In this article we are going to explore how to work with older adults in need of intervention. Mental health and Substance Use Disorders (SUDs) don’t discriminate. Substance Use Disorder in older adults and baby boomers may have been carried through from their past or may begin as a result of the difficulties they face in their older age. While illicit drug use generally declines as individuals age, “more than 1 million individuals aged 65 or older (“older adults”) had an SUD in 2014, including 978,000 older adults with an alcohol use disorder and 161,000 with an illicit drug use disorder.[1]” According to a report from SAMHSA, substance use is an emerging public health issue among the nation’s older adults. Illicit drug use among adults aged 50 or older was expected to increase from 2.2 percent to 3.1 percent between 2001 and 2020. For example, the number of older Americans with SUD was expected to rise from 2.8 million in 2002–2006 to 5.7 million by 2020[2].
In his theory of personality, Erik Erikson describes eight life stage virtues that humans experience[3]. He describes the eighth stage (65 and over) as Wisdom, Ego integrity vs. despair. During this time, a person has entered into the third act of life in which retirement has or will happen, loss of friends and partners occurs, and the body begins to experience more issues due to aging. During this phase, individuals reflect upon their life and may find meaning and a sense of accomplishment or lapse into hopelessness, despair and depression. Some individuals will enjoy the fruits of their labors and their families and relationships, whereas others resort to substance abuse and can become at high risk for suicide.
Though substance use disorder and mental health issues can be a problem for everyone affected, it can have unique life-threatening consequences for older people. This demographic is at greater risk of accidental injury, disease, falls, memory loss, and overdose as a result of compromised memory.
It is important for families to intervene with compassion and love in order to improve the older loved one’s life.
One of the obstacles to helping older adults is that substance use symptoms can present as signs of aging or other illness. Memory loss and blackouts from excessive drinking may look like dementia or just the expected decline in memory functioning that comes with aging.
Signs and Symptoms
Look out for the following signs and symptoms when assessing the possibility of substance abuse or mental health issues.
- Preoccupation with a substance such as alcohol. They may talk about it regularly or constantly check if it’s around.
- Use of prescription medications above their doctors recommended dosage.
- Sudden mood changes.
- Changes in sleep patterns
- Increased insistence on privacy
- Decreased interest in things they used to enjoy.
- Preference for attending events where drinking is accepted, such as luncheons, happy hours, and parties
- Runs out of medication early
- Drinks in spite of warning labels on prescriptions
- Secretly disposes of large volumes of empty beer/liquor bottles
- Drinks despite health problems
If you have reason to believe that your older loved one may have a substance use disorder or mental health issue, or even if you’re just worried it could be a possibility, speak to a medical professional. They can properly assess the situation and advise you on how to move forward.
Other Forms of Addiction
Addiction is not only a substance use issue. It can also occur in the form of gambling, viewing pornography, shopping, and online/mobile games. Addictive behaviors like these result in a person spending a lot of money unnecessarily. Watch out for these behaviors as they can present as many problems to older adults as substance misuse.
Intervention
In many cases, individuals don’t see that they need treatment. When this is the case, intervention is necessary. A trained, professional interventionist can be of great benefit in the planning and execution of the intervention itself. A professional can provide insight on how treatment should be approached, which can assuage families’ concerns.
Intervention supports Recovery
According to SAMHSA, older adults who have received treatment for alcohol and chemical addiction experience an increased incidence of improved health over other age groups.[4]
Recovery is most likely to happen when individuals participate in age-specific group treatment that is supportive and non-confrontational, aims to build the patient’s self-esteem, focuses on coping with depression, loneliness, and loss, rebuilds the social support network, and moves at a pace and involves content that is appropriate for the older person.
Furthermore, patients generally demonstrate improved chances of recovery when working with staff members who show interest in and have experience with working with older adults.
According to a five-year treatment outcome study carried out by Lemke and Moos[5], older adults of age 55 and over were observed at one year to present significantly reduced alcohol use and less physiological distress than middle-aged patients.
At the five year mark, older adults also showed higher incidences of reduced alcohol use and related problems and lower psychological distress than other groups aged 19 and over.
Busting the Myths
Intervention for older adults can be stifled by many of the myths that surround it. One myth in particular is that the sufferer will not be helped until he or she has hit “rock bottom” or is ready to be helped. The harsh reality here is that “rock bottom” can sometimes mean death in this demographic, so timely intervention is essential.
Another common myth is that interventions are an attack or an ambush. In truth, most interventions are loving, caring and respectful.
Many believe that the only person in the family who needs help is the person struggling with the substance use disorder or mental health condition. However, these conditions experienced by a loved one impact the entire family dynamic, and for an intervention and recovery to be effective, it needs to involve a shift in all people who are closely involved.
The Importance of Words
Given the general attitude of older generations around substance abuse and mental health disorders, it can be hard to discuss the issue openly and calmly. Consequently, it’s important to be mindful of what you say and how you say it. Try to use words that are accurate and descriptive. Labels can immediately shut down the potential for a discussion, but facts speak for themselves. You can discuss the frequency and volume of substance use, how much alcohol or medication is missing, how much money has been spent, or certain behaviors that have been out of the ordinary. Facts like these are more likely to have a positive impact than loaded terms like “addict” and “abuse.”
Beneficial phrases include:
“I want to help.”
“I love you.”
“I want to understand.”
The Importance of People
The best way to do an intervention with an older adult, as with anyone, is to have everyone who loves and cares for the suffering individual present. Anyone who believes they have had a quality relationship with that person over their lifetime should be there to show support and solidarity at this time of need.
For older adults, having all of their younger family around them may drive home the choice they have–to live out the rest of their lives with a bottle or struggling with depression or to be present and available for their children and grandchildren who are standing in front of them imploring them to get help.
For the younger generations within the family, it can be extremely powerful and influential to watch a grandparent seek help. It can put the wheels of family healing into motion and change the family legacy by proving that there is a way out and that it is okay to ask for help.
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Sources:
[1] https://www.samhsa.gov/data/sites/default/files/report_2792/ShortReport-2792.html (accessed 28/5/2020)
[2] Ibid.
[3] https://www.simplypsychology.org/Erik-Erikson.html (accessed 27/5/2020)
[4] Blow, F., 1998. TIP 26: Substance Abuse Among Older Adults: Treatment Improvement Protocol (TIP) Series 26. [ebook] Rockville. Available at: <http://lib.adai.washington.edu/clearinghouse/downloads/TIP-26-Substance-Abuse-Among-Older-Adults-67.pdf> [Accessed 27 May 2020].
[5] Lemke, S. and Moos, R., 2003. Outcomes at 1 and 5 years for older patients with alcohol use disorders. Journal of Substance Abuse Treatment, 24(1).
