CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Communicating Screening Results

Negative

Conveying negative screening results provides an important opportunity to reinforce healthy practices and educate older adults about the impact that alcohol and drugs can have on aging systems. However, even older adults who have had negative screening results may need screening repeated in the future. Because life events render older adults vulnerable to developing problems. Therefore, as changes occur, screening questions should be asked again and the benefits of maintaining healthy habits reemphasized.

Positive

Guidelines follow for communicating positive screening results to older patients:

• Describe the impact that alcohol and drugs are having on the older adult’s health or functional status.
  • Example for alcohol: "The screening results indicate that alcohol may be having a negative effect on your blood pressure."
  • Example for drugs: "The screening results indicate that taking too much Xanax may be impairing your functioning. It could explain your drowsiness."
• Immediately follow up by noting: "This is very treatable." Note how reducing or stopping use can improve the patient’s life. For example, "It will help you maintain your independence" or "help keep you out of a nursing home" or "decrease the likelihood of future hip fractures" or "keep you from getting so confused."
  • Examples of statements for reducing alcohol use: "Cutting down on the amount you drink" or "giving up drinking altogether" or "using other methods to help you sleep." Most problem drinkers cannot address their problems by reducing use, so emphasize the importance of abstinence by saying something like: "Though I strongly recommend you stop altogether, cutting down is a good start."
  • Example of statement for reducing drug use: "Adjusting the dose and following the instructions." It is important to work with the patient to accomplish these goals so that future problems do not occur.
• Present the options for addressing the problem: If the problem seems severe, "I’d like to do a complete assessment (or refer you to someone for assessment) so we know how to proceed."
  • If an alcohol problem appears to be in the early stages of development, try something such as, "I’d like to see you change your drinking habits to no more than one beer (drink) per day. We’ll monitor your progress over the next few weeks and see if this will help with your hypertension." This is a good time to explore the patient’s willingness to change by adding, for example, "Would you be willing to change your drinking habits if the other problems we have discussed improve?"
  • If a drug problem appears to be in the early stages of development, try something such as, "I’d like to wean you off the medication and monitor your progress over the next few weeks. Let’s see if this lessens your drowsiness and confusion." This is a good time to explore the patient’s willingness to change by adding, for example, "Would you be willing to explore other ways to treat your anxiety?"
• Occasionally, a situation may appear dire, and the clinician suspects that the older adult needs to be detoxified. In this case, admission to an inpatient unit for detoxification may be the most prudent choice. Referral to an outpatient detoxification center that can monitor the person daily is appropriate if there is social support at home.

Before discussing positive results with an older adult, clinicians must be prepared with information about:

• Community resources available to assist in coping with this problem (e.g., meeting dates, times, and locations of Alcoholics Anonymous and other self-help recovery groups whose membership is largely 55 and older; contact and eligibility information for treatment programs that respond to the special needs of older adults)
• The older adult’s available supports (e.g., Is transportation available? Is the recommended program affordable or covered by insurance?)
• The older adult’s special needs (e.g., Is the program bilingual or wheelchair accessible?)

See Module 7 for more on treatment options.

A strategy for responding to denial or refusal to follow through with a plan of action should be in place. With the agreement of an older adult involved in a self-help group or treatment program, clinicians can broker an introduction to a peer "who’s been there." Frequently, these "veterans" will accompany prospective members to meetings and mentor them through the treatment process.

For some older adults coming to grips with an alcohol or drug problem, repeated contacts will be necessary before they are willing to cooperate with a referral. Clinicians have observed that this process is akin to planting and nurturing a seed. Bringing the seed to fruition, however, ultimately depends on the older adult.

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