CONTENTS

Table of Contents
Introduction

1. Overview
2. Alcohol
3. Prescription and Over-the-Counter Medications
4. Barriers to Recognizing Problems
5. Signs and Symptoms of Misuse
6. Talking About Sensitive Issues
7. Assessing a Problem
8. Preventing Misuse
9. Intervention and Treatment

Supplements
Resources

Alcohol, Medication and Older Adults
For Those Who Care About or Care for an Older Adult

Module Content Introduction Intervention Treatment Summary

Treatment

For some older adults, especially those misusing prescription drugs, the above interventions can be effective. Followup intervention and support may be enough to change behavior. However, there are older adults who will need more intensive treatment.

Treatment Approaches

No single approach works for everyone. There is a range of options. Selecting an approach that fits the needs of the older adult is important.

Information is collected from interviews with the individual and family members, a physical exam, mental and social assessments, and laboratory results. This helps the doctor, family, and older adult make an appropriate decision about treatment. Treatment objectives will also affect the approach chosen.

General approaches for effective treatment include:

• Individual/group counseling on alcohol effects, relapse prevention, and management of stress, depression, isolation, socialization, and relationships
• Medical/psychiatric assessments of medication, pain management, antidepressants/antianxiety medications, detoxification, and provision of medical care as needed
• Marital and family counseling
• Case management services to provide links to community services and home visits

Treatment Settings

If an older adult does not respond to intervention, specialized treatment may be necessary. Understanding the family history and family relationships is necessary for treatment of the older adult to succeed.

Once the need for further treatment is determined, a physician will decide if detoxification is necessary. Detoxification or "detox" is the withdrawal from the problematic substance.

Detoxification can take place in the hospital or at home and depends on each individual situation. For example, the older adult may need detoxification in a hospital setting if he or she has:

• Unstable medical condition
• Threatened suicide
• Withdrawal symptoms or seizures from the withdrawal of alcohol or medications
• No social support, lives alone, and continues to have access to the drug or alcohol

Remember that detoxification is not a long-term solution. It is the first step to improving the health of the older adult.

Inpatient Settings

Inpatient treatment options are for those patients who need 24-hour monitoring of their medical and psychiatric conditions.

Recent changes in the health care system have reduced the availability of inpatient settings, particularly for older adults. Cost is also an issue as these programs can be very expensive and not covered by insurance.

Residential Rehabilitation Settings

Residential rehabilitation offers a wide range of options in interventions. These programs can provide a slower paced, more repetitive treatment approach for older people.

Treatment can be specialized to address the needs of older adults, particularly those with cognitive impairment caused by chronic illness. This may be a good option for older adults with limited resources and few social supports.

Outpatient Settings

Outpatient treatment offers people group sessions, individual counseling, and case management services. Monitoring and supporting the gains made by treatment can reduce or prevent relapse. One's doctor should be involved in this care to monitor progress.

Self-help groups like Alcoholics Anonymous are often a recommended part of outpatient treatment. Older adults do better in self-help groups with other older adults, because their experiences tend to be similar. These groups can be difficult to find. Contacting local agencies or organizations can help in finding resources.