Keep in mind that almost all clients will have mixed feelings about their substance use. They will find some aspects of it pleasant and beneficial but other aspects difficult, painful, or harmful. You can help clients discover their own reasons for wanting to change by talking about these mixed feelings and pointing out problem areas. Per SAMHSA, it is a clinical substance abuse in older adults approach to helping clients make positive changes in their behavior.
Alcohol and Older Adults Ages 65+
This section discusses examples of substance misuse screening instruments useful for older adults. A full selection of screening resources appears in the Chapter 3 Appendix. Many tools described here were developed specifically for older adults.
Fall Risk Assessment
The attending physician sees him immediately, takes a medical history, and orders lab tests to rule out a heart attack. The ED physician then performs a more indepth screen and assessment of Walter’s substance use history and, with Walter’s permission, invites Sally to discuss the effects of Walter’s drinking and cannabis use. The brief intervention focuses on helping older adults increase awareness of their drug use or prescription medication misuse and motivation for changing health risk behaviors.
- Box 2 reviews the potential symptoms or indicators of problematic substance use.
- Substance use can result in psychological and physical dependence on drugs or alcohol.
- Pharmacologic preparations are approved by the Food and Drug Administration (FDA) for specific indications such as seizures or anorexia 34.
Screening for Co-Occurring Cognitive Disorders
- Clients with depression, PTSD, or other mental disorders may be more likely to succeed in addiction treatment if those conditions are managed.
- Make sure you have the required training and credentials or licensure before performing screening, assessment, or diagnosis.
- The most common substances abused are alcohol, prescription drugs such as opiates and benzodiazepines (BZD), and over-the-counter (OTC) medications.
- When older adults taking pain medication use alcohol, they can experience additional negative health effects.
- There are some options we can talk about that could help you feel better without all of this medication.
The AUDIT has demonstrated reliability in studies of AUD screening.329 The AUDIT (self-report version) and the AUDIT-C are available in the Chapter 3 Appendix. Screen regularly, before starting new medication, and when potentially substance-related problems arise, such as injury or accidents. Have clinical assistants administer screening instruments in an interview or as part of other health screenings. Provide a paper or digital tablet version for clients Halfway house to complete by themselves. USPSTF recommends electronic screening and brief intervention as an effective strategy to prevent excessive alcohol use.320 Some older adults may not be comfortable using computers or tablets. Be sensitive to each client’s skills and abilities when selecting screening formats.
Prescription Drug Abuse
Contact local support group offices and ask which meetings are accessible to people with disabilities and have active members who are older adults. Flexible (e.g., provide in-home or phone service for clients without transportation). Use large type for printed questions and screen reader-friendly adaptations for computer screening. More research should be done to evaluate the efficacy of such therapeutic modalities specifically in older adults.
Because of physiological changes, older adults show higher blood concentrations of opioid metabolites. This results in greater substance potency, toxicity, and longer duration of action than in younger adults.881,882 These factors may increase older adults’ risk of opioid overdose, which should be treated as a life-threatening emergency. Use of substances to cope with sleep problems, depression, anxiety, stress, or pain. Current prescription medications, OTC medications, and dietary supplements. When changes in physical or mental health status occur (e.g., falls, memory issues).
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If You Think You Have an Alcohol Problem
He was stopped by the police for unsafe driving recently =https://ecosoberhouse.com/ but was not arrested. She began taking opioids for pain in the hospital and was sent home with a prescription so that she could continue to use the medication during rehabilitation. She was still having pain during the day, with greater pain at night.
Adults ages 65 and older were the largest group of people taking five or more prescription medications in the past 30 days (39.8 percent) compared with adults ages 45 to 64 (19.1 percent) and adults ages 18 to 44 (3.9 percent). Taking opioids for pain is one pathway to drug use or prescription medication misuse for older adults. They may start taking opioids for pain and become physically dependent. This manual serves as a quick reference guide for clinicians treating chronic pain in adults living with a history of substance use. It covers patient assessment and treatment, and provides an algorithm for managing chronic pain, as well as a summary of non-opioid analgesics.