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)

Terminating Treatment

Some professionals, as well as older problem drinkers, doubt whether a successfully rehabilitated older person should ever terminate treatment. AA offers long-term affiliation with graduated responsibilities, which is one of its greatest strengths. A number of treatment programs offer volunteer status or "alumni" affiliation that supports continuing ties of every client to the program.

Discharge Planning

Effective discharge planning is essential to case management for older clients. Their social networks may have shrunk as a result of their substance abuse problems, physical limitations, or the loss of family members and friends. In this context, it is crucial for clients’ counselors or case managers to help them tap into available community resources by:

• Assisting them in identifying ongoing needs (e.g., income maintenance, housing)
• Scheduling services (e.g., homemakers, eye care, hearing tests, financial planning)
• Obtaining equipment (e.g., large-number telephones, home banking systems, walkers and other devices).

As part of the discharge process, a counselor or case manager also develops an aftercare program with the client. For older adults, this may entail arranging transportation to followup appointments and reminders to note dates and times on the calendar. It also may involve more traditional functions, such as monitoring progress to prevent or minimize relapse. Standard features of most discharge plans for older adults include:

• Age-appropriate Alcoholics Anonymous, Narcotics Anonymous, Rational Recovery, women’s groups, or other support groups
• Ancillary services needed to maintain independence in the community
• Ongoing medical monitoring
• Involvement of an appropriate case manager if needed to advocate for the client and ensure needed services are provided

Aftercare and Recovery Services

Aftercare and recovery services for older clients differ in some respects from those typically offered by substance abuse treatment programs where fraternization is discouraged. Programs oriented to older clients often sponsor socialization groups or weekly alumni meetings run by long-sober peer counselors. Others allow clients to return to the program to participate in group therapy. Still others initiate a network of contacts for older clients and teach them how to expand it.

Some communities have established, integrated social service networks that enable clients to receive coordinated care. However, standalone programs in communities without defined networks may have to initiate linkages with other services themselves. Some treatment programs have begun this process of network building by publicizing their services to other local agencies and health care facilities. Prior consultation with the local Office on Aging and other groups that target older adults helps to ensure that the resulting network responds to their special needs.

In rural areas, treatment programs serving older adults face additional challenges. Collaboration among health and social service programs is crucial to resolve problems posed by geography, lack of public transportation, sparse and distant services, and social isolation. CSAT has several Technical Assistance Publications with information on surmounting these barriers:

• Rural Issues in Alcohol and Other Drug Abuse Treatment
• Treating Alcohol and Other Drug Abusers in Rural and Frontier Areas
• Bringing Excellence to Substance Abuse Services in Rural and Frontier America