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)

A Culture of Respect

Treatment programs should cultivate a culture of respect for older clients. Nurturing clients’ self-esteem and reawakening their sense of themselves as valuable, competent human beings are central to the process. Older adults frequently enter treatment depleted physically, socially, and emotionally, convinced that their situation is hopeless.

Adding the stigma of addiction to the stigma of aging can compound older persons’ despair. They may have been disowned by their families and rejected by friends because of their drinking or drug abuse. If they seek help outside the family, their experiences with agencies are often impersonal, dehumanizing, and humiliating.

To increase clients’ self-esteem, staff members should express confidence in each client’s ability to participate, persevere, and succeed in treatment. Staff members need to state this confidence frequently and at each phase in the treatment process in a way that is upbeat but not patronizing. They should avoid acting overly helpful and implying that the individual is impaired and helpless. However, they still need to recognize the need to help with the substance abuse problem.

Managing his or her own life helps an older client regain self-esteem. Treatment providers should take care to treat all their clients with an unconditional positive regard, whether they are wealthy or on welfare. Many actions and speaking manners demonstrate respect in ways the older client will understand:

• Abide by the manners that the older client sees as customary (e.g., do not swear).
• Ask the individual how he or she would like to be addressed and introduced to others. Use surnames and formal terms of address until given permission to be more familiar.
• Avoid condescending or patronizing behavior.
• Speak directly to the client, not the client’s spouse or adult child, when the client is present.
• Recognize the client’s privacy and personal space. If making home visits or entering the client’s personal space at the treatment facility, acknowledge the client’s ownership of the space. Knock and gain permission to enter, ask where the person would like you to sit, and respond graciously to any offer of hospitality, whether accepting the offer or not. Make adequate provision for personal privacy and the security of the person’s possessions, in both inpatient and outpatient settings.
• Talk to the client. Interacting spontaneously communicates appreciation for the person as an individual. Honoring the client’s pain, needs, and joys validates the person in his or her attempt to process life’s experiences in sobriety.
• Fulfill the client’s request to speak to his or her clinician, immediately if possible.
• Honor the patient’s requests and needs. In a treatment program, a number of shorter, informal sessions, particularly in response to a patient’s request, may be more valuable than a longer, scheduled session. Honoring a patient’s requests sends the message, "You are important."
• Respect the client’s spiritual concerns and desire to discuss meaning and purpose in life. Spiritual issues may be addressed by professional counselors or pastoral counselors in addition to ministers or other mental health professionals trained in existential interventions. Often, older adults have a need to discuss these issues, and alcohol misuse may be a symptom of a deeply felt lack of purpose in life.
• Respect the client's cultural heritage and customs. For example, provide a translator for non-English-speaking clients or an interpreter for hearing-impaired clients. The Office of Minority Health Resource Center has a searchable database of organizations that can help with such issues.

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