Workshop Summary Report - Best Practices - Treatment and Rehabilitation for Seniors with Substance Use Problems, March 6 and 7, 2003

Informal Caregivers: Family And Peer Involvement

a) Presentation by Denise Bradshaw

The Seniors Well Aware Program (SWAP) provides in-home assessment and support, withdrawal management, education, care management and support groups to adults 55 years and older in three cities in British Columbia. The mandate is to develop and deliver specialized services to clients who may be experiencing problems due to misuse/abuse of alcohol, prescription and/or over the counter medications. A unique aspect of the service is that it provides in-home detoxification for clients.

Four main psychosocial factors that impact substance use by seniors:

• The death of spouse, family and friends: Seniors are often dealing with significant loss in their lives. Some may have more coping skills due to their life experience, but loss can still have a large impact.
  
  
• Retirement: At this stage in life, identity experiences a shift. Adults may no longer feel productive or may lose self-esteem, and may need help in finding new ways of being and feeling productive.
  
  
• Losses in the social network: Retirement often brings a reduction in a person's social circle. Relocation to a new community or different housing can also accompany retirement.
  
  
• Enabling attitudes and behaviours: Service providers must be cautious in labelling behaviours as "enabling" because there can be a fine line between enabling and care giving behaviour. For example, adult children assist a parent's drinking by buying alcohol for them. They may be embarrassed by the thought of people seeing their parent buying alcohol or simply do not want the parent to be injured by falling. There can be many reasons why enabling behaviour occurs and these need to be determined and addressed appropriately.

Certain characteristics of the older population point to the need for age-specific approaches to treatment. Zimberg (1996) identified three steps to an age-specific approach to treating seniors:

1. Stresses associated with aging must be identified and dealt with (such as retirement, deteriorating health, relocation etc.) This implies a holistic client centred approach;
   
   
2. An accurate diagnosis must be made in order to rule out the existence of other factors that may affect treatment outcome; and,
   
   
3. Seniors should be encouraged to find activities and interests, and to create a new or expanded social support structure. They also need to create new roles for themselves and self-identify new roles that are vital and meaningful for them.

Specific types of support are needed for informal caregivers:

• Validation: The knowledge and concerns of informal caregivers should be validated. Listen and hear what they have to say. These people can provide a wealth of information to service providers that would be difficult to obtain through other means.
  
  
• Information and education: Informal caregivers are sometimes better equipped to understand what is happening and to be effective when provided with information on addictions and guidance in knowing how to help.
  
  
• Counselling - individual and groups: Families also benefit from counselling and support groups.

SWAP has found a number of ways to incorporate informal support networks into treatment:

• Peer-led self-help groups: These groups help build social relationships not based on substance use. For example, the largest group of residents in downtown east side are older adults, many of whom are men who live alone, many who were involved in resource industries. Many are in social housing and have been involved in 12-step programs. These clients wanted a senior-specific 12-step group, so one was created. They meet weekly and many social activities have been created around this group.
  
  
• Co-facilitating: Through SWAP older adults working with a professional conduct clinical supportive groups and psycho-educational support groups all over Vancouver, Burnaby and New Westminster. There is a prevention component as many of the people attending the groups do not have substance use problems but go because they are support for seniors. Here they learn about substance use issues.
  
  
• Groups for co-dependents: Half of these groups are made up of partners and the other half are parents of adult children with substance use problems.
  
  
• Social activities: SWAP believes in parties and social engagement and have recreational and social outings every month. Some seniors have also formed social clubs as offshoots of their experience in SWAP in their own communities.
  
  
• Education/prevention activities: SWAP has taken a creative approach to doing prevention work by setting-up a theatre group comprised of people affected by substance use problems. The group tours the lower mainland presenting skits that raise awareness and explore a range of issues pertaining to substance abuse.
  
  
• Mentoring/peer programs: Working with clients who have participated in SWAP and that may still be drinking, but are managing their lives and want to connect with newly involved people. New clients can talk with someone who has been involved with SWAP before. Mentors work with designated staff for support and debriefing.

All of these activities ensure that SWAP is driven by the needs of the client. Overall experience in SWAP has shown that listening to what the older adults were telling them was what most led to program improvement.

b) Group Discussion - Applying Best Practices

Strategies identified by the participants to apply "Best Practice 14 - Treatment Issues: Family and Peers" to community programs and services

• Organize information sessions for seniors and their families and caregivers. These should be delivered where seniors congregate and feel most comfortable, for example at community-based events.
• Invite family members to participate in a session that focusses on how addictions affect the family.
• Offer group therapy simultaneously for seniors and caregivers.
• Establish a structured 8-week self-help group for seniors and their families around substance use.
• Include the client and family members for case planning and information exchange at case management meetings.
• Have seniors who have overcome substance use problems share their stories via presentations to groups or one-on-one.
• Group families together for series of short educational meetings that can offer strategies, resources and information on a practical level.
• Establish co-dependency groups.
• Organize 'Care for the Caregiver' retreats delivered by skilled professionals, for families, friends and caregivers.
• Link people to existing seniors' groups.

Defining 'Family'

There needs to be a broad definition of family to include relatives, friends and others who are in a caring relationship with the client. 'Family' members need support, affirmation and information. They can provide professionals with useful information and insights which contribute to improved treatment.

When family/peers cannot participate

Families are sometimes too far away or have other reasons for not participating in treatment with their family member. Agencies can still provide support to families by sending information packages helping them understand the recovery process.

When some family members are not willing participants

The focus for professionals should be on family members who are willing to participate in education and treatment programs. Experience has shown that unwilling family members may eventually be drawn in through the process.

Expectations on families

Agencies and professionals need to have realistic expectations of what families will be able to do in assisting their family member through treatment and recovery. Families need to be guided to access other available supports.

When seniors are isolated

When seniors are isolated, often because family are living at a distance, it may be appropriate in some cases to move seniors in with the family. When this works, it is found to be beneficial to both the family and client.

Involving seniors in programming

Seniors should be involved in planning programs in a meaningful way, not just as 'tokens'. Participatory approaches can be effective. There are also opportunities for seniors to be involved in multiple levels of service delivery.

Principles in working with volunteers

It is important to clearly define roles and boundaries for volunteers. Efforts must be made to find ways to value and validate volunteers, as they need to get something back from the experience.

When family members turn up intoxicated

Programs need to establish clear boundaries and guidelines whereby work will proceed only when participants are sober.