Do not assume that a score below 13 means the client does not misuse cannabis.334 The CUDIT-R is available in the Chapter 3 Appendix. He comes home to a Middleton condo and, through PACT, knows how to identify and manage symptoms on the rare occasions they arise. He began his adulthood dealing with police mistreatment, systemic discrimination, stigma and five hospital admissions between 1974 and 1977. Since then, he’s been able to live a life of independence and advocacy.
TIP 42: Substance Use Treatment for Persons With Co-Occurring Disorders
Using diagnostic decision trees made specifically for SUD in older clients. If you answered “yes” to any of these questions, you may want to assess the client for fall risk. Remember the importance of helping clients feel safe physically and emotionally. In addition, ask about periods following treatment where clients were successful (e.g., what worked for them). Reasons for starting and continuing to use the substance, which may change over time. Discuss with clients the benefits and possible harms of taking opioids.
Referral and Treatment Locators
This is the first study to examine lifetime trauma experiences among a large sample of individuals in MOUD. The results highlight the high prevalence of trauma in both childhood and in adulthood, as well as both interpersonal and non-interpersonal traumatic events in both men and women. Individuals in this sample were stabilized on MOUD for a substantial amount of time and reported high levels of abstinence from substance use yet were not accessing a level of mental health care commensurate with their need. Also notable is the particularly high report of sudden and unexpected death of a close friend or loved one – reflecting the tragic experience of loss among this sample likely due to drug overdose in their communities and the need for related support services. A well-thought-out approach to comprehensive screening and assessment will help you identify older adults with or at risk for substance misuse and related conditions.
Looking for Treatment?
Keeping an open, nonjudgmental attitude will help your clients feel more comfortable sharing more information with you. Screening is helpful when clients feel afraid or ashamed of revealing their problem spontaneously. The crystal meth detox and withdrawal addiction rehab and recovery support first section of Chapter 3 is about the challenges to screening and assessing older clients for substance misuse. You will be more likely to use screening and assessment once you understand why they are so important.
When considering referral for treatment, first consider the client’s thinking abilities. Problems with thinking could affect a client’s ability to participate in treatment. The client might need a treatment provider who has experience working with older clients with cognitive problems. Individual treatment rather than group treatment might also be a better choice. Research supports involving clients with SUDs in treatment decision-making processes.539 In some cases, matching clients’ substance-related treatment preferences has led to improved outcomes.540 However, shared decision making in the context of SUDs can be challenging.
There was equivalent exposure to accidents across genders (see Table 3). The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
- In recent months, her one glass has turned into two or more, sometimes even a whole bottle.
- Screening is helpful when clients feel afraid or ashamed of revealing their problem spontaneously.
- Substance use patterns can also change with life events, cognitive functioning, and mental health status.
- Older adults may be more likely to experience mood disorders, lung and heart problems, or memory issues.
- Older clients may be more likely to talk about physical symptoms than emotional ones.
- This updated TIP is designed to help providers and others better understand how to identify, manage, and prevent substance misuse in older adults.
Alcohol can interact dangerously with medications taken by older adults, including over-the-counter drugs, herbal remedies, and prescriptions. Different years of NSDUH, TEDS, and DAWN data were used in this analysis because they are the latest years of data available. All NSDUH estimates in this report are annual averages based on combined 2007 to 2014 NSDUH data. Combining multiple years of NSDUH data allows substance use among older adults to be examined in greater detail by improving the precision of estimates for making statistical comparisons. TEDS data provide information on admissions to substance abuse treatment in 2012, and DAWN data provide information on drug-related ED visits in 2011. Individuals ages 65 and older have lower odds of perceived treatment need than younger individuals, and often report a lack of readiness to stop using substances as one of their primary reasons to not seek treatment (Choi et al., 2014).
It’s been called the “invisible epidemic.” But knowing what to look out for can help you protect yourself or a loved one. Remember that a wide range of providers in many different settings can be involved in helping to identify, screen, and assess older clients for substance misuse. There’s no “wrong door” through which older adults can receive a diagnosis and the treatment they need. Several medication and nonmedication treatments can improve sleep problems.
Provide a paper or digital tablet version for clients 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 ayahuasca and abilities when selecting screening formats. Screening can help you learn whether a client’s alcohol or drug use could be harmful because of an existing condition or use of prescription medications. Many older clients have chronic medical illnesses and take more than one prescription medication.
This questionnaire includes a checklist of symptoms and open-ended questions about alcohol use.331 A score of 1 or higher suggests problem alcohol use. Older adults experience substance-related functional impairment, which providers may have a hard time detecting in older clients who no longer work, drive, or have significant obligations to others professionally or at home. The main reason victory programs for screening and assessment is to help you decide whether, where, and how to address substance misuse. Pharmacologic treatment of SUD has been extensively studied in adult patients but not older adults.3,12 There are no randomized, control trials that study pharmacologic treatment of SUD in older adults.3,12 Disulfiram, acamprosate, and naltrexone have indications for alcohol abuse.
Using DSM-5 criteria to make an SUD diagnosis.534 Using an SUD assessment instrument based on DSM-5 criteria will improve diagnostic accuracy. Before assessing for depression and PTSD, make sure you have a safety plan in place. This will help you respond appropriately to any client’s reports of abuse and self-harm. All three of these tools (the IPT-R, the revised Faces Pain Scale, and VDS instruments) are easy to use and easy for older clients to understand. Assessment and treatment planning should consider not just how a client rates on a pain scale but also his or her level of functioning in the presence of pain. However, even more follow-up sessions may be needed depending on the setting, the severity of the substance misuse, and clients’ responses.
Chapter 3 will be useful across settings in which these workers encounter older adults. No single service provider or setting is solely responsible for making sure older adults receive the substance use-related care they need. According to Mary Kay Battaglia, the executive director of NAMI Wisconsin, a majority of inpatient rehab facilities don’t accept clients with serious mental illness. She’s also on the verge of 90, and has been pushing for the improved treatment of people with mental illness since she got the phone call from jail 50 years ago. In older adults, especially, too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries. Older people have thinner bones than younger people, so their bones break more easily.
Tell clients that they can answer whichever questions they wish, however they wish. The item scores are added to produce a total score ranging from 16 to 80, with higher scores reflecting more worry. A score of 50 or higher by an older person could mean significant worries are present, but research on cutoff scores in older people is too limited to know for certain.396 Do not assume that an older client who scores below 50 does not have anxiety.
However, the CAGE-AID does not ask about certain important aspects of substance use, including past substance use, frequency of use, and effects of using the substance. The CAGE-AID should be used with, but not in place of, longer and more detailed alcohol and drug screeners. The fourth section describes how to fully assess older adults who screen positive for moderate-to-severe substance misuse. A full assessment does more than just ask clients about substance use. This will give you a more complete picture of your clients’ substance-related issues and will help you understand how substance misuse affects them.
Be aware that not all of these measures have been validated—in other words, tested and approved for use—in older adults. Your practice should also identify steps to take when screening tests are positive (see the section “Communicating Screening Results”). The ASSIST has yet to be validated among older adults, and there is at least anecdotal evidence that it underperforms in this population in part because of the same limitations with a formal DSM diagnosis; the criteria do not apply in the same way for older adults as they do with younger adults.
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