Best Practices - Treatment and Rehabilitation for Seniors with Substance Use Problems

1. Project Background and Description

1.1 Introduction

The purpose of this project is to identify best practices related treatment and rehabilitation for seniors with substance use problems and to identify specialized substance abuse treatment programs for seniors in Canada. The project was initiated by Health Canada as part of a research agenda developed by the Federal/Provincial/Territorial Committee on Alcohol and Other Drug Issues.

The project was carried out under the direction of the Working Group on Accountability and Evaluation Framework and Research Agenda (ADTR Working Group). The working group is appointed by the Federal/Provincial/ Territorial Committee on Alcohol and Drug Issues. Part of the mandate of the working group is to oversee the development and implementation of research studies that contribute to innovative substance abuse treatment and rehabilitation programs by identifying best practices, evaluating model treatment and rehabilitation programs, and identifying emerging issues; the knowledge is then disseminated across the country.

This project builds on a series of best practices publications including: Best Practices - Substance Abuse Treatment and Rehabilitation (Health Canada, 1999a); Best Practices - Fetal Alcohol Syndrome/Fetal Alcohol Effects and the Effects of Other Substance Use During Pregnancy (Health Canada, 2001a); Best Practices - Treatment and Rehabilitation for Women with Substance Use Problems (Health Canada, 2001b); Best Practices - Treatment and Rehabilitation for Youth with Substance Use Problems (Health Canada, 2001c), Best Practices Concurrent Mental Health and Substance Use Disorders (Health Canada 2001), and Best Practices Methadone Maintenance Treatment (Health Canada, 2002).

1.2 Project Goal

The goal of this project is to make current information on best practices associated with treatment and rehabilitation for seniors with substance use problems available across Canada. The outcomes from the research are intended to be a resource for service providers and program planners who deliver specialized substance abuse programs. The best practice guidelines were identified by reviewing current literature and interviewing key informants on the issue of seniors with substance use problems and synthesizing the results.

1.3 Sources of Information

1.3.1 Literature Review

The literature review analyzes research related to treatment and rehabilitation for seniors with substance use problems, and identifies current practices and potential implications for effective service delivery. Specific criteria were developed for the selection of the key articles. These criteria formed a basis from which to evaluate the literature in terms of scientific rigour and significance.

The research activities included:

• a detailed review of relevant published and unpublished reports; and
• an examination of specific substance use issues and data.
  

The review considered both research and professional documents from Canadian and international literature, including:

• post 1990 publications (with the exception of two noteworthy studies from 1988 that were identified as pertinent in recent literature);
• professionally reviewed or expert juried research documents;
• summary articles of gerontology research and treatment outcome research;
• experimental studies;
• comparison studies of different approaches or methods;
• quasi-experimental investigations;
• program evaluation reports; and
• theoretical literature directly relating to best practice research.

Several databases were searched, using keywords pertaining to seniors, substance use and treatment, including:

• PsycInfo (database of psychological research);
• DrugInfo (Drug information database from University of Minnesota);
• CCSADOCS (database of the National Clearinghouse on Substance Abuse); and
• CANBASE (database of the Canadian Substance Abuse Information Network).

Several university databases were used to search for publications, including:

• EBSCO (social sciences journal database);
• Novanet (for Dalhousie University and affiliates); and
• Eloize (Université de Moncton).

1.3.2 Key Expert Interview Methodology

A list of key experts was identified in consultation with members of ADTR Working Group. Representatives from each province and territory with expertise in the area were contacted. Twenty-nine key experts participated, and their insights reflect their various backgrounds, training and experience. The key experts were contacted by phone to establish the most convenient method for administering the questionnaire. All respondents were given the time and opportunity to provide detailed information for each question. Most interviews were completed over the telephone, while some of the respondents preferred to answer the questionnaire in written form. Interviews were conducted in either French or English, given the preference of the interviewee. Interview duration ranged from one to three hours, with the average length 80 minutes.

1.3.3 National Program Inventory

The national program inventory describes programs and specialized services in Canada available to seniors with substance use problems. Key personnel in each program were contacted and asked to provide a profile of their program by completing a survey questionnaire.

1.4 Project Definitions: Treatment and Best Practice

1.4.1 Definition of Treatment

For the purposes of this project, treatment is defined as an organized set of approaches and strategies that assist clients to reduce or eliminate problematic use of substances, and that support healthy personal and interpersonal functioning. Although the term substance use treatment implies a single entity, in fact, it includes a complex and variable network of services.

As defined in Canada's Drug Strategy (Health Canada, 1998), treatment and rehabilitation services in Canada include:

... detoxification services, early identification and intervention, assessment and referral, basic counselling and case management, therapeutic intervention, and aftercare and clinical follow-up. Treatment is offered on an out-patient, day-patient, or in-patient basis, including short-term and long-term residential care.

(Health Canada, 1998:9)

1.4.2 Definition of Best Practice

The definition of best practice as it relates to program delivery in the health field has been approached with varying degrees of rigour.

Within health care, the application of the idea of "best practice" has ranged from simply publishing particular practices under the rubric of "best", ... to engaging in a systematic identification of what would constitute "best" within a particular health issue or practice area, ... to a rigorous research-based investigation to identify evidence associated with particular practices (Varcoe, 1998:4).

For the purposes of this project, best practices are emerging guidelines, gleaned from key expert perspectives and supported by the literature, on the approaches and elements of treatment that appear to result in successful treatment outcomes for seniors. Given this definition, best practices are recommendations that may evolve, based on ongoing key expert experience, judgment and perspective, and continued research.

1.5 Project Limitations

This literature review cannot be taken as a definitive analysis of the links between substance use problems and gerontology. The emphasis is on the substance use problems literature. However, it identifies several links that warrant further research (e.g., resilience).