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)

Types of Treatment

Many forms of treatment exist. Depending on the desired outcome, different approaches may be used. It is important to match treatment objectives for older substance abusers to approaches that can best accomplish them.

Types of formal specialized treatment include:

• Cognitive-behavioral approaches
• Group-based approaches
• Individual counseling
• Medical/psychiatric approaches
• Family involvement and therapy
• Case management/community-linked services and outreach

Not every approach will be necessary for every client. Instead, the program leaders can individualize treatment by choosing from this menu to meet the needs of the particular client. Planning information comes from:

• Interviews
• Mental status examinations
• Physical examinations
• Laboratory, radiological, and psychometric tests
• Social network assessments

See Module 4 for more on screening and assessment.

Case Studies on Treatment

The case studies will help you practice dealing with treatment issues.

Other Approaches

In addition to formal treatment, a number of other treatment approaches are useful in responding to older substance abusers. Generally, however, they work best when they complement the major approaches listed above.

Spiritual or religious counseling with a clergy member, either in a group or individual setting, may be an important adjunct to therapy for individuals who feel more comfortable addressing their concerns in a religious context. Many older adults are concerned about their spiritual preparation for death, even when it is not imminent, and welcome opportunities to explore that topic.

Substance abuse treatment providers are moving toward a greater recognition of the role of spirituality in recovery. Providers should not hesitate to build on the religious belief systems of older clients, when appropriate. From its inception, Alcoholics Anonymous has spoken of "a higher power," and much of its effectiveness may derive from its spiritual aspects. One caution: Older adults who have never subscribed to a religious belief system may not be ideal candidates for spiritually oriented therapy or referral to 12-Step fellowship programs. Rational Recovery may be a worthwhile alternative.

Spirituality is often a key element in brief interventions, especially in minority communities. Programs that specialize in the treatment of a particular ethnic or racial group may adopt strategies specific to that group (e.g., the use of tribal rituals in the treatment of Native American substance abusers). A variety of nontraditional methods for tension reduction (e.g., therapeutic massage, meditation, acupuncture) have been suggested as applicable to older adults, although these methods remain largely untested.