10 Barriers to Addiction Treatment for Older Adults
It's no secret that we, as a society, are growing older more quickly than at any other time in history. When we look at the lack of treatment facilities and programs available to seniors and the comparative lack of discourse regarding this rapidly growing social concern, it is easy to see how the issues around seniors and addictions have crept in quickly and well under the radar of governments and health authorities.
Addicted seniors are, apparently, a lesser concern than warranted with much of the service dollars going to womens' and youth issues. With a very narrow focus on the wide-spread problem of seniors being active addicts it is little wonder that senior services and research receive a very small portion of the treatment dollars available.
The Barriers to Age-Appropriate Treatment
It is not just the lack of public or governmental recognition of the problem that is troubling. I have compiled a list of ten barriers to treatment for seniors that are a 'MUST' to consider if we are going to head off a growing problem with huge implications for addicted seniors who are in desperate need of support and services:
(in no particular order of importance)
1. Family Secrets
Many families are more likely than not to keep "dad's drinking problem" an internal family issue than to actually deal with it and get the appropriate support necessary. The rally cry is "we can handle this ourselves." After all, we are a very private bunch who likes to keep those secrets-secret. This is especially true if the family has a professional reputation to protect.
It is not about embarrassment but rather about judgements and a lack of understanding what is required to provide help but not knowing how to keep it 'quiet'.
2. Family Embarrassment
Then there is the 'embarrassment factor'. This is similar to 'Family Secrets' above, but different in that it happens, not from a lack of understanding, but from having to publicly admit that dad or mom is a drunk or an addict.
What is similar is that the addict doesn't get the support, encouragement or the acceptance they need to get better. They become disconnected from the family system because of damaged familial egos.
Seniors are less motivated to change their lifestyle. In some cases they welcome the negative attention since ANY attention is better than no attention.
Because of the lack of age-appropriate treatment programs covered by public funding, private clinics and facilities tend to be quite expensive. They can range up to $40,000 per month in some cases (and as little as $3,000 per month in more basic no-frills programs). So funds definitely play a role whether focused treatment is an option or not.
4. Inadequate Physicians Training & Frequent Mis-Diagnosis
Even though there are more physicians learning about addictions and treatment and some are beginning to 'specialize' in the treatment business, there are still too few who are making themselves available for every-day service. Many physicians still don't have the assessment skills to pronounce a client with a prescription drug problem or a drinking problem. Unfortunately there are some, for a variety of reasons, who may not want to. They are seeing the presenting symptoms as early onset of dementia or mental health related problems such as depression or some other chronic illness and then end up prescribing a medication that could exacerbate the substance abuse problem an often doesn't do much to deal with the psychological (and philosophical) aspects of what the presenting symptoms are truly indicating.
5. Bad Physician-Client Communication & Follow Up
Seniors don't have a great deal of credibility in the 'system' when it comes to describing their issues - so they give up trying and just 'go with the flow'. The physicians rarely take the time to actually listen to what they are being told.
Senior clients often don't know how to speak up and say "hey doc, you missed this..." or "what about that?"
Once they are diagnosed and given a script there is a lack of follow-up visits. "How are you doing?", "Has the medication changed the way you...?", "Have things gotten better or worse for you?"
Clients need frequent follow up visits to provide some accountability on the clients part and to determine the outcomes of the treatment protocol as well as the efficacy of the meds prescribed. That doesn't happen nearly as much as it needs to to be effective.
Two weeks in the life of an addict can be a lifetime when considering life-changing events. Much progress or disintegration can occur in two weeks. If a client has not responded well in terms of his/her drinking or using drugs the chances of them having another chance to go to treatment again are very slim. Their reports become untrustworthy.
6. Lack of Senior-Specific Treatment Programs
There really aren't many treatment programs that are senior-specific and many times seniors end up going to a public program that is attended by clients of all ages.
Seniors tend not to do all that well with teenagers, for instance, who have a very different view of the world around them and the seniors tend to feel frightened, lost, disconnected from their 'real' world and angry. They truly don't understand the type of behaviour that passes for OK now.
The biggest drawback, however, is that older adults lose the belief that they can be helped in a place like this and so they give up. They do their time and leave with little benefit because they see themselves and their problems differently from the 'young ones'. Remember seniors are no different from others in that they have a communication network that chats together. Have one senior talk about his/her experience in a "place like that" and that is often enough to put any others who may need the help off from going for help. There is a lack of credible information.
7. Programs 'Too Remote'
Programs can be quite a distance from their holes, families, neighbourhoods and their friends. They feel isolated and that they are being punished in some way.
The toughest hurdle is their own denial that anything is wrong. They say, "So I have a few too many sometimes-big deal-just leave me alone I've earned the right to enjoy myself" or they forgot to take their meds so they double up thinking that they need to get back on track. They don't want to see the problems with their behaviour and the choices they are making as being potentially harmful.
Seniors use because they are lonely and that isn't going to change whether they cut down or quit. If they don't feel they have a place in the family or that they are loved and valued they are likely to increase their use or use more secretly. If family doesn't have the time to spend with them that is the problem not that they treat their loneliness with alcohol or drugs. They use as a replacement for family and social contact. Why would they give that up by cutting down? In this case it's the family and the relationship with the senior that is the barrier.
10. Lack of Peer Support Groups for Seniors
There is a lack of counseling groups specific to this issue available in appropriate settings that have other folks the same age attending so that they can identify with others who have similar things going on in their lives. There needs to be solid and consistent care and support with accurate information available to seniors about health concerns -- truthful but not threatening. They need to understand what is happening and what their options are.
Taking Care of Our Seniors
Some of the barriers that exist are those created by governments who have lost sight of a whole group of people who need to be represented more energetically. Our seniors need to be acknowledged and treated as equitably as women and youth are when considering treatment solutions. It is true that some of these barriers are created by the seniors themselves but we still need to break them down and make it easier for seniors to accept help. The other part of this is that families need to stop judging their parents or relatives and try to be more supporting, understanding, accepting and caring.
Our seniors are an important resource for us and we need to provide for them at a time when they are most vulnerable. It is time for the rest of us to step up and take care of our seniors just like they took care of us all those years when we needed it the most. We need to represent them publicly. We need to remove the barriers that prevent them from receiving the qualified assistance they deserve. It's called the circle of life.
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