It was my pleasure to speak to the School of Social Work at the University of Michigan last week. The topic was “Alcohol and Other Substance Use Treatment and Monitoring” for a class addressing “Interpersonal Practice with Older Adults”. Higher education continues via zoom during the pandemic. And I can say that I have adapted my presentations, including white boards and props (somewhat grudgingly), to a smaller stage.
Alcohol and Other Substance Use Treatment & Monitoring – Older Adults
The topic is an important one. The world has changed dramatically in the past year, due to the pandemic. By every marker, overdoses, overdose deaths, and alcohol and drug use have increased. Stress, of course, is the primary cause. 53% of U.S. adults report they have depression. Alcohol package sales were up by 55% in 2020. And during COVID-19, older adults reported their increased drinking was much greater when symptoms of anxiety and depression were also present.
One thing we know with certainty, is that alcohol and drug dependence is not a character flaw or a moral failing. Addiction is defined as a chronic, relapsing brain disease that affects both the brain and behavior. But, the biggest challenge to treating addiction is stigma. As the body ages, dopamine “sprinklers” (my term) can wear out, thus the risk of self-medication increases just to accomplish feeling normal. Similarly, some of the symptoms of addiction, such as confusion and memory loss, are akin to signs of aging.
Addiction Treatment for Older Adults
How do we treat older adults? First, during the pandemic we have been able to treat adults of all ages with telehealth. The CDC reports that telehealth use has increased a thousandfold during the pandemic. This means addiction treatment centers must provide ease of use and assistance for those older adults who are not used to technology.
Next, standard screening tools and all evidence-based models work as effectively with older adults as with any other age group. But treatment only works if it’s utilized! Education and early identification and assessment are key. If we can catch older adults while they are in the “misuse” stage, before the “chronic” stage of disease, we have a much higher degree of successful outcomes. At Sanford we use a Recovery Oriented System of Care This means a person enters treatment at the level appropriate for them, and their treatment plan is individualized.
Creating a therapeutic alliance is critical. Especially during a pandemic. And motivational interviewing (MI) is a person-centered therapy that is appropriate for older adults. In MI, we motivate an individual to change a specific negative behavior, such as substance use. This is how it works for older adults:
Establish a supportive relationship.
Talk with care and concern, not judgement of behavior. Older adults who are isolated may need to “touch base” often, but therapy can serve as connection to the outside world.
Recognize values, stigma, beliefs and fears.
Consider the traditional male and female roles, especially with older males who have been taught to “take charge”. And understand privacy issues, cultural orientation and spiritual beliefs. Older adults may fear labels, loss of control or being placed in assisted living.
Treat with dignity and respect.
Avoid judgement. And value the person’s life experience. Show respect by using titles (Mr. Mrs. Dr.) and build self-worth.
Emphasize the disease model of addiction.
Use an educational approach which addresses changes to the body due to aging. Also, stress the added impact of drugs and alcohol on the older adult’s system. Explain what alcohol does to the whole body. Define a “drink”, “binge drinking” and the efficacy of medication-assisted treatment if appropriate.
Be sensitive to physical limitations in older adults.
Build rest periods into the schedule, and be aware of the pace of presenting information. Similarly, make sure the environment is well lit, quiet, free from distractions and accessible. Print materials in readable font.
Use an age-specific treatment approach.
Provide options for age-appropriate therapy and activity groups. Be aware that some older adults are uncomfortable with the expression of strong feelings, profanity, or peer disclosures of personal issues.
Identify and build a support system.
Have awareness that some older people may have few, if any, family members available for family programs or family recovery. In fact, their “family” may be made up of neighbors, clergy, or health care providers. Help to identify recovery advocates for the older person and connect them to a support system.
Interesting facts about drug and alcohol use in older adults…
- Older women seeking treatment is rising. In fact, 33% of clients at Sanford in the past two years were women over the age of 55.
- Women are more likely than men to start drinking heavily later in life.
- 21% of those over 60 reported increased drinking due to COVID-19 stressors.
- Alcohol related problems hospitalize older adults as often as heart attacks.
- And there are 2.5 million older adults in the U.S. with an alcohol or drug problem.
- We should not discount the use of opioids in the older adult population. Chronic pain and prescription medications are often the cause of opioid use disorders. And medication-assisted treatment (MAT) is effective for all ages.
- Widowers over the age of 75 have the highest rate of alcoholism in the U.S.
I’d just like to say it’s been quite a year. Clinicians are often the first point of contact for those struggling with mental health and substance use disorders. Negative bias continues to be a challenge; stigma is defined as “general discrimination against an identifiable group of people”. In the wake of George Floyd’s murder and the protests for change which followed, we as a profession can shed light on and be part of meaningful change. This occurs by addressing systemic and institutional racism in our actions, words, policies and clinical interventions. It was a privilege to share with this class how we can be a part of changing the narrative.
The use of non-stigmatizing language is consistent and essential to our professional roles. By using person first language, we can maintain the integrity of individuals as whole human beings. It is important to promote evidence-based practices and chisel away at the antiquated belief that mental health and substance use disorders are a moral failing and those struggling are at fault for their condition. It is equally important to compliment evidence-based practices with brain-based and experiential tools for managing anxiety disorders, stress, grief, and trauma as a result of social injustice, uncertain times, and the pandemic.
At Sanford, we work to eradicate the stigma of addiction and embrace all marginalized populations. During this presentation we explored substance use disorder treatment for older adults and the science-based understanding that this is a chronic, treatable disease from which patients of any age can recover.