Treating Seniors for Addictive Diseases: It’s a Whole New BallgameBHOPB
In 2013 the American Society of Addiction Medicine (ASAM) designated “seniors” to be a special population. Since that happened a number of quality treatment programs have attempted to enhance the services they provide to senior patients. In my professional experience I have found that there is a lot to be considered when treating seniors for addictive diseases. To properly treat seniors for addiction, it takes a lot more than making a few adjustments to a rehab’s existing treatment program that is already being used to treat their younger patients.
Behavioral Health of the Palm Beaches (BHOPB) is one of the leading addiction treatment providers in the country today. We are proud to offer patients several paths to recovery, including gender-specific and highly individualized care. Seaside Palm Beach is the luxury rehab facility at Beahvioral Health of the Palm Beaches. I’ve been fortunate to be directly part of Seaside Palm Beach since its opening back in 2009, and I know that it was not specifically designed to provide senior care when we first opened.
However, highly individualized care is expensive, so it may not be surprising that Seaside has attracted an older population than most of BHOPB’s other facilities. Honestly, this was not anticipated when the doors were opened in 2009. Highly individualized care is very good care. It so happens that Seaside has been affordable to a more senior, successful and entrepreneurial group of people.
We didn’t anticipate the downside of achieving success. Successful people have been fairly good at avoiding consequences and are less likely to experience confrontation from colleagues, family and peers than their less successful counterparts.
Seniors in need of addiction care generally have a longer history of substance abuse. It is not uncommon for us to treat patients who are baby boomers and have been using alcohol, benzodiazepines, and/or opiates for twenty to forty years.
Who is a Senior?
Our country’s population of seniors is growing significantly because of our baby boomer generation. There are 50 million people over age 65 in the United States, and people over 70 are the fastest-growing group in the nation (Vimont, 2015). Would this entire population meet the admission criteria for senior specific care? It’s unlikely. Age needs to be a factor, but far from the only factor. Other things need to be considered: substance use history, medical/neurological impact, and psychosocial factors.
It may sound reasonable to say that a person who is fifty-five years old would meet the admission criteria. However, there may be some fifty-five year old people who have used substances for a very short period of time. There may be forty-eight year old people who started using at the age of fifteen. The forty-eight year old may meet the criteria. The fifty-five year old may not. There are numerous factors that would need to be considered.
It would not take long to realize that traditional withdrawal management protocols are not likely to be effective when managing the withdrawal of a senior with a forty-year use history. In these cases withdrawal management protocols should be extended.
Perhaps that’s one of the reasons why ASAM designated seniors to be a special population. Traditional protocols need to change.
ASAM (2013) has described five levels of withdrawal management:
- 4.0 Medically Managed Inpatient
- 3.7 Medically Monitored Inpatient
- 3.2 Clinically Managed Residential
- 2.0 Ambulatory extended on site monitoring
- 1.0 Ambulatory without extended on site monitoring
All five levels need to be considered when treating seniors.
With longer histories of substance abuse come more substance-related physical ailments. Seniors will bring more instances of chronic hypertension, diabetes, liver and pancreas damage and other ailments often associated with chronic substance use disorders. A treatment program for seniors will need to have the ability to provide or access a higher level of medical care than has been provided for younger populations.
Long histories of substance abuse may cause extensive brain damage. I’ve seen men and women arrive at Seaside who can be ambulatory only with the help of a wheelchair or walker. More senior women have fit this description than men. It is likely that chronic substance abuse has impacted their motor cortex. The only upside is that the motor cortex begins to heal quickly.
Three to four weeks into recovery they get around just fine.
Other areas of the brain that have been damaged seem to take longer to heal.
Long histories of substance abuse can also cause severe memory loss, cognitive impairment (Korsakoff’s psychosis, Wernicke’s syndrome), and accelerated dementia. I have worked professionally with people having addictive diseases for almost thirty years; it’s only been in the past five that I’ve encountered two senior gentlemen who could not be treated in the setting that I’m familiar with. In the afternoon they could not recall what took place in the morning.
Seniors may experience the worst consequences of addiction. It is truly sad to see people who have been bright, hard-working, successful and creative, and who have raised families and often made significant contributions to our culture be reduced so much in their later years.
I’ve witnessed cases of alcoholism that have been different from what I’ve seen before. I’m talking about a few people between the ages of fifty-eight and seventy-seven whom I believe truly could not stop drinking alcohol outside of a structured setting.
I have a patient who is ninety-two years old who is functioning well, which is another good argument for individualized care.
Length of Stay:
Sometimes our senior patients have unrealistic expectations about how long it will take them to get well. These estimates are likely to formed from observing younger people who are also in recovery.
I think that families and patients who meet the criteria for admissions into any seniors’ program need to accept the reality that a longer stay will usuaully be needed then the average stay for younger patients.
Other Things to Consider:
Helping our senior patients maintain their dignity is of the utmost importance to us. Let’s not forget that seniors have not been enlightened to the fact that an addiction is a disease; even many younger people still have a hard time accepting it. So the time-honored technique of “confrontation” should be avoided (ASAM, 2013), especially if it going to be coming from a therapist half their age.
As much as possible, staff should be mature and experienced. Staff needs to be able to relate to senior issues such as isolation, changing role in the community, mortality and many other speicialized considerations.
Family treatment also needs to be different. It too needs to be provided by age-appropriate staff that is more likely to be dealing with adult children than spouses.
The whole point of this article is to say “give a lot of thought to the needs of seniors” before installing a program, It’s not a matter of a few adjustments, it’s a whole new ballgame.
A lot of of what we know about treating addictive diseases is based on people in their early to middle years—from the Baby Boomers generation when they were young. Those who have survived wars in Korea and Vietnam, as well as those who attended Woodstock are showing up on our doorsteps today for treatment as seniors. As addiction treatment professionals we need to do the right thing for them and by them.