The mission and responsibility of social workers and other social service professionals is to provide direct care and treatment to vulnerable populations, as well as to expand the tangible resources that are needed by underserved groups (Haynes & White, 1999). This is something that moralists and those in the field of social research can usually agree upon, even if the path to action isn’t always clear.
Nonetheless, even within the field of social service, there are populations of clients who remain invisible, underserved even by the professionals who have the knowledge and skills to assist them (Haynes & White, 1999). One such population consists of adults over 50 who have substance abuse problems. Although senior citizens using illicit drugs may seem to be the stuff of which bad jokes and comedies are made, the fact of the matter is that this is a problem that is increasing dramatically in the United States, and is likely to continue doing so as the baby-boomer generation ages (Colliver, Compton, Groeferer, & Condon, 2006). Although it is widely recognized that the shifting demographic of the ageing population is creating a health care crisis for which the nation is not prepared adequately (Jeste, Alexopoulos, Bartels, & Cummings, 1999), the social service system has not seemed to acknowledge the full range of needs that the densely populated elderly segment of society will present, and one such need is treatment for elderly adults with substance abuse problems.
Although research on the population of elderly drug users is scant, estimates of the prevalence of drug use among this population are alarming. Patterson and Jeste (1999) reported that among a population of 98,000 patients at Department of Veterans’ Affairs clinics who were identified as having diagnosed drug abuse disorders, 22%, or 21, 139 people, were age 55 or older. While it is not known precisely how many elderly adults in the general population have drug dependence issues, researchers and clinicians anticipate that the number is higher than in previous generations of older adults, given that the baby-boom generation is aging and it is this generation which has had the most experience with illicit drug use (Colliver et al., 2006; Patterson & Jeste, 1999). Also, as Patterson and Jeste (1999) point out, the elderly may have both more reasons to turn to illicit drugs in the second half of life, as well as greater availability to drugs than has been understood previously. Both of these factors may boost the prevalence rate of drug use among older adults. Experts conclude that actual rates of use probably exceed any published rates, as drug use is generally secretive, and is particularly so among this specific population (Patterson & Jeste, 1999).
Patterson and Jeste (1999) identify a number of reasons why older adults may be using drugs more than ever before. First, older adults already tend to have access to licit drugs that are prescribed by their doctors; some of these prescribed drugs are controlled substances. Older adults may, either intentionally or unintentionally, take more than the prescribed amount, turning a pharmacological aid into an abusive habit (Patterson & Jeste, 1999). Second, as people age, they experience an increased number of psychological, economic, and social stressors, and they often suffer these in isolation as their social support networks diminish (Patterson & Jeste, 1999). What may begin as a recreational habit of alcohol use may become routine and excessive, used as a means of attempting either to escape from or dull the pain of adverse events (Patterson & Jeste, 1999). In a similar fashion, drug use may be seen as a way to mitigate the physical pains that increase as people age (Patterson & Jeste, 1999). One of the problems that is particular to elderly drug users is that their use may go unnoticed far longer than is typically the case for younger users (Patterson & Jeste, 1999). Because they are more isolated than younger adults, who may have families, rich social networks, and jobs—all providing more opportunities for their drug use to be noticed and addressed—elderly people are often alone, and thus there are fewer opportunities for another person to notice their drug habits and attempt to intervene (Patterson & Jeste, 1999).
The implications of drug abuse are always serious, but among the elderly they are even more so (Patterson & Jeste, 1999). As Patterson and Jeste (1999) explain, illicit drug use can have deleterious effects on cognition and judgment, as well as on mood. Drug abuse can also exacerbate or create physical distress and even serious medical disorders. In both cases, elderly adults are already more vulnerable to psychological and physical problems than younger adults, and so secondary stressors place an even more dangerous burden on already fragile systems (Patterson & Jeste, 1999). Furthermore, because the elderly have fewer treatment options than younger adults and because they tend to be more isolated from any treatment options that do exist in their area, a drug problem is far more likely to go untreated for an elderly user than it is for a younger user (Patterson & Jeste, 1999). Thus, one sees the need for treatment services that take the specific realities and needs of elderly drug users into account, and which makes intervention plans that are tailored to those needs, as they are different from those of other drug-using groups.
