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 • 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 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?