Substance Use in Older Adults: Screening and Treatment Intervention - - PowerPoint PPT Presentation
Substance Use in Older Adults: Screening and Treatment Intervention Strategies A Roadmap for this Training Series Todays Training: Overview and skill building for screening and brief intervention with older adults (repeated x 3)
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Understand the prevalence of at-risk drinking,
Know drinking guidelines for adults age 65 and
Know the interaction effects of alcohol with various
Identify signs and symptoms of alcohol problems
Know how to use brief alcohol interventions with
Be able to discuss barriers to interventions and
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(Source: Breslow et al., 2003)
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(Source: Moore et al., 2009)
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At-risk Drinkers 12% Low-risk Drinkers 25% Abstainers 60% Abusing or Dependent 3%
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(Source: USDHHS)
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*Average rates for general population without additional risk factors
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(Source: Weathermon et al., 1999)
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(Source: Moore et al, 2009)
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15.9 56.8 37.8 12.8 7.8 58.3 30.3 7.6 4.9 53.0 21.1 5.3 1.0 37.5 9.4 2.3 10 20 30 40 50 60 70
Any Illicit Drug Use Any Alcohol Use "Binge" Alcohol use Heavy Alcohol Use
18 to 25 26 to 34 35 to 54 55 or Older
Percent Reporting Use in Past Month
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While in the home, scan the
A LOT about the person
Failure to fulfill major obligations at work, school or home Substance-related legal problems
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Prevention/ Education Formal Specialized Treatments Pre-Treatment Intervention Brief Advice Brief Interventions
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For persons with substance use disorders Those who are at risk of developing these
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Source: SAMHSA, 2005 National Survey on Drug Use and Health (September 2006).
Conclusion: The vast majority of people with a diagnosable illicit drug or alcohol disorder are unaware of the problem or do not feel they need help.
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SBI may reduce alcohol and other drug use significantly
SBI reduces accidents, injuries, trauma, emergency dept visits, depression
Studies have indicated that SBI for alcohol saves $2 - $4 for each $1.00 expended
SBI may reduce work-impairment and DUI
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There are grounds for thinking SBI may:
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(Sources: Field & Caetano, 2010; Miranda et al., 2005; Munoz & Mendelson, 2005)
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Alcohol Acetaldehyde Acetate H2 O CO2 ADH ALDH
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(Source: NIH/NIAAA, 2007)
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SOURCE: ATTC National Office, CONNECT to Fight Prescription Drug Abuse.
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SOURCE: State of California Department of Justice, Office of the Attorney General.
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SOURCE: State of California Department of Justice, Office of the Attorney General.
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Source: NIAAA, 1995
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*Average rates for general population without additional risk factors
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Include prescription misuse
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Depression Anxiety Anhedonia Psychotic Thinking Trauma/PTSD Confusion Memory Issues …
Cirrhosis Gastroenteritis Abscess Diabetes High Blood Pressure HIV/HCV Cardiac Problems TB …
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Do you frequently take aspirin, Tylenol, Advil, or other non- prescription pills for pain?
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Do you ever tell your physician about the type of non- prescription pills you buy?
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Do you use herbal pills such as Ginkgo, Saw Palmetto, St. John's Wort?
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Do you take non-prescription pills or remedies for improving your memory?
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Have you ever felt worse soon after taking over-the counter remedies?
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Are you taking medications to help you sleep?
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Do any of the non-prescription pills you take make you feel groggy?
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Do you use plants or herbs to make your own remedies such as garlic, or aloe?
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Order from http://www.samhsa.gov/
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Prochaska & DiClemente
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Family Con- fusion
Medical Issues
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Hypertension Diabetes Cancer
Family
Con‐ fusion
Medical Issue
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Ask for Permission explicitly
Preface advice with permission to disagree
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Provide Clear Information or Feedback
Elicit their reaction
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the pro)
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Anthony Jackson is a 67-year old man living alone in an apartment in a mixed-age housing project. For the past month he has been seen by a visiting nurse from your agency. The nurse was assigned upon his discharge from the hospital where he spent 4 days. He had a fall in the middle of the night prior to the hospitalization , was a bit confused on admission, and was also diagnosed of anemia in the hospital. The nurse noted the smell of alcohol during two of his visits, but Mr. Jackson did not ever appear intoxicated.
When the nurse asked him about his drinking, he said, “Oh, I don’t drink very much, really. I just seem so tired all the time and a little drink now and then makes me feel better”. He has complained about difficulty sleeping at night and was prescribed medication for sleep 6 months ago.
A homemaker is assigned to his case and visits two times/week. In addition, he has one friend who visits almost every day. Not counting his stay in the hospital, he has been confined to his apartment for the last two months.
The nurse asked you to see Mr. Jackson to assess his alcohol problems and determine what additional services are needed.
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