Coalition on Substance Abuse & Older Vermonters

A Growing Problem

The senior population is expected to significantly increase over the next several decades and so is the substance abuse epidemic in this age group. That will make it much harder to overlook substance abuse in the senior population.

• By the year 2050 the U.S census bureau predicts that more than 20 % of the population will be over the age of 65- almost one in four U.S. citizens!
• By 2030 the Substance Abuse and Mental Health Services Administration estimates that one third of adults 55 years and older will have a substance abuse problem.
• We are all living longer thanks to advances in medicine, new prescription medications and healthy lifestyle changes. Many young and middle age men and women will carry their abuse of alcohol and/or drugs with them as they age and live longer than today's senior citizens.
• Seniors age 60 and older consume more prescription and over the counter drugs than any other age group. This number is expected to grow.
• The overall increase in alcohol problems throughout the U.S. population, coupled with the aging Baby Boomers means that the number of older adults with alcohol related problems will rise.

Reasons for Substance Abuse

There are many reasons why people abuse substances. For seniors however the reasons can often be related to the aging process.Growing older brings with it new challanges and changes. Some of these challanges that play a role in substance abuse include:

• Retirement: It should be a welcomed time but it often brings a dramatic change in lifestyle and sense of purpose.
• Increase health problems: physical distress, chronic pain, disabilities vision loss, memory loss ,hearing loss, more doctor's visits and more hospitalizations.
• Grief and loss: the death of a spouse, sibling or close friends; also sadness about the loss of social status, occupation and work related identity.
• Isolation: fewer social contacts and activities.
• Loss of independence: more difficulty or even the inability to perform activities of daily living, not being able to drive, reduced coping skills.
• Financial changes: increased medical bills, lack of prescription drug insurance, a rising cost of living and lowering or loss of income.
• Other reasons: include having experienced substance abuse earlier in life.Sometime individuals in recovery will experience a relapse after long periods of sobriety. Some of the events that can trigger a relapse are loss of a spouse or friends, loss of income and boredom.

Promoting Healthy Behavior

Things that help to promote and reinforce healthy behaviors are called protective factors. Some of the most important protective factors include:

• Access to sufficient housing and health care.
• Good support networks within the community.
• Involvement in community activities
• Supportive family relationships
• Knowing how to safeguard your health and having the skills to do so.
• A sense of purpose and identity
• The ability to live independently.

Treatment Options

There are many treatment options and also special considerations when working with seniors who are struggling with substance abuse.

A good place to start is with the least intensive options which are 1) brief intervention, 2) intervention and 3) motivational counseling. All three options are very effective with seniors, especially with support from those who care for them.

The first option, brief intervention , provides stratagies to give motivation for change, sets goals and follow up and also behavior modification.

The second option is intervention and it provides an opportunity for the significant people in the senior's life to collectively confront the person with their concerns about his or her drinking or drug use. Interventions are always conducted with a counselor's help. This technique can be helpful if a person is in denial about the problem.

The third option, motivational counseling uses the person's own willingness to change and enlists the person to play the biggest role in his or her recovery.

Specialized In patient and out patient treatment options with many levels of care are also  available. Out patient services are offered in a variety of community based organizations, drop-in centers and senior centers. Out patient programs typically refer individuals to self-help groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) . People who attend self help meetings usually have a greater rate of success because they offer on-going support.

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Treatment Guidelines for Seniors

Seniors have unique needs that need to be addressed appropriately to help ensure success.

• Provide age specific treatment settings. Research has shown that seniors do better when they are with others their age rather than mixed age groups.
• Show respect for an older person. Seniors can sometimes feel there is no hope for them because of their age. Adding the stigma of age to their other problems can doom them to failure.
• Encourage them to help themselves. Never convey the attitude that they are helpless or dependent.
• Be aware that depression, loneliness and loss may at work and they may need help developing stratagies to cope.
• Help seniors to strengthen their social support network.
• Pace the treatment to a level that is appropriate for an older person. Informal, shorter and more frequent sessions may be more effective.
• Always make sure the senior and their needs are the focus. When family members are present always talk directly to the senior.
• Remain flexible in order to address any changing need that may arise.
• Make sure you are aware of any other co-occuring disorders that may exist, whether they be physical, mental or other substance abuse issues.
• Be aware of any vision or hearing problems that may exist that could interfere with daily activities as well as treatment.
• A reliable friend or family member should be available as an advocate to help maneuver through the medical and social services maze.
• Be aware of gender and cultural issues among seniors, such as women taking a subservient role to men or not wanting to discuss certain issues in front of the opposite sex.

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