Substance Abuse & The Elderly

Learning ObjectivesUpon completing this course leaner will be able to:

List and define terminology associated with substance abuse

Demonstrate the skills to recognize symptoms of substance abuse/misuse

List and define Models of Substance Abuse

Identify and define the Classification of Drugs

Learning Objectives

Identify the obstacles involved in providing effective services

Develop an understanding of the current issues surrounding substance abuse/misuse in the elderly population

Identify how the elderly are at risk for developing a substance abuse problem

Demonstrate knowledge of the cultural/societal factors that influence the increase in substance abuse/misuse within the elderly population

Overview:Recognizing Substance Abuse/Dependence

A heightened need for the substance

This need leads to patterns of behavior associated with the substance

Upon discontinuation of the substance, the individual experiences various levels of withdrawal symptoms

The willingness to continue use of the substance in spite of apparent consequences

Terminology

Substance Abuse and Misuse

Physical Dependence

Withdrawal

Routes of Administration

Set and setting

Tolerance

Synergism

Definitions of Terminology

Substance Abuse/Misuse

The primary distinction between substance abuse and substance misuse involved the quality of intention: abuse is deliberate ~ misuse is not.

Abusive use of a substance requires an awareness that the frequency or quantity of use is inappropriate.Misuse of a substance involves the continuation of the behaviors despite all knowledge of the physical, psychological, and/or social consequences that are likely to result.

Definitions

Physical Dependence

Person cannot stop taking a certain drug without suffering symptoms from physical withdrawal

Definitions

Withdrawal

Physical symptoms from stopping the use of the drug

Definitions

Routes of Administration

Method of ingestion of the drug ~ how the substance gets into the blood stream

Definitions

Set and Setting

Set refers to the user’s state of mind

Settings is the physical environment

Definitions

Tolerance

Person requires increasingly larger doses to achieve the same effect

Definitions

Cross-tolerance

Tolerance to other substances that share similar chemical structures

Definitions

Synergism

The combined effect of two substances, for example alcohol and tranquilizers, enhances or increases the effect of the other producing what is called a synergistic effect…1 + 1 does not = 2, but 4,5,or 6.

This is very common with people who accidentally overdose. And can be fatal for elderly people who are unaware of drug combinations.

Models of Alcohol & Drug Dependence

Disease Model

Tension Reduction Model

Family

Self-medication

The Disease Model

The AMA declared alcoholism a disease in 1957 based on three criteria for a condition to be called a disease.

it has a known cause symptoms get worse over time known outcomes

Tension Reduction Model

The body needs to return to Homeostasis or balance out

the physiological responses caused by stress, anxiety, conflict, frustration

Alcohol/drugs are used to reduce these experiences.

Self-Medication

An active attempt to numb the feelings and/or minimize other issues

This behavior suggests that the individual learned to self-medicate in order to cope with life situations

Family

Imbalance and maladaptive resolution of family issues

Inappropriate boundaries

Poor communication dynamics

Shame, abandonment, and rejection

Classification of Drugs Non-Psychoactive drugs are substances that in normal

doses do not directly affect the brain, such as vitamins, antibiotics, and topical skin preparations.

Psychoactive drugs affect brain functions, mood and behavior and are subdivided primarily on the basis of physiological and psychological effects.

Classification of Drugs

1. Narcotic Analgesics (pain reliever)2. Central Nervous System Depressants3. Central Nervous System Stimulants4. Hallucinogens5. Cannabis sativa: marijuana and hashish6. Inhalants: volatile solvents7. Phencyclidine (PCP)

Classification of Drugs

Narcotic Analgesics

Although considered CNS Depressants, Narcotic Analgesics refer to opium and the opiate derivatives, such as morphine, codeine, percodan, and heroin.

Their primary purpose is to “kill pain”

Classification of Drugs

Central Nervous System Depressants

Most central nervous system (CNS) depressants are sedative hypnotics and include:

Alcohol

Barbiturates

Tranquilizers

Classification of Drugs

Central Nervous System Stimulants

• AmphetaminesRitalinCocaine/Methamphetamine

• Tobacco

• Caffeine

Elderly Substance Abuse/Misue

The issue of elderly substance abuse/misuse is reaching epidemic proportions among the population.

The Federal Substance Abuse and Mental Health Services Administration has characterized substance abuse as "under-estimated, under-identified, under-diagnosed and under-treated" among the elderly. And is referred to as the “invisible epidemic”

The reasons for this are varied, although may be the fact they are no longer active in mainstream society.

