Substance / Alcohol Abuse among the Elderly Substance/alcohol abuse among the elderly 60 years and older

Alcohol and substance abuse among the elderly is a significant social problem, not only because people in this age group tend to have very permissive attitudes towards social drug and alcohol usage but also because the stressors that accompany aging may result in increases in drug or alcohol usage to problematic levels. While people may begin experiencing age-related problems in their 40s and 50s, it is not generally until their 60s that most people begin to experience significant physical or emotional challenges related to age. These challenges are often accompanied by major life changes, such as retirement, the death of a spouse or friends, relocation, and diminished physical and intellectual capabilities. These changes may mean a lack of access to the coping mechanisms that have traditionally served the individual, leading to a rise in other coping behaviors, including alcohol usage.

There are a number of models that have proven successful in the treatment of alcohol and drug addiction, though no one model is successful in treating all addicts. One approach that may have greater efficacy than other treatments is a type of cognitive therapy known as Mindfulness-Oriented Recovery Enhancement (MORE). MORE involves the use of mindfulness meditation to direct attention to the sensory features of a pleasant experience, image, or object (Garland et al., 2014). This mindful meditation allows them to focus more on positive images than on neutral images, which can be verified with examinations of brain activity (Garland et al., 2014). Given that people with substance addictions demonstrate decreased brain reactivity to naturally occurring rewards, the use of MORE to increase brain response to positive images could have the potential of redirecting addicts from the pursuit of substances to the pursuit of other naturally-occurring positive stimuli.

MORE has been used in a number of different contexts. For example, Garland and Howard examined its efficacy in chronic pain management where patients may be hypervigilant for pain-related stimuli (2013). By increasing the patient's attentiveness to positive stimuli, MORE was able to reduce their ability to focus on the pain-related stimuli (Garland & Howard, 2013). The belief is that it would work similarly in an addiction context. Addicts pick up on cues in their surroundings that prompt them to use; focusing on positive stimuli would prevent them from picking up on these cues to use.

Examining the MORE model and its impact on opioid dependence in patients with chronic pain, Garland et al., discovered that MORE actually serves two functions: first, MORE teaches patients skills that allow them to focus attention elsewhere, lowering their perceptions of pain; second, it appears to lower their desire for opioids, resulting in less drug use (2014). However, these results were short-term and not sustained over longer periods of time, suggesting that follow-up care and intervention is critical to long-term sobriety goals.

Specifically in the context of alcohol dependence, MORE's efficacy seems to be linked to its utility as a coping mechanism that can be substituted for drinking behaviors, rather than simply the fact that it replaces cueing behavior. In a study that used MORE with alcoholics seeking treatment in a residential treatment facility, the participants discussed their feelings about the MORE process. "The themes of awareness, acceptance, and nonreactivity permeated the narratives of participants, many of whom appeared to believe that mindfulness was a useful means of coping with addiction and stress. On the whole, it appeared that as individuals engaged in mindful breathing practice over time, they discovered it to be an increasingly potent means of decentering or "stepping back" from the stressors and hassles of their everyday lives" (Garland et al., 2012). Given that addicts typically use drugs to step back from their everyday lives, having a coping skill that permits them do the same thing, without the negative impact of the drug usage, creates an ideal substitute behavior.

Furthermore, elderly people in the 60 plus demographic grew up in a time period when meditation was being introduced to the United States in a widespread manner, and, therefore, may be more receptive to the use of mindfulness and meditation as a treatment modality. Another benefit of MORE treatment is that it does not contraindicate other treatments and would not interfere with other therapies; therefore, it could be used as a stand-alone therapy or as an adjuvant therapy along with other treatments. This would make it a great approach for people who seem amenable to treatment and for patients who present as treatment resistant.

The use of...

Substance abuse disorders are one of those health issues, though society has been reluctant to talk about addiction and substance abuse and misuse among the elderly. The cultural attitude has, instead, been one of acceptance of addiction in the elderly or a denial that a problem exists. The reality, however, is that substance abuse among the elderly is a significant problem impacting up to 17% of the population (Center for Substance Abuse Treatment, 2012).
Substance abuse in the elderly is often misdiagnosed. "Alcohol and substance use disorders in the elderly are underrecognized and may be misattributed to aging. Family members and mental health practitioners should look for signs of falls, relationship conflicts, and memory impairment in their diagnosis of substance use disorders" (Klimstra & Mahgoub, 2010). This is due, in part, to the fact that traditional definitions of substance abuse, such as those found in the various iterations of the DSM may not be inclusive enough to cover the type of drinking that would be indicative of a problem in an older population. This is because, while younger adults may be heavy drinkers without being problem drinkers, the thought is that older adults who are heavy drinkers are likely to experience problems, and therefore should be categorized as either at-risk or problem drinkers, instead of receiving a three-part classification scheme, which younger drinkers would receive (Center for Substance Abuse Treatment, 2012). In addition, there are cultural considerations that hamper diagnosis and treatment; family members are less likely to intervene when an elderly family member is addicted because they may not perceive the addiction as having a negative impact on quality of life, and instead may assume that some of the negative consequences of addiction are actually linked to the aging process.

Part of the reason that heavy drinking is considered so problematic in the elderly is that the aging body becomes increasingly susceptible to the impact of alcohol. This susceptibility is increased by the medications and other drugs that elderly people are likely to use. "People 65 and older consume more prescribed and over-the-counter medications than any other age group in the United States. Prescription drug misuse and abuse is prevalent among older adults not only because more drugs are prescribed to them but also because, as with alcohol, aging makes the body more vulnerable to drugs' effects" (Center for Substance Abuse Treatment, 2012). This is true even when the other drugs being used are not ones considered psychoactive, because they may still impact the central nervous system, and, therefore, mediate the impact of alcohol or other drugs on the patient (Folkman et al., 1987). Therefore, the impact of alcohol or drug use can be far more severe in an elderly patient.

Denial can have severe negative health consequences for the elderly. One problem that medical professionals see frequently is withdrawal from drugs or alcohol in hospitalized elderly patients. Depending on the severity of the addiction, withdrawal symptoms can be severe and can complicate the medical treatment for the underlying reason for hospitalization. Furthermore, the withdrawal process tends to be longer in the elderly, especially those who also suffer from dementia (Ondus et al., 1999). Furthermore, ongoing addictions can significantly alter treatment plans because drug or alcohol usage may contraindicate some therapies or medications.

Another way that alcohol or drug addiction can have a significant impact on the elderly is by increasing the risk of falls. Falls are a serious health risk for the elderly; they are the leading cause of non-fatal injury and can lead to a loss of independence and even to death (Finkelstein et al., 2007). Elderly patients with substance abuse issues are not only more likely to experience falls, but also more likely to experience injuries from those falls. Furthermore, the strategies used to minimize the risk of falls in the regular population, such as Tai Chi and other strengthening exercises, may actually exacerbate risk in the substance-abusing population (Finkelstein et al., 2007). .

Introduction of Client

The client, Pat, is a 62-year-old female with an alcohol-abuse problem. While she acknowledges that she is a daily drinker and the amount of alcohol that she consumes, which is four or more alcoholic beverages each evening, she does not acknowledge that her drinking…