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)

Goals of Treatment

Each individual in treatment will have specific long- and short-term goals. However, all specialized substance abuse treatment programs have three similar general goals^1,2:

• Reducing substance abuse or achieving a substance-free life
• Maximizing multiple aspects of life functioning
• Preventing or reducing the frequency and severity of relapse

For most patients, the primary goal of treatment is attaining and maintaining abstinence. The exception is methadone-maintained patients. It may take numerous attempts and failures at "controlled" use before sufficient motivation is mobilized.

Until the patient accepts that abstinence is necessary, the treatment program usually tries to minimize the effects of continuing use and abuse. This goal is achieved through education, counseling, and self-help groups that stress:

• Reducing risky behavior
• Building new relationships with drug-free friends
• Changing recreational activities and lifestyle patterns
• Substituting substances used with less risky ones
• Reducing the amount and frequency of consumption, with a goal of convincing the patient of his or her individual responsibility for becoming abstinent.² Total abstinence is strongly associated with a positive long-term prognosis.

Becoming alcohol- or drug-free, however, is only a beginning. Most patients in substance abuse treatment have multiple and complex problems in many aspects of living, including:

• Medical and mental illnesses
• Disrupted relationships
• Underdeveloped or deteriorated social and vocational skills
• Impaired performance at work or in school
• Legal or financial troubles

These conditions may have contributed to the initial development of a substance use problem or resulted from the disorder. Treatment program staff need to assist patients in addressing these problems so that they can assume appropriate and responsible roles in society. Goals include:

• Maximizing physical health
• Treating independent psychiatric disorders
• Improving psychological functioning
• Addressing marital or other family and relationship issues
• Resolving financial and legal problems
• Improving or developing necessary educational and vocational skills

Many programs also help participants explore spiritual issues and find appropriate recreational activities.

Increasingly, treatment programs are also preparing patients for the possibility of relapse and helping them understand and avoid dangerous "triggers" of resumed drinking or drug use. Patients are taught how to:

• Recognize cues;
• Handle cravings;
• Develop contingency plans for handling stressful situations; and
• Handle "slips."

Relapse prevention is particularly important as a treatment goal in an era of shortened formal, intensive intervention and more emphasis on aftercare following discharge.