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)

Barriers to Treatment

Although treatment works, many older adults' substance abuse problems go untreated. As noted in Module 2, various factors hinder accurate diagnosis and intervention. These include:

• Stereotypes about older people and alcohol and drug abuse
• Pessimism about treatment outcomes for older people
• Lack of information about treatment
• Denial
• Difficulty diagnosing due to conditions with symptoms similar to alcohol or drug abuse (e.g., dementia)
• Lack of adequate assessment tools and age-appropriate diagnostic criteria
• Financial issues (e.g., lack of insurance coverage for treatment)

Eliminating these barriers can go a long way toward addressing substance abuse among older adults and improving their quality of life.

To illustrate the difficulty in diagnosing and intervening when older adults have alcohol and drug problems, here is a brief case study:

Jane, age 75, is unsteady on her feet, has tremors in her hands, and is malnourished. She is also forgetful and disoriented. She has difficulty "staying on track" with a conversation. What do you think is Jane's problem? (Click on your response.)

Medical illness
Dementia
Depression
Delirium
Interaction of medications
Drinking
Combination of the above

Answer:

Denial of a problem can present difficulties as well. People with alcohol problems use a number of common psychological defenses to help them adapt to the early stages of treatment and recovery. These defenses should be confronted only to the degree necessary to assist the person in entering treatment.

For example, denial may be used to avoid overwhelming shame about the destructive effects of alcohol abuse on self and others. Sudden realization of these consequences could be detrimental to treatment. Confronting denial in the early stages of treatment should focus on issues related to entering treatment and managing immediate life problems.

See the table for other common defensive patterns and ways they may be used in therapy.