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Taking a generational approach to providing substance use treatment and services

Originally published by the Substance Abuse and Mental Health Services Administration (SAMHSA), 2015.

For some older adults with substance use disorders, attending group therapy with many younger adults can be uncomfortable.

“Elders are in a different stage of life and grew up in a time when having an addiction or mental illness received a great deal of stigma,” explains Nicole MacFarland, executive director of Senior Hope, an elder-focused outpatient substance use program in Albany, New York. She notes that seeking help or talking about trauma, substance use, or mental illness may even have been discouraged in the past.

Many of the people receiving care at Senior Hope have told MacFarland and her staff that they feel like the “mom” or “dad” in mixed-age group therapy sessions and end up catering to the needs of younger participants. Older adults may also be uncomfortable with use of profanity by other group members.

Senior Hope addresses these concerns by offering small group, elder-specific sessions that provide a comfortable space for attendees to discuss age-related or generational issues with peers. Professionals with expertise in geriatric substance use disorders lead the sessions.

“We believe one-size doesn’t fit all when it comes to addiction treatment,” she says.

Addiction treatment options tailored to recipients

William Rockwood, Ph.D., and his wife Adrienne founded the program in 2002 to meet the needs of people aged 50 and over with substance use disorders. It remains the only senior-focused, nonprofit, free-standing outpatient treatment center licensed by the New York State Office of Alcoholism and Substance Abuse Services (OASAS).

The program is designed with accessibility in mind, says MacFarland. It is accessible for those using wheelchairs or other mobility aids, program materials are printed in larger type to help those with vision impairments, and facilitators are trained to talk more loudly and slowly and to design group sessions to accommodate older adults’ needs.

Many older adults with substance use disorders have medical co-morbidities. About two-thirds of those receiving care at Senior Hope developed substance use disorders before the age 40. As a result, they may have high blood pressure, liver disease or neuropathies that can contribute to falls. Many are using opioid medications to treat chronic pain. "They have medical problems that impact their quality of life and, often use substances to escape the pain and suffering."

Most misused substances are alcohol and heroin

Alcohol remains the most common misused drug among those seeking help at Senior Hope. However, recently the proportion of people admitted to Senior Hope for heroin use has increased from 11 percent (17 out of 155) in 2014 to 23.1 percent (six out of 26) so far in 2015, according to OASAS data. The trend mirrors what is happening through the state of New York where the number of admissions for people aged 50 and older to outpatient treatment programs statewide for opioids misuse has increased by 22 percent from 2,769 in 2010 to 3,370 in 2014, according to OASAS.

Longtime substance use may also have consequences for the individual’s family and housing status. For example, a 67-year-old man with an alcohol use disorder may turn to a local homeless shelter after divorcing and losing his job. Others may move from the home of one family member to another in lieu of permanent housing. MacFarland and her colleagues work with local service providers to secure more stable housing for those people in their care.

Common risk factors are trauma and age-related concerns

Understanding some of the underlying concerns of older people with substance use disorders is a key part of MacFarland and her colleagues’ approach.

“We listen very carefully,” she says. She notes that many older people report feeling they have lost meaning and purpose at this stage in their lives. Others may be nursing old wounds. Surveys of participants have found that many suffered childhood trauma. Support groups have been created specifically to deal with these concerns and learn more about trauma and violence.

For service providers working with older people, MacFarland says it is important to consider whether substance use might be contributing to age-related concerns. For example, a person with unexplained bruises, reduced hygiene, or the smell of alcohol on his or her breath may have mental and/or substance use disorders that require a referral for specialized care.

“Older adults may truly feel alone in their situation and not reach out for help,” says MacFarland. “There is hope and help for this vulnerable population. The first step is to identify the problem and begin the process of helping the elder reach out for support.



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