1. Substance Abuse & Older Adults February 2, 2010 Helene Bergman, LMSW. C- ASWCM Mark Zilberman, LCSW

2. Case Study: H The Bumpy Road to Recovery Stumbling Blocks Crisis-Eviction APS Personality Disorder Dementia Depression Insurance Issues System Failure Collusion/neglect of professionals

3. Less Successful Cases- Harm Reduction J- the depressed concert pianist who smokes and drinks Mrs. K & Mrs. M- dementia and a drinking family Mrs. B- dementia/drinking/oxycontin The Drinking Duo- til death do they part Mr. H – The Shopping Bags of Meds

4. What is Substance Abuse for Older Adults? Prescribed Medications Benzodiazepines Narcotics Sleep Aids Alcohol Heroin, PCP, LSD, Crack Marijuana?

5. The Most Abused Prescription Meds

6. Older Adults- A Hidden Population: WHY?! Individual, family & system denial Collusion-family/system Physician neglect; misdiagnosis Long Distance Caregivers Impact more hidden (i.e, retired) Prescription Drug Culture Legality of supply; easy access

7. DSM-IV Inapplicability of Standard Diagnostic Criteria (303.90, 305.00)- If you follow the criteria of the DSM-IV, maybe there is no substance abuse problem with the elderly. Here's 305, DSM-IV, Alcohol Abuse:

8. DSM-IV A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: recurrent substance use resulting in a failure to fulfill major role obligations at work, school, home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

9. Functional Assessment- the Individual - Assessment Tools: CAGE Questionnaire Two "yes" responses indicate that the respondent should be investigated further. The questionnaire asks the following questions: Have you ever felt you needed to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about drinking? Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

10. Functional Assessment- the Individual Other assessment tools (find on Google): 1) MAST- Michigan Alcohol Screening Test 2) AUDIT-Alcohol Use Disorders Identification Test 3) RIASI-RIA Self Inventory 4) SSI-Simple Screening Instrument 5) DAST- Drug Abuse Screening Test

11. Functional Assessment- the Individual How is the PROBLEM a PROBLEM? Always go further than standardized tests with mental illness to avoid over diagnosing. Question: a)Social impact? b) Physical consequences? c) Emotional effects?

12. System's Approach: You Can't Just Fix The Addict. The Family Role Theory: The addict, the fixer, the overlooked, etc... Taboos Resistance to Change Significant Others Enabling Sabotage: If he gets better, what do I do now? Who am I?

13. Treatment Models: *Abstinence *Harm Reduction Survey of Structured Programs * Detoxification *Medical Detoxification *Inpatient Rehabilitation *Partial Hospitalization *Outpatient Rehabilitation *Individual *Group Dearth of Structured Programs for middle class *Private Pay Facilities *Medicare/Medicaid

14. Non-structured Interventions for PGCMs Assess Leverage Limit Access Alter Substance Limit Substance Collaborate w/PCP (support meds) Research/Accompany to 12 Step Groups Function as Sponsor System Intervention Private Therapy Medicine: antabuse, naltrexone