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)

Program Philosophy and Basic Principles

Many programs have abstention from alcohol and other substances as a rigid requirement and terminate treatment for lapses. Some model programs for older adults have found that it is better to treat abstention as an ideal to be strived for. These programs do not respond to drinking slips or lapses in a punitive manner, but as a problem requiring further resolution. A philosophy of harm reduction views clients as making progress as long as the trend is toward fewer and less severe lapses.

Based on the literature on alcohol treatment for older adults, the following six features are key in treating older persons with alcohol problems⁶:

1. Age-specific group treatment that is supportive and nonconfrontational and aims to build or rebuild the patient’s self-esteem
2. A focus on coping with depression, loneliness, and loss (e.g., death of a spouse, retirement)
3. A focus on rebuilding the client’s social support network
4. A pace and content of treatment appropriate for the older person
5. Staff members who are interested and experienced in working with older adults
6. Linkages with medical services, services for the aging, and institutional settings for referral into and out of treatment, as well as case management

Based on these six features, treatment programs should follow these principles:

• Treat older adults in age-specific settings when possible.
• Create a culture of respect for older clients.
• Take a broad, holistic approach to treatment that emphasizes age-specific psychological, social, and health problems.
• Keep the treatment program flexible.
• Adapt treatment as needed in response to clients’ gender.