Table of Contents

About This Course

1. Introduction to Elder Abuse
2. The Basics of Elder Abuse
3. Substance Use and Other Risk Factors
4. Screening and Assessment
5. Intervention and Treatment
6. Preventing Elder Abuse

Supplements
Case Studies
References
Resources

Out of the Shadows
Uncovering Substance Use and Elder Abuse

Substance Abuse Treatment Services

Many victims and perpetrators require intervention and treatment for substance abuse. Treatment needs among older adults may involve addressing legal or illegal substance use. However, most substance abuse problems involve alcohol and/or its combination with prescription drugs.

Most professionals who treat addictions use the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to help diagnose anxiety disorders, affective disorders, psychotic disorders, and substance abuse disorders. DSM-IV defines substance abuse as "a maladaptive pattern of substance use characterized by hazardous or compulsive use or the presence of role impairment or recurrent legal problems, but without evidence of tolerance or withdrawal." Most people meeting the criteria for substance abuse eventually will meet the criteria for alcohol dependence if they continue their behavior.ref

A knowledgeable, positive, determined, hopeful orientation toward alcoholism and its treatment is indispensable in persuading abused and nonabused older people to overcome denial and shame and seek help. Whether the substance abuse rests with the victim or the elder abuser, a tool for understanding the motivation to address the problem is FRAMES.

Clinically, addressing alcohol abuse in older adults is challenging, especially if it is long-standing behavior. One approach is motivational interviewing, which helps people recognize their problems and increase their motivation to change. It is useful in resolving ambivalence. It is a supportive, respectful approach -- persuasive without being coercive.

Motivational interviewing differs from other more confrontational approaches in the following ways: ref

• Deemphasizes labels such as "alcoholic" or "addict"
• Emphasizes personal choice and responsibility for change
• Focuses on eliciting the client's own concerns
• Understands the clinician's role can affect the client's resistance
• Uses reflection to meet resistance

Treatment programs for alcohol abuse can benefit older adults, even those with long-standing problems. Studies show older adults comply with treatment and recover as well as or better than younger patients.ref

Even a brief intervention by a physician or other clinician -- one or more counseling sessions -- can reduce drinking to moderate levels among 10 to 30 percent of nondependent problem drinkers. This intervention may include:ref

• Motivation-for-change strategies
• Patient education
• Assessment and direct feedback
• Contracting and goal setting
• Behavioral modification techniques
• Self-help manuals

Substance abuse treatment, for the perpetrator or the victim, also encompasses:

• inpatient/outpatient detoxification treatment
• inpatient rehabilitation
• residential rehabilitation
• outpatient services

The Medicare Web site includes an interactive database that allows older adults to access information about Medicare coverage for outpatient substance abuse treatment and other conditions on a State-by-State basis.

In cases involving substance abuse, professionals must be aware that addressing addiction issues in perpetrators will not necessarily make the violence disappear. Domestic violence experts have found that violence does not always stop or even diminish when the batterer becomes abstinent, and when it does diminish, an increase in other abusive and controlling behavior often replaces it. Professionals must treat both the substance abuse problem and the problem with violence.