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(L) - HazeLDeN Research Update is published bythe Butler Center for Research toshare significant scientificfindings from thefield ofaddiction treatment research. BUTLER CENTER FOR RESEARCH DECEMBER 2001 Alcohol Problems and THE HAZELDENEXPERIENCE Older Adults TheHussResearchChaironOlderAdultswithAlcohol and DrugProblemswasestablished attheButlerCenterfor Researchin2001.Thefirstthree-yearawardwasgranted The U.S. faces unpiecederited growth in the numberofolderadults. Accordingtoa 1998 U.S. totheteamofFrederic Blow.Ph.D.andDavid Oslin,MD. Census Bureau report, by2025 an 87% increase ofthose 60 and older is expected. In 1998 Together, theResearchChairsand ButlerCenterfor alone, over 23,000 people aged 60 and olderentered a U.S. treatmentfacilityforalcohol or Researchstaffwill design and conducttreatmentstudies drugdependence. Asthe numberofolderadults increases, the numberofolderadultswho toimprovethe livesofchemicallydependentolderadults need treatnientforalcohol ordrug dependencewill increase as well. Researchers have begun andtheirfamilies. to studythe prevalenceofalcohol dependence, treatment needs, and treatnient outcomes amongthis population. CONTROVERSIES& QUESTIONS Controversy:Whataboutotherdrugsofabuse? Prevalence of Problem Drinking Response:Illicitdrugabuseand dependencearenot Although alcohol consumption tendsto declinewith age, a significant proportion ofolderadults commonamongolderadults.’However,olderadultsareat continues or beginsto drink at problematic levels. Amongcommunity samples, prevalence riskforabuseofpsychoactiveprescription medications. rates of problem drinkingamongolderadults range from 0.9to 9% with rates upto 24% found Question:Whatfactorsputolderadultsatriskfor amongolder medical and psychiatric patients. Similartoyoungeradults, olderadult °° alcoholproblems? males exhibit higher prevalence rates than do females. Response:Slowedalcohol metabolism, high levelsof Prevalence rates ofalcohol or drugdependence amongthis population may be under-estimated previousdrinking, and beingmalearefactorsthatappearto due to problems with assessment. Assessmentoften focuses on social, legal, and occupational placeolderadultsatincreased risk. consequences ofdrinking, which may notapplyto olderadults. In addition, the commonly used diagnostic criteria ofsubstance dependencedo not readilyapplyto olderadults. HOWTO USETHISINFORMATION — Treatment Counselors: Incorporateage-specific Treatment Needs of Older Adults assessmenttoolsintoclinical practicetoimprove Older adultswith alcohol and drug problems have specific medical, cognitive, and emotional diagnosticaccuracy. treutment needs. Thosewho began drinkingearly in life aretypically in worse health than late- — Health Care Providers: Regularlyand carefully screen all olderadult patientsforalcohol ordrug dependence. Specificassessmentquestions ReasonsforRelapseAmongOlderAdults are provided ontheAmerican Geriatrics Society website(www.americangeriatrics.org/products! Tocnpevathconflict positionpapers). Copingwith health problems Totestcontrolofdrinking uno/c, — Familiesand Friends: Don’tmistakenlyassume thatchemical useamongtheelderly “isn’t 1o/7 Inresponsetotemptation/urges hurtinganyone.” In reality, alcohol usecan have Toenhanceintrapersonal 0% significantnegative consequencesforolder ,, adults.’ Rememberthattreatmentforolderadults positiveemotions withalcohol and drug problems iseffectiveand 7% Social pressure improvesthequalityoflivesand relationships, (Othersdrinkingnearby( 32% Negativeemotions (i.e. loneliness,grief( 21% “ Toenhanceinterpersonal positivestates Notreported in article 10% 7% >CONTiNUEDONBACK <CONTINUEDFROMFRONT Alcohol Problems and Older Adults onsetdrinkers and non-dependent peers. have greater difficultywithdrawing from substances, require longerdetoxification stays, and exhibit more severe emotional problems.. Compared toyoungeradults, olderadultsare at increased risk forcognitive and functional impairment References duringwithdrawal. In addition, many olderadults identify depression, grief, loneliness, and t. U.S.CeasesBureaa.lt99Ul.MastLatiaAmericaucuuntriesaging social pressure as common antecedentstotheirdrinking.’ tauterthautheUnitedStates,CeususBureaareportslon-linel. AsailabluInteruet:www.censos.gosfPress-Belease. 2. SAMRSA.120U11. 199tTreatmentEpisodeDataSetITEUSIIOn-heel. Asailableloteruet:www.dasis.sanrhsa.gns/teds9g. Treatment Outcomes 3. SAMUSA.119991.NationalUoasehnldSurveyoaDragAbase,1999IOn A variety oftreatmentapproacheswork well forolderadults, from briefinterventions forat- line).Availableletenet:sswe.sanrhsa.gesleas/NHSDW1999. risk drinkers to inpatient programs for those who are alcohol dependent. Several treatment 4. Mirand,A..&Welte.J.VLh199Ul.Alcoholcuusuroptrnaameagthe eldedpiaageneral papalatian,ErieCoanty,NessYork.Amer/can facilitiesaround the country have designed elder-specific programmingwhich includes a JaaraatatPablicOealth,RU,97U-9U4. slower pace, accommodationsfor medical and ambulatory problems, supportive ratherthan S. Moore,A.A..Hays,U.U.,Greeudale,0.A..Darnespa,ll.,&Reuben, U.U.11999).Drinkinghabitsamongolderpersons:Eindings1mm confrontational approaches, and focus on specific issuessuch as grief, loneliness, boredom, theNHANESIEpidemislngicEnllewupStudy)19U2-U4).Jaaroalattue and retirement. AmencanGeriatricSacrety47,412-41U. U. Patterson,T.L.,&Jeste,U.V11599).Thepotentialirepactotthe Research data showolder adultstend to do well in age-specific programming. One study of baby-honorgeaeratiaaaasubstanceabaseanreegelderlypersans. PsychiatricServices,5U,11U4-11UU. men found thatthose whowere randomly assigned to receive age-specific programmingwere 3 7. Blew.EC.,Walteu,M.A.,Barry,U.L.,Cayne,i.C.,Madd,S.A.,& times more likelyto report abstinenceat 6 months and 2 times more likelyto reportabstinence Cepeland.L.A.I2UUUaI.Therelatranshipbetweenalcoholproblems andhealthtuoctioniugotolderadultsinprrrosecaresettings. at 12 months compared to peerswho received treatmentas usual in a niixed-age setting: JaarrralattireAmerican GeriatricSacrety4U,7U9-174. U. Friedrnaae,P5.,un,L.,Uarrisoa,T.,Uerney,0..Haplep,D.C., Factorsfound to be positively related to treatmentoutcomesamong olderadults include lower Malliken,H..Walter,J.,Millnr.A.,&Chin,El.U.ltDUY).Theettect atalcoholabaseenthehealthstatusatolderadultsseeninthe pre-treatrnentalcohol consumption levels, havinga social group thatdisapproves ofdrinking, emergencydepartnreot.AmericanJaarmralatDragandAleahatAbase, and seeking help from mental health professionals. Treatmentforalcohol problems and 25,529-542. 