While there is minimal extant research that has examined the subjects of drug use among the elderly and specialized treatment services and their outcomes among this population, the literature that does exist is both compelling and encouraging. In a longitudinal study in which the researchers compared the treatment success rates of older drug users, middle-aged drug users, and younger drug users who had engaged in outpatient drug treatment, Satre, Mertens, Arean, and Weisner (2004) found that older drug users had a significantly lower relapse rate than the other two age cohorts. Two other findings from the Satre et al. (2004) study were similarly encouraging about the prospects of treatment. First, the researchers reported that the older adults were less likely to be drug dependent than the other two age cohorts, and second, their treatment attrition rates were significantly lower than the drop-out rates of the other age cohorts (Satre et al., 2004). Although these findings are extremely encouraging, what they do not offer is a consideration of best practices that can be used by clinicians to identify older adults who are in need of drug treatment services, connect those individuals to treatment, and deliver treatment according to a model that has been substantiated as being empirically effective. More research is needed in this area.
One of the approaches that has been suggested by the literature and which is also being experimented with in the field is taking treatment services directly to clients, rather than expecting them to come to an agency or other social service site to receive treatment (Beardsley, Wish, Fitzelle, & O’Grady, 2003). This strategy seems particularly promising for older drug users, who may be limited, either by mobility, economic resources, or physical and psychological ailments, in their ability to seek services outside of their immediate community. The portable model of drug treatment involves a multidisciplinary team of care providers going into the community and meeting clients where they live, either in their homes or in local community centers and elderly residences (Beardsley et al., 2003). The team members work together to assess clients’ needs using a biopsychosocial evaluation framework, and based on the information collected, begin to develop a targeted and customized treatment plan. In some cases, it may be possible for the team to provide intervention in the community; in other cases, it may be more appropriate for the team to bring the client into a clinic or make an inpatient referral (Beardsley et al., 2003). The key to this approach, though, is that the initial engagement of the patient requires little effort on his or her part; it is the treatment team that is deconstructing the barriers to treatment engagement. It is assumed, based on the results reported in the existing studies, that with these barriers eliminated, it will become easier for older drug users to enroll in treatment, and, by extension, to remain in treatment and complete it successfully (Beardsley et al., 2003).
To this writer’s knowledge, although this model of treatment is already in use in some areas, it has not been tested for its efficacy. To do so would be particularly important in terms of making comparisons between this newer treatment model and the existing and traditional treatment approach. The writer hypothesizes that a treatment program that is interdisciplinary in nature, addressing both medical and psychological needs, and which reaches out to the client and requires minimal effort on his or her part initially is likely to be successful because it removes many of the obstacles that have been documented in the literature as creating resistance to engagement in treatment services for this population. The writer recommends that more research be conducted to determine the viability of this treatment approach with this specific population and, over time, to determine what specific components of the treatment model result in positive long-term outcomes.
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References
Beardsley, K., Wish, E.D., Fitzelle, D.B., & O’Grady, K. (2003). Distance traveled to outpatient treatment and client retention. Journal of Substance Abuse Treatment, 25(4), 279-285.
Colliver, J.D., Compton, W.M., Groeferer, T.C., & Condon, T. (2006). Projecting drug use
among baby-boomers in 2020. The Annals of Epidemiology, 16(4), 257-265.
Haynes, D.T., & White, B.W. (1999). Will the “real” social work please stand up?: A call to stand for professional unity. Social Work,
Patterson, T.L., & Jeste, D.V. (1999). The potential impact of the baby-boom generation
substance abuse among elderly persons. Psychiatric Services, 50, 1184-1188.
Satre, D.D., Mertens, J.R., Arean, P.A., & Weisner, C. (2004). Five year alcohol and drug
treatment outcomes of older adults versus middle-aged and younger adults in a managed care program. Addiction, 99(10), 1286-1297.
