Combined Motivational Interviewing and Cognitive-Behavioral Therapy with Older Adult Drug and Alcohol Abusers

Abstract

More than 2.5 million older Americans struggle with alcohol abuse and its associated medical and social consequences. This number is expected to double to 5 million by 2020 (Gfoerer, Penne, Pemberton, & Folsom, 2003). Marijuana is the most commonly used illicit drug among older people followed by the nonmedical use of prescription drugs (Bartles, Blow, Brockmann, & Van Citters, 2005). The number of marijuana users age 50 and over is expected to grow from the current 719,000 to 3.3 million by 2020. It is estimated that one in four older adults use psychotropic drugs with abuse potential and that nonmedical use of such drugs will increase from the current 911,000 to 2.7 million by 2020 (Colliver, Compton, Gfroerer, & Condon, 2006; Simoni-Wastila & Yang, 2006). Comorbidity of drug and alcohol use is also a problem among older drug and alcohol users. Older people with alcohol disorders are at high risk for prescription drug abuse (Culberson & Ziska, 2008). Overall, physical and mental difficulties related to combined misuse of alcohol and medications affect up to 19 percent of the older population (Bartles et al., 2005; Cummings & Cooper, 2011). The combination of drugs, such as marijuana, with alcohol and prescription medications can lead to decreased cognition, impairment of memory and attention, and increased falls (Benshoff, Harrawood, & Koch, 2003). Comorbid psychiatric illness, including depression and anxiety, are also common among elderly drug and alcohol abusers. Additionally, older adults who use alcohol and marijuana have a higher risk of suicide (Rigler, 2000). Substance abuse and the related physical and mental comorbidities are expected to rise among the population of older adults in the coming decades. This increase in substance abuse among the older adult population coupled with the high comorbidity of substance misuse with mental and physical health disorders presents many challenges to the current treatment system. The Older Adult Healthy Living Program (HELP) was developed to address these challenges. This article describes both the barriers to older adult treatment effectiveness and the means by which HeLP overcomes these barriers. BARRIERS TO EFFECTIVE OLDER ADULT TREATMENT Older people see medical professionals frequently, which makes medical offices an efficacious place to screen for alcohol and drug use among this population. However, studies indicate that medical professionals overlook substance abuse and misuse among older people (O'Connell, Chin, Cunningham, & Lawlor, 2003), Additionally, medical professionals are often unaware of the special physiological vulnerabilities to substances that the elderly experience and of the altered substance use guidelines established for older adults (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2005; Simoni-Wastila & Yang, 2006), For these reasons, medical professionals underdiagnose older patients with alcohol and drug abuse disorders and rarely refer their older clients to substance abuse treatment (Weintraub et al., 2002). Poor communication among prescribing physicians (Benshoff et al., 2003), lack of physician inquiry concerning older patients' medication concerns (Alemagno, Niles, & Treiber, 2004), and medical professionals' failure to determine whether an older patient uses alcohol or other substances along with prescription medication (Simoni-Wastila & Yang, 2006) contribute to the lack of recognition of alcohol and drug abuse by older adults as well. Older people often do not recognize the signs of addiction and, therefore, do not present for treatment. They often perceive the negative effects of substance use as a natural consequence of aging (Benshoff et al., 2003). They sometimes engage in dangerous behavior such as borrowing medications from a friend, taking medications for other than approved purposes, and taking higher than prescribed doses, without realizing the potentially dangerous effects of such behaviors (Simoni-Wastila & Yang, 2006). …