SAMHSA logo Report to Congress - Nov 2002








Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

Chapter 4 - Evidence-Based practices for Co-Occurring Disorders - Interventions for Older Adults with Co-Occurring Disorders




Interventions for Older Adults with Co-Occurring Disorders

Today, older adults tend to under-utilize mental health and substance abuse services. This may be a generational issue related to the considerably greater stigma that was associated with these disorders in the past. The reliance of older adults on primary care providers also contributes to the under-utilization of services - and to the under-identification and diagnosis of mental and/or substance abuse disorders. Also, many primary care physicians receive insufficient training in geriatric assessment and care, or in the treatment of substance abuse and mental disorders in older adults (Administration on Aging, 2001). As SAMHSA constituents observed, the need is great and the cost of such inattention is high (SAMHSA, 2002f). For example, depression is a known risk factor for suicide in older adults; national rates of suicide are highest among Americans age 65 and older (The Surgeon General's Call to Action to Prevent Suicide, 1999).

Substance abuse, too, is likely to remain undiagnosed in older adults for a number of reasons. Symptoms of substance abuse in older individuals may mimic symptoms of other diseases common in this group, including diabetes, dementia, and depression, leading to potential misdiagnosis (CSAT, 1998). Older adults may be ashamed to seek treatment for substance use, and family members and even providers may not understand that substance abuse can be successfully treated in older adults. Here alcohol testing may be helpful; for the same reason, drug testing among older adults should include attention to prescription drugs that are subject to misuse and abuse. Further, mental health services and substance abuse treatment providers rarely receive sufficient training in the diagnosis and treatment of these disorders in older adults (Schuckit, 1982, in Bartelsand Liberto, 1995).

Older adults often receive care from many different providers - including psychiatrists, elder care workers, mental health case managers, homemakers, visiting nurses, respite care workers, and substance abuse counselors - and they may attend 12-step and other self-help groups and senior citizen center programs (Bartels in Liberto, 1995). Coordinating that care can help contribute to better diagnosis and treatment; it can help avoid the dangers of inadvertent medication misuse that arises so frequently among older adults - the foremost users of both prescription and over-the-counter medications.

Effective Interventions

Few studies have been conducted to assess the efficacy of various treatment models for older adults with co-occurring disorders. What is known, however, is that, successful programs for older adults often involve collaboration between a behavioral health care provider and an aging services provider. One such example is in Adair County, Kentucky. The program - a joint venture of the county government, the community mental health center, and the area agency on aging - provides a broad range of treatment and services that can benefit older adults with co-occurring disorders, such as outreach, assistance with daily activities, nursing services, individual and group counseling, personal care, advocacy, and meals. Referral arrangements exist with the local hospitals, self-help groups, nursing homes, rehabilitation programs, and physicians (SAMHSA, 2002b).