Addicted! Helping Elders Find Pathways Back from Abuse
Schonfeld, Lawrence, Aging Today
FLORIDA'S BRITE MODEL
With the aging of the boomers, concern is increasing about elders who mis-.use alcohol, medications or illicit substances. Relatively few programs are specifically designed for this age group.
In recent years, though, important new models of evidence-based practices have emerged to serve the aging population. A prime example is Florida's Brief Intervention and Treatment for Elders (BRITE) Project. BRlTE began as a state-funded pilot project and is now a federally funded program-called Screening, Brief Intervention, Referral and Treatment (SBIRT)-that is being implemented on a large scale throughout the United States.
The Florida BRITE ProjecJ provides a cost-effective substance abuse treatment service for a difficult to reach-and hard to serve-population. Focusing heavily on screening elders in hospitals, trauma centers, primary care practices and services in aging, BRITE is the only elderspecific project funded to implement and evaluate the SBKT model.
According to the federal Substance Abuse and Mental Health Services Administraticin (SAMHSA) Office of Applied Studies, based on data from the 1999 National Household Survey on Drug Abuse, almost one in 10 (9.4%) adults ages 55-plus were heavy drinkers and 2.3% were binge drinkers. SAMHSA also determined that illicit drug use was rare (present in less than 0.1% of those surveyed) but increasing. However, elders are rarely admitted to treatment services, and screening for alcoholism or substance abuse is performed infrequently by physicians or services in aging.
Older adults often lack social indicators for substance abuse observed in younger people, such as driving under the influence, having problems at work or experiencing marital difficulties. Our research at the Florida Mental Health Institute of the University of South Florida (USF) indicates that older problem drinkers imbibe more often than younger drinkers in response to feelings of depression, loneliness and boredom.
Medication misuse is often lumped together with substance abuse in the literature. For older adults, however, the concern often centers on unintentional misuse, because elders not only consume more prescription and over-the-counter medications than younger people, but also experience a higher incidence of adverse drug effects-even death-due to difficult prescription regimens, memory problems and drug interactions.
Furthermore, medications commonly prescribed for older adults, such as benzodiazepines and sedative hypnotics, are particularly problematic because they can cause dependence and withdrawal. Unlike routine screening for alcohol abuse, though, no standard screening methods exist for prescription misuse. Instead, most of these screens rely on informal brown-bag reviews in which an elder meets with a health educator to discuss medications and how he or she uses them.
Since the late 1970s, our work at USF and our collaborations in California and Tennessee have focused on a three-stage relapse-prevention model for elders in group treatment. This model is now available as a 16-session curriculum titled "Substance Abuse Relapse Prevention for Older Adults," published by SAMHSA's Center for Substance Abuse Treatment (CSAT).
The first stage of the curriculum identifies each person's A-B-C chain of behavior in high-risk situations for substance use. This chain includes antecedent (A) conditions, behavior (B) typical of those who misues or abuse substances and potential consequences (C) that reinforce the behavior.
Our research has shown that typical antecedents elders report include being home alone with no planned activities; thinking about losses of the recent past; feeling depressed or lonely; remembering that alcohol is present in the household; and making a self-statement, such as "A drink will help me forget my troubles."
In the second stage, group treatment participants learn to diagram their behavior chains. …