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

Supplements

Age-Specific Treatment

Age-specific treatment is group treatment in which older individuals come together exclusively with their peers. Such treatment can be provided in one of two formats. The first is a discrete program designed for older alcoholics and substance abusers in which the entire program provides age-specific services and all of the patients are older. The second option is age-specific groups within an all-ages treatment program.

In contrast, mixed-age treatment and mainstreaming integrate adults of all ages with similar substance abuse problems in the same program. The question of whether older adults achieve better outcomes in age-specific treatment has not received adequate study. Some evidence shows that age-specific treatment improves older adults’ compliance and outcomes.1-4

Treatment works best when the issues dealt with are congruent with the life stage of the client. Younger and older adults’ problem drinking can usually be traced to different types of problems, even when the emotional responses to the problems seem similar. For example, the drinking of younger and older clients may both be attributed to depression. However, the causes of that depression may be as different as being unable to find one’s first job and facing the prospect of retirement.

Older adults will recognize the problems of younger adults but may no longer find them relevant. Younger adults, with no knowledge of how growing old feels, may lack empathy and become impatient with older adults. The design of educational groups, the skills clients need to acquire, and the linkages that need to be made through case management are all different for older adults than for younger adults. For all of these reasons, treating the older client in an age-specific setting is preferable.

Of course, this is not always possible, particularly for prescription drug abusers. Because very few older adults with prescription drug problems seek treatment or are referred for care, most drug treatment facilities do not have specialty "older adult track" programming. If specialized treatment is not available, older adults can at least be grouped with younger people whose lifestyles and problems are most compatible and with whom they feel most comfortable. It is difficult to treat older adults who have only abused prescription drugs together with consumers of illicit substances, or even alcoholics who have "hit bottom."

Some clinicians argue that commonality in the drug of choice is the most important factor in grouping patients. Because lifestyles vary dramatically among different drug cultures, it may be better to group older patients with other patients who also have a primary problem with legal drugs. This grouping may make more sense than age cohort, gender, or socioeconomic status.5

If circumstances preclude treatment in an age-specific setting, a program can still address the age-specific themes of older clients by hiring at least one person specializing in work with older adults. In mixed-age settings, case management can provide an effective means of addressing age-specific themes.

References

  1. Kashner, T.M.; Rodell, D.E.; Ogden, S.R.; Guggenheim, F.G.; and Karson, C.N. Outcomes and costs of two VA inpatient programs for older alcoholic patients. Hospital and Community Psychiatry 1992, 43:985-989.
  2. Kofoed, L.L.; Tolson, R.L.; Atkinson, R.M.; Toth, R.L.; and Turner, J.A. Treatment compliance of older alcoholics: An elder-specific approach is superior to "mainstreaming." Journal of Studies on Alcohol 1987, 48:47-51.
  3. Thomas-Knight, R. Treating alcoholism among the aged: The effectiveness of a special treatment program for older problem drinkers. Dissertation Abstracts International 1978, 39:3009.
  4. 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.
  5. Finlayson, R.E. Misuse of prescription drugs. International Journal of the Addictions 1995, 30(13-14):1871-1901.
<< Previous Page