Magazine article Clinical Psychiatry News

Helping Elderly Drug Abusers

Magazine article Clinical Psychiatry News

Helping Elderly Drug Abusers

Article excerpt

The Department of Health and Human Services predicts that the number of seniors with substance abuse problems will rise by 150% by 2020. Because many of these patients are resistant to therapy, treating them can prove challenging. What strategies have you used in your practice that have proved effective with these patients?

Diagnosis Is a Big Problem

In our experience, the biggest problem in dealing with elderly drug abusers is the lack of diagnosis. For various reasons, including physicians' own biases, we either ignore or minimize this issue. If these disorders are not diagnosed, they will not be treated. Since the number of older adults with these problems has been increasing, psychiatrists need to be vigilant in their diagnosis and treatment of these disorders.

Another problem is the DSM-IV criteria for substance abuse in older adults. Often, the elderly have no employment, legal, or social problems because of substance abuse, but family members may shelter and minimize the elderly individual's substance use. By the time the patient is diagnosed, the substance use has worsened.

Many of these individuals have never been treated before, and they find it hard to acknowledge that their lifelong behavior is wrong and harmful. Motivational techniques that identify contradictions between what the patients are saying with what might be happening in their lives may be useful. Confrontation is not effective, and it may be counterproductive and drive them away. Grouping older adults with substance abusers who are younger and face different problems makes their connection with their peers and the program difficult, but an elderly group therapy session might be beneficial.

Assessment of these patients should include the reason for their use. Most alcohol- and drug-using patients can identify a particular reason for using, and once it is identified, it can often be treated with psychiatric medications.

Our experience suggests that older adults have underlying medical and psychiatric disorders that increase their substance abuse. Treatment of these underlying disorders promotes abstinence. Involvement of family members, restriction of their access to alcohol, restriction of their access to money, and referral to structured living facilities may be considered in extreme cases.

S. Pirzada Sattar, M.D.

Navdeep Baath, M.D.

Omaha, Neb.

Screening and Treatment Are Possible

According to one study, alcohol abuse and dependence occurs in 1%-3% of the U.S. population older than 65 years. Alcohol abuse and dependence among patients over 65 also occurs in about 5%-10% of primary care outpatient departments and 7%-22% of medical inpatients (J. Geriatr. Psychiatry Neurol. 2000;13:106-14). The 2000 National Health Interview Survey showed that 38% of men older than 55 years participated in moderate drinking, and 10% drank heavily. Of women over 65, 32% drank moderately, and 2% drank heavily (J. Stud. Alcohol 2003;64:884-92).

The CAGE questionnaire can be used to screen elderly patients for alcohol problems by asking only four questions:

* Have you ever felt you should cut down on your drinking?

* Have people annoyed you by criticizing your drinking?

* Have you felt bad or guilty about your drinking?

* Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

Besides developing a rapport with the substance-abusing patient, you may want to develop a relationship with his or her relatives and caregivers. They may be able to give you some insight.

Brief intervention strategies can be effective for substance abuse patients. At our Kaiser Permanente facility, we provide hospital detoxification, 30- to 60-day residential programs, and outpatient day and evening groups to provide education and counseling about the addictive disease process. …

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