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)

Pretreatment Intervention

	Abstinence	Low-Risk Use	At-Risk Use	Problem Use	Abuse/Dependence
Pretreatment Intervention

The formal process begins before the intervention. It includes a progressive interaction between the counselor and the family or friends for at least 2 days before meeting with the patient. The counselor helps plan the intervention and educates the family about substance abuse and its prevention.¹ Participants are coached about offering information in an emotionally neutral, factual manner while maintaining a supportive, nonaccusatory tone. The key is to present incontrovertible evidence to the loved one that a problem exists.

When using this approach with older adults, it is important to limit the number of people involved, because:

• Older persons can become overwhelmed cognitively and emotionally if too many people take part. They cannot track what is being said, which may precipitate an avoidant response. The most influential person to include in interventions or any other pretreatment activity may be a spouse, cohabitant, caregiving son or daughter, clergy member, or visiting nurse or caseworker, depending on the particular social network of the client.

• Involving extended family, especially grandchildren, can produce shame, humiliation, and resentment in the drinking/using elder that can be virtually impossible to resolve.

Because denial is also a part of psychoactive prescription drug dependence, an intervention may help move psychoactive drug abusers toward detoxification or other formal treatment. However, extra caution is advisable. Older adults may have difficulty accepting the diagnosis of abuse or dependence and the need for treatment. It is particularly difficult because their initial use of psychoactive prescription drugs was, in almost all cases, sanctioned by a health care provider. The drugs usually have been prescribed as a remedy for a legitimate medical problem or complaint.

As a group, older adults tend to have even greater disdain for "drug addicts" than the general population. Any implied linkage with the criminalized population of illicit drug users is unnecessarily stigmatizing and appropriately resented. Such labels as addict, alcoholic, and drunkard should be avoided.

Like treatment itself, pretreatment activities such as interventions may be conducted best in the client's home and can be coupled with other personal or social services^2,3 or with home-based detoxification services.⁴ This approach is ideal for the large number of at-risk older individuals who are homebound. It can be conducted by visiting nurses, housing authorities, and social workers. Community health services often have staff designated to make visits to older adults in their homes. In addition, some in-home treatment programs have a visiting nurse who identifies and treats substance abuse.

References

1. Johnson, V.E. I’ll Quit Tomorrow. New York: Harper and Row, 1973.
2. Fredriksen, K.I. North of Market: Older women's alcohol outreach program . Gerontologist 1992, 32:270-272.
3. Graham, K.; Saunders, S.J.; Flower, M.C.; et al. Addictions Treatment for Older Adults: Evaluation of an Innovative Client-Centered Approach. New York: Haworth Press, 1995.
4. Cooper, D.B. Alcohol home detoxification: A way found. British Journal of Nursing 1995, 4:1315-1318.

See Module 7, Treatment, for more information.

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