9. Ganry,0.,Dobreail,A.,July.i.,&Quesal.1,1.I2RUUI.Presalenceat regular AA partIcipatIon are also related to alcohol abstention among olderadults.’A recent alcoholproblemsamoagelderlypatientsinaaeruersityhospital. study found no relationship between age ofonsetand inpatienttreatment outcomes: Addictiao,95,1R7-t13. 19. Holrayd,S.,&Surpee.I.i.119971.Substaaceasedisordersioa geriatricpsychiatryoatpatieetcliuic:Preaaleoceandepiderainlagic characteristics.JaaroatatNaraaaaaodMentalDiseasetU5,U27-U32. Summary 11. Graham,K.,&Schmidt,0.)1A99).Alcoholuseaadpsychosucialwell Alcohol use and dependence have significant negative consequences for olderadults. beingamoogolderadults.JauroalatStudresanAtcahat,345-351. Fortunately, treatment is effectiveand improves the qualityof lives forolderadultsand their 12. SAM[ISA)t99Ul.Sebstauceabuseaeroogolderadults,TIP2UIOu haul.AsailableInternet:wwccsanrhsa.gas/denterslcsat. familiesforyears to come. 13. Uraemer,U.L,Mayo-Smith,M.F,&Calkias,U.H.)t9971.Impactat ageouthesuaerity,cearse,andcoreplicatioasatalcohelwithdrassal. Archivesattotenratt,lerlicrrre.157,2234-224U. 14. Blow,EC.,Walton,M.A.,Cherroack,S.‘F,l,ludd,S.A.,&Brewer,U. J.l2UUUbl.Ulderadalttreatmentsatcometellnwrngelder-specitic inpatientalcoholismtreatureut.JaaroatatSabataoceAbase Treatment19,U7-7S. IS. Schouteld,L.,&Bupree,LP1.119911.Antecedentsotdrinkingter early-andlate-onsetelderlyalcoholabusers.JaareatatStadieaan Alcahaf52,5U7-592. tU. Hless,FC.,UBarry,U.L.)2ggUI.Olderpatieatswithat-riskarrd preblemdrinkingpatturos:Newdeuelopmentsinbrietinterventions. JaaroaIatGeriatricPsychiatryandRerrralagyt3,115-123. 17. UashueT.M.,Hodel,B.E.,Ogdeo,S.H.,Guggenheim,E0..&Uarsno. C.N.11992).OutcomesandcustsnttssaPAinpatienttreatment prograorstarolderalcoholicpatmeato.tlaapitatandCaromandy Psychiatry43,9U5-9U9. 1g. Muas,B.H.,Brennan.RL.,&Moos,B.5.11991).Shed-termprocesses otremissmuoandoenremissinaameoglate-liteproblemdriukers. Alcahahsw:ChnrcalaadEsperrmeotalResearch,15,94g-9S5. 19. Chermack,S.T.,Blew,FC.,Gomberg,E.S.L.,Mudd,S.A,UHill,F. 0.)199U).Olderadultcontrolleddrinkersaridabstainers.Jaarnalat SubstanceAbase,U,453-4U2. 2U. Bauks,S.1st.,Paodiaoi.J.A..Schacht,L.M.,&Gauaie,L.M.)2UUU). Ageaaderurtahrtyamongwhitenralepreblemdrinkers.Addictiae,95, <CONTINUED 1249-1255. 21. Breaeaa,PL,Moos,H.H.,UMertens.I.B.11994).Persenaland eanireunmeutalrisktactersaspredictorsatalcahaluse,depression, hazelden.org andtreatment-seekieg:Alongitudinalanalysisotlate-hiteproblem drinkers.JearoatatSabstanceAbase,U,19)-2U8. BUTLER CENTER FOR RESEARCH OECEMBER 2001 The RuderCentertorResearch iniormsand improves recnverv serviceN.nnd produces rcsearch rharbenefits the fieldofaddicnion treatment.‘Wearededicated to concluenugclinical rcsearch. collaboratingsvirii esrernal researchers, andcoromunicariirgscientificfindings. PatriciaOmen,Ph.D..Director Ityouhavequestions,orwouldliketerequestcopiesatResearchUpdate. pleasecall8UU-257-7800uet.44U5,emailbutlerresearch©haaelden.urg. arwriteBC4,RD.Ben11.CenterCity,MN 55912-UO11. c:sseCav’,jv:,Fo’:<svi:<< .15‘:-,<H<veivvem.91< ecRRuue raa<rn<’k<mrevCues,.,:r<<na<r,vn eeuaaa CDTcal