At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Supplements

Outpatient Services

Outpatient services usually involve two phases. The first phase is intensive involvement for the first few weeks or months that more closely resembles a day treatment model. This is followed by weekly continuing outpatient care for a longer period (3 to 12 months).

Specialized outpatient programs vary greatly in the intensity of treatment. Partial hospitalization/day treatment programs require patients to attend day-long treatment 5 days per week. Intensive outpatient programs are sometimes hospital based and provide 2 to 3 hours of treatment each day. Finally, traditional low-intensity outpatient care normally involves one group session per week and one individual session per month.

Nonspecialized, nonresidential services are provided by many partial-day treatment programs structured for outpatient care. These include community-based drop-in centers and senior centers. They are generally less available in rural areas. These facilities are good for:

Some of these structured programs can deal with comorbidities in an intensive outpatient setting.

If an older patient needs more help and structure than is readily available, an individually tailored, case-managed approach may work well for coordinating outpatient treatment. This would entail:

Usually the patient’s primary physician and his or her team will be the chief players in ongoing case management.

Providers of primary drug dependence treatment should not overlook the physician, who will prescribe all medications, in their planning. It is important to include the physician in treatment planning and as a player in the recovery network. Without the physician’s participation, the entire plan may unravel.

Older adults who are dependent on psychoactive prescription drugs may best be served in flexible, community-oriented programs with case management services. Case management may be better than traditional, standalone substance abuse treatment facilities with standardized components.

Specialized outpatient treatment generally includes psychiatric consultation and individualized or group psychotherapy. Outpatient programs frequently encourage patients to attend regular meetings of self-help groups. These include Alcoholics Anonymous, Alcoholics Victorious, Rational Recovery, and Narcotics Anonymous.

Often a proactive case manager helps an older patient connect with an appropriate group. After a patient’s release from the formal and time-limited outpatient substance abuse treatment program, a case manager plays an important aftercare role. He or she coordinates community-based support and monitoring to reinforce gains made during treatment and prevent or minimize the impact of slips.

Although the success of treatment for older adults has been documented, the literature on substance abuse lacks empirically derived, proven methods for treating older alcoholics and substance abusers. Instead, individual practices borrow heavily from what is known in the general fields of addiction treatment, geriatric medicine and psychiatry, and social gerontology. The cumulative experience of existing programs that have specialized in treating older alcoholics also helps.1,2 Before referring an older adult to a community-based treatment program, health care providers should carefully consider the program’s philosophy and practices regarding older clients.

References

  1. Atkinson, R.M. Treatment programs for aging alcoholics. In: Beresford, T., and Gomberg, E., eds. Alcohol and Aging. New York: Oxford University Press, 1995, pp.186-210.
  2. Schonfeld, L., and Dupree, L.W. Treatment alternatives for older alcohol abusers. In: Gurnack, A., ed. Older Adults’ Misuse of Alcohol, Medicines, and Other Drugs: Research and Practice Issues. New York: Springer, 1996, pp. 113-131.
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