# Presentation: 286992

## Substance Abuse Among Older Adults 

*Presentation prepared for the Illinois Department of Human Services, *
*Division of Alcoholism and Substance Abuse by*
- Rick Alonzo, Ph.D., CADC.
*Specialist over HIV Aging and Disabilities Programs*

## DHS / DASA Funded Pilot 

- In 1999 DASA and IDOA mapped out a plan to work jointly
- DASA funded  (for $190,650 GRF)
- Human Service Center of Peoria - White Oaks
- Central Illinois Agency on Aging

## DHS / DASA Funded Pilot Paid for 

- Training Video / Manual
- Training for Aging Network workers in SFY01
- In SFY02 DASA offered training to DASA Licensed and funded AOD Providers

## DHS / DASA Funded Pilot

- Since March of 2000 to June of 2004, this project has admitted 165 - 60 + individuals into the DAYBREAK Program

## DHS / DASA Funded Pilot

- But not all of those this project has served have been admitted.
- In the DASA system we also have early intervention services that we pay for. This way we provide substance abuse related interventions before they become problems

## DHS / DASA Funded Pilot

- Since implementation of the project, there have been at least 242 that are seen on an ongoing basis.
- Approximately 5,600 individuals have been oriented about DAYBREAK and about AOD and Seniors

## DHS / DASA Funded Pilot

- <date/time>

- The program was designed according to recommendations made in the CSAT TIPS # 26 available by going to
- _[http://kap.samhsa.gov/products/manuals/index.htm](http://kap.samhsa.gov/products/manuals/index.htm)_

## Barriers in Identification and Treatment 

- Ageism. Our society tends to assign negative stereotypes to older adult behavior, ignoring specific medical, social or psychological causes. “They only have a little time, let them enjoy”
- Health care providers tend to overlook alcohol abuse and medication mismanagement (AA&MM) among older adults
- The symptoms are mistaken for those of depression, dementia or other problems common to older adults

## Barriers in Identification and Treatment(cont’d)

- Older adults are more likely to hide their AA&MM and less likely to seek help
- Relatives are ashamed and choose not to address it (“there is an elephant in my living room, but it’s not in my corner”)
- Stigma - “alcoholics” and “dope fiends” ‘look different’ from the older adult who has begun drinking more than they should or mismanages their medication

## Barriers in Identification and Treatment(cont’d)

- While ‘early onset’ of AOD problems is easier to identify in older adults, ‘late onset’ is more difficult to identify because of stigma
- Late onset: an older adult begins AA&MM due to loss, loneliness
- Medicare / Insurance: Medicare doesn’t cover many programs and imposes a complex system of rules on programs it does cover.

## Barriers in Identification and Treatment(cont’d)

- AOD Treatment: Older Adults are often overwhelmed by the AOD intake / treatment process - also they have difficulty identifying with ‘hard core’ addicts and alcoholics
- Co-Morbidity: Medical and psychiatric co-morbidities complicate diagnosis

## Barriers in Identification and Treatment(cont’d)

- Special Populations
- Women: have less insurance coverage and supplemental income
- Women are prescribed more and consume more psychoactive drugs than men and are more likely to be long-term users
- Racial and ethnic minorities may face workers who lack knowledge of their language and culture

## Conversation vs. Interrogation

- Many Older Adults are aware of the stigma associated with substance abuse
- Utilizing conversation will provide better results rather than a question and answer session
- Preface what is said with a link to medical condition
- Why? Older Adults are more willing to accept a medical diagnosis as an explanation for their problems.

## 4 Components of Active Listening

- Observing and reading nonverbal behavior – posture
- Listening to and truly understanding verbal communication
- Listening to the “whole person” within the context of the social settings of her / his life
- Listen for the “sour notes”: things they say that a little off and need to be challenged

## Specialized AOD Services for Older Adults

- Outreach services
- In-home visits
- Off - site exceptions (to provide services in senior homes, etc.)
- Harm reduction model
- Brief Intervention Model

## What Works in AOD Treatment of Older Adults

- Persistence
- Consumer Friendly Services
- Cultural Competence
- Multi Service Programming
- Health Promotion
- Comprehensive Assessment and consumer direction

## What Works in AOD Treatment of Older Adults

- Peer Support, Staffing and Evaluation
- Collaboration at all levels
- Appropriate linkages (partnerships)
- Cross-Training
- University Links (for research)

## The Problem

- According to CSAT, as many as 17% of older adults are affected by alcohol and prescription drug misuse

## The Problem

- According to USDHHS / SAMHSA / CSAT in FFY 2002 our State served a total of 1,505 persons age 56 to 65 and over
- According to the IDOA State Plan, the Aging Network serves approximately 500,000 Older Adults every year.
- Using the National average, at least 85,000 Older Adults in the IDOA system may be impacted with ADOA problems

## The Problem

- If this data is accurate, our substance abuse system is serving only 2% of those who really need these services

## The Problem

**WHY AREN’T WE SERVING MORE OLDER ADULTS IN OUR AODA SYSTEM?**** **