Recognizing Substance Abuse in Older Adults
Getting Them the Help They Need
Substance abuse among older adults can be difficult to detect because it mimics the normal signs of aging and conditions commonly diagnosed in older adults, such as dementia. Friends and family may notice an older adult is "acting funny," but assume this is a natural consequence of aging and ignore it, instead of investigating and getting medical help. They may also notice that the older adult is drinking more than usual, but they decide the person can have a few drinks if he or she wants to.
Studies show there are direct links between physical and behavioral health. Someone who is physically ill is also more likely to be depressed and more likely to self-medicate with alcohol or other drugs. Treating only one side of the equation, either behavioral or physical sickness alone, still leaves the consumer dealing with a serious ailment. Primary care physicians and families need to be aware of these links so that a person can get treatment for both ailments.
Substance abuse, either alcohol or drugs of any type, is a quality of life issue. Treatment works at any age, but first someone must recognize when an older adult may have a substance abuse problem and help the person find the treatment he or she needs.
The Center for Substance Abuse Treatment published a list of signals that may indicate an alcohol or medication-related problem in older adults:
- Memory trouble after having a drink or taking a medication;
- Loss of coordination (walking unsteadily, frequent falls);
- Changes in sleeping habits;
- Unexplained bruises;
- Being unsure or confused;
- Irritability, sadness, depression;
- Unexplained chronic pain;
- Changes in eating habits;
- Wanting to stay alone much of the time;
- Failing to bathe or keep clean;
- Having trouble concentrating;
- Difficulty staying in touch with family or friends; and
- Lack of interest in usual activities.
Even though older adults can have legitimate pain issues that need to be treated, there are signs when someone has begun misusing prescribed drugs, according to Sandy Calvert, program director for Making Prevention Work for Older Americans. An older adult will begin:
- Excessively worrying about whether prescription drugs are "really working" to alleviate numerous physical complaints; complaints that the drug prescribed has lost its effectiveness over time;
- Displaying detailed knowledge about a specific psychoactive drug and attaching great significance to its efficacy;
- Worrying about having enough pills or whether it is time to take them to the extent that other activities revolve around the dosing schedule;
- Continuing to use and to request refills when the physical or psychological condition for which the drug was originally prescribed has or should have improved, for example sleeping pills should not be taken beyond two weeks;
- Resisting cessation or decreasing doses of a prescribed psychoactive drug;
- Complaining about a doctor who refuses to prescribe for preferred drugs, who tapers dosages or who does not take symptoms seriously; and
- Self medicating by increasing doses of prescribed psychoactive drugs that aren't "helping anymore" or supplementing prescribed drugs with over-the-counter medications of a similar type.
If you think an older adult has a substance abuse problem, what do you do? Communication and education are key to helping an older adult who is abusing substances, but how do you start what may be a difficult conversation with someone?
Building a relationship and spending time with the older adult is essential to determining if he or she has a substance abuse problem. Ask questions during assessments or casual conversation about how the older adult handles stress or boredom. Several behavioral health professionals suggested the CAGE screening tool to help determine if an older adult is abusing alcohol. Casually, ask the person:
- Have you ever tried to cut down or cut back on your alcohol use?
- Have you ever felt angry or annoyed when others ask about your alcohol use?
- Have you ever felt guilty after your alcohol use?
- Have you ever needed an eye opener to get going or reduce shakiness?
Two yes responses or more suggests the need for a comprehensive chemical dependency assessment.
The assessment should be conducted by a professional who works with a provider certified by the Ohio Department of Alcohol and Drug Addiction Services (ODADAS) or a private provider who is licensed as eligible to provide a comprehensive chemical dependency assessment. This could be a licensed counselor or social worker who has experience as a chemical dependency professional, or a specific license as a chemical dependency counselor. The assessment will determine the diagnosis and will recommend an appropriate treatment intervention.
Anyone interested in the availability of substance abuse services in their county should contact the local mental health or drug/alcohol board for a listing of providers. Some counties have special treatment programs for older substance abusers, whose special needs must be considered for treatment to be successful. Older adults have more health problems and consume more prescribed and over-the-counter drugs than any other age group. They can have legitimate pain issues, and stopping all drug use may not be possible, or medically advisable.
Behavioral health professionals agree that most older adults do not feel comfortable receiving services at mental health or drug and alcohol agencies. Seniors may not feel comfortable or safe, or may not feel like they belong at "those places." Transportation to a treatment facility may not be available, and uprooting an older adult from his home for treatment can be disruptive and counter-productive. Most older adults respond best to non-intensive, outpatient treatment in the home or in a nearby community.
In addition to your local mental health or drug/alcohol board, you can find treatment referral information by calling 1-800-662-4357 to reach the U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration's (SAMHSA) toll-free telephone number for alcohol and drug information/treatment referral assistance. A recorded message (in English or Spanish) will give you the option of either speaking to a representative concerning substance abuse treatment or requesting printed material on alcohol or drugs; or for local substance abuse treatment referral information in your state. By selecting the local option, the call will be routed to ODADAS, which plans, initiates and coordinates an extensive system of services designed to prevent substance abuse and treat Ohio's addicted populations.
The National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) provide information, educational materials, statistics and research about substance abuse.
Experienced behavioral health professionals are available to answer questions:
| Sandy Calvert
HANDS Foundation - Senior Citizen Advocacy
Making Prevention Work; For Older Americans
| Maureen Dee, MSSA, MBA, LISW-S, LICDC
Catholic Charities Services
Cleveland, Ohio 44115
(216) 391-2064, ext. 12
| Minda Brown-Jaramillo
Cleveland, Ohio 44114
| Laura M. Kidd, LPCC-S, LICDC
Director, D. Bruce Mansfield Center
(a division of Mature Services)
Akron OH 44320
(330) 253-4597, ext. 115
| David C. Ross, PCC
Director of Program Planning & Evaluation
Mental Health & Recovery Board of Ashland County
Ashland, Ohio 44805
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Research & Resources
Correction: The July issue of Aging Connection contained a bad link to the article "Planning a Funeral: Know Your Rights and Shop Around." You can find the complete article here.
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