jersey Senior Gamblers Study) ~ Seniors are fastest growing group of gamblers between 1974 and 1989 (Gambling Impact and Behavior Study 1999) ~ A 2008 study reveals that they gamble for ~ Extrinsic reasons include winning money, gaining independence, and supplementing income ~ Intrinsic reasons include entertainment/excitement, being around other people, distraction from everyday problems such as loneliness and boredom, and escaping feelings of grief and loss associated with the death of a loved one or close friend. (Arizona Compulsive Gambling Council) Introduction ~ Among adults over 65 years of age gambling is the most frequently identified social activity (McNeilly & Burke 2001) ~ Reduced cognitive capacity can make it difficult for them to make sound decisions. ~ Older adults living on a fixed income with limited savings can’t necessarily afford the financial drain of a gambling disorder. ~ When you’re younger, maybe you’re $100,000 in debt, but you’ve got your spouse, you’ve got your children, your job; you still have some reason to get up in the morning,” Nower says ~ Because older adults tend to have less contact with friends and family, gambling-related problems may go unnoticed. Introduction ~ Gambling should be identified as a problem when it disrupts, damages, or limits a person’s life ~ Signs of problem gambling are spending more money on gambling than intended; feeling bad, sad, or guilty about gambling; not having enough money for food, rent, or bills; being unable to account for blocks of time; experiencing social withdrawal; and experiencing anxiety or depression. ~ Older adults may try to hide or deny a gambling problem, they may feel hopeless or ashamed about the situation, or they may be unaware that help is available. Alcohol and the Older Adult ~ Age-related changes affecting the way an older person responds to alcohol: 1) Normal decrease in body water that comes with age ~ Same amount can now cause intoxication ~ Increased sensitivity and decrease tolerance 2) Decrease in rate of GI metabolism ~ Blood alcohol level remains raised for a longer time ~ Increased hepatic workload Alcohol and the Older Adult Cont… ~ Trigger or worsen serious problems ~ Heart problems ~ Risk of stroke ~ Cirrhosis and other liver diseases ~ Gastrointestinal bleeding ~ Depression, anxiety and other mental health problems Prescription Drugs ~ Medications interact negatively with alcohol ~ Dependence on psychoactive medication ~ Misunderstood directions ~ Multiple prescriptions from different doctors; no coordination ~ Unintentional misuse leading to abuse Screening ~ Psychoactive substance use associated with negative central nervous system effects ~ Indications of problematic psychoactive substance use: ~ Diminished psychomotor performance ~ Impaired reaction time ~ Loss of coordination ~ Falls ~ Excessive daytime drowsiness ~ Confusion ~ Aggravation of emotional state ~ Amnesia ~ Dependence Risk Factors ~ Emotional and Social Problems ~ Bereavement and sadness ~ Losses ~ Spouse, friends, family members ~ Social status ~ Occupation and sense of professional identity ~ Hopes for the future ~ Ability to function ~ Social isolation and loneliness ~ Reduced self-regard or self-esteem ~ Fam