Recent census data estimates that nearly 35 million people in the United States are 65 years or older. Substance abuse/misuse among those 60 years and older (including misuse of prescription drugs) currently affects about 17 percent of this population. By 2020, the number of older adults with substance abuse problems is expected to double.

Source: 2002 National Survey on Drug Use & Health (SAMHSA)

Americans are Living Longer

8481

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47.34045505560657075808590

1900 1950 1960 1970 1980 1990 2000 2025* 2050*

Year of Birth

Lif

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tanc

y at

Bir

th

0

5

10

15

20

25

30

35

40 "Gen X & Y"

"Baby Boomers"

"Greatest Generation"

Source: 2002 National Survey on Drug Use & Health (SAMHSA

Estimated Cost of the Consequences of Substance Abuse Among Mature Women

INPATIENT HOSPITAL CHARGES ($10.1 BILLION)

NURSING HOME EXPENSES (12.2 BILLION)

• Medicare - $8.5 Billion• Medicaid - $338 Million• Private insurers/individuals -

$1.3 Billion

Only 2% was spent to treat the substance abuse problem itself

• Medicare - $1.4 Billion• Medicaid - $5.8 Billion• Private insurers/individuals -

$5 Billion

Source: CASA, Under the Rug: Substance Abuse and The Mature Woman, June 1998

Gender Issues Older men tend to have substance abuse/misuse problems

compared to older women; however, women are more likely than men to start drinking heavily later in life.

Substance abuse/misuse is more prevalent among persons who suffer a number of losses, including death of loved ones, retirement, and loss of health.

Women are more likely to be widowed, divorced, or live alone. They also tend to be diagnosed more with depression and as a result been prescribed psychoactive medications that increase the likelihood of complications .

Problems Specific to the Elderly

Complications of drug-alcohol interactions

Cognitive dysfunction

It is often mistaken for other conditions associated with the aging process.

Emotional factors – grief, loneliness, loss of youth

Many start drinking later in life

Problems Specific to the Elderly

Acute drug reactions are common in this age group

Alcohol/drug misuse potentiates other drug interactions

Coping attempts to deal with the stresses of aging

Physical illness/infirmity

Boredom/retirement

Problems Specific to the Elderly Health care providers often overlook substance abuse/misuse among

older adults because they don't know what to look for or they mistakenly assume that older adults cannot be successfully treated.

Older adults more often present their substance abuse/misuse problems in the form of medical and social complaints.

Patients complain of a variety of problems which may be the effects of substance abuse/misuse.

Problems Specific to the Elderly Data on substance abuse is difficult to obtain

Medications are often used in nursing home environments to control behavior

Older females are likely to conceal any substance abuse/misuse problem with symptoms of depression and reliance on psychoactive

drugs

Problems Specific to the Elderly The broader society often stereotypes aging and the elderly in ways

that dismiss or disregard signs of a substance abuse/misuse problem

Family members may excuse an older relative's substance abuse/misuse as a result of grief or loss or a reaction to boredom. Or family members may not want to confront an elder, fearing they will offend or anger them.

Some signals to look for: Memory trouble after having a drink or taking a medication Loss of coordination ( walking unsteadily, frequent falls) Changes in sleeping habits Unexplained bruises Being unsure of yourself Irritability, sadness, depression Unexplained chronic pain Changes in eating habits Wanting to stay alone much of the time Failing to bathe or keep clean Having trouble concentrating Difficulty staying in touch with family or friends Lack of interest in usual activities * Source ~ The Center for Substance Abuse Treatment

Assessment Complete medical or psychological history

Complete physical examination

Corroboration of all patient statements

Drug use history

Family history of addiction

Problems specific to the elderly

Some relevant issues in developing prevention, detection/diagnosis, and treatment programs for the elderly

Elderly persons use prescription medications approximately three times as frequently as the general population

Age-related brain changes Changes in drug sensitivity Use of different drugs Side effects more severe/more of an issue Different access to the drugs Different settings (i.e. nursing homes) Age-specific screening instruments needed Stigma Need better education re. prescription drugs Data systems to track prescription use

* Source – The National Institute on Drug Abuse

Treatment & Prevention Collaboration among health care providers, state agencies, and family members

Attention to patient’s physical & psychological condition

Active involvement of the family

Education of health care providers

Treatment for the Elderly = their own age group

Physicians and health care providers need to discuss alcohol use as well as medication management

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