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

4. Best Practices

The best practice statements are based on a synthesis of the review of literature and documented expertise provided by the key experts. A wide range of issues were considered regarding access to, and provision of, services to seniors. In many cases, a general consensus was evident as to the central components that underlie optimal treatment and rehabilitation services. These statements reflect important implications to be considered in the provision of treatment for seniors. As research continues these statements will need to be revised and modified to reflect new and additional insights into the needs of seniors and evidence-based practices. The best practice statements follow the order in which the isues were addressed in the document.

Best Practice 1: Prescription and Over-the-counter Medications

Seniors can reduce potential harm to their health by ensuring that their physicians and pharmacists are informed of all medications and substances being used, including prescription drugs, regardless of who prescribed them or how they were obtained, over-the-counter medications, herbal remedies, alcohol or illicit drugs. In some instances, adverse medication reactions may resemble substance use problems, but appropriate monitoring of medications can help differentiate the cause of the symptoms.

Best Practice 2: Prescribing Practices

Prescribing practices must be monitored. Dosage requirements and medications need to be properly addressed.

Best Practice 3: Medication Compliance

Providers of services to seniors must ensure instructions for taking medications are explicit and understood. It may be difficult to recall verbal instructions given in the physician's office. In addition, potential declines in hearing, small fonts on labels, and terminology used in instructions may interfere with communication regarding use of medication.

Best Practice 4: Illicit Drugs

The use of illicit drugs among seniors is currently not considered to be a major issue. Problems in the future may arise as baby boomers become seniors. They will likely bring with them different experiences with marijuana, cocaine, heroin and illicitly purchased prescription medications. These changes should be anticipated and planned for accordingly.

Best Practice 5: Losses as Risk Factors

Isolation and multiple losses (i.e. loss of family, health, independence, roles and social networks) are associated with problem substance use among seniors. In addition, ongoing losses may pose challenges to pursuing treatment and maintaining treatment gains.

Best Practice 6: Screening and Diagnosis

Professionals working with seniors should receive training on screening for substance use problems. Personnel working with seniors in areas unrelated to substance use should be offered training in substance use screening and assessment skills to help them recognize the need for services. Trained service providers need to share their knowledge with family members and clients.

Best Practice 7: Education and Training: Professionals

Educational programs for treatment professionals should include senior-specific training components. Within substance use treatment programs, it is important to have appropriately trained personnel and training should include content relevant to substance use and gerontology.

Best Practice 8: Education and Training: Public

Increased public education and awareness is needed, and initiatives must be senior-specific rather than generic to all adults.

Best Practice 9: Awareness of Services

Awareness of treatment services for seniors should be enhanced. Community and workplace educational sessions provide a forum for information to be obtained regarding substance use and treatment services.

Best Practice 10: Engagement

Engagement may take time. A non-threatening and unhurried approach helps establish the rapport. It is important for service providers to remain flexible and adaptable, and be willing to reschedule appointments or to meet in the home.

Best Practice 11: Assessment

Assessments should not focus only on substance use, but should be comprehensive and include physical and psychological health, social activities, interpersonal relationships, the physical environment, and the strengths of seniors.

Best Practice 12: Treatment Issues: Client-centred

Effective treatment for seniors employs a client-centred approach. Client-centred approaches emphasize reducing the harm of substance use and improving quality of life. Seniors are encouraged to set the pace, goals, and direction of treatment.

Best Practice 13: Treatment Issues: Social Roles

In conjunction with treatment efforts, opportunities for seniors to fulfil social roles or resume responsibilities have benefits. For example, peer-led self-help groups foster hope, social relationships and a sense of purpose.

Best Practice 14: Treatment Issues: Family and Peers

Peers and family should be involved in the interventions offered to seniors, and should be eligible for counselling services. Peers and family members need acknowledgement and support in their coping efforts, and need to understand when they may be inadvertently contributing to the substance use. Establishment and use of support groups for family and peers are useful program strategies.

Best Practice 15: Treatment Issues: Daily Living

Basic living needs, such as housing, nutrition or access to medical services, must be addressed as part of a comprehensive treatment plan.

Best Practice 16: Treatment Issues: Socio-Cultural Differences

Service providers need to be aware of the socio-cultural environment. Peer helpers can help to overcome treatment obstacles related to socio-cultural differences when appropriate.

Best Practice 17: Treatment Issues: Collaboration and Communication

Collaboration and communication among professionals and agencies are critical components of service delivery. Community partnerships enhance the awareness of both clients and case managers regarding the availability of services and how they may be accessed. Partnerships also provide the basis for increased coordination of services and the development of a continuum of care for seniors. The links and partnerships that are forged will be unique to each community, and determined by community needs and resources.

Best Practice 18: Treatment Approaches: Outreach

Office visits or residential components may deter some seniors from seeking services. Outreach services facilitate participation in assessment and treatment planning activities and help build rapport.

Best Practice 19: Treatment Approaches: Transportation

Transportation is an important complement to service delivery. In cases where outreach services are not available, the provision of transportation is a minimum requirement.

Best Practice 20: Treatment Approaches: Harm Reduction

Some seniors may be more receptive to harm reduction approaches, for example if abstinence-based treatment has not been successful. From this perspective, emphasis is placed on reducing harms resulting from problem substance use, and relapse is seen as part of the recovery process.

Best Practice 21: Treatment Approaches: Age-specific Interventions

Seniors benefit from age-specific interventions. Age-specific programming addresses lifestyle issues, the social context, personal concerns, health issues, and creates a new social support network.

Best Practice 22: Treatment Approaches: Tailoring to Individual Needs

Tailoring strategies to individual needs requires integration of various treatment approaches. Those experiencing mild or moderate difficulties with alcohol use comprise the majority of users. For these individuals, full treatment is not warranted, but brief interventions can be effective. These methods are also effective for late-onset problem users.
Cognitive-behavioural therapy is also indicated for seniors.

Best Practice 23: Measuring Effectiveness

Efforts to evaluate treatment program effectiveness would be improved by regular budgetary resources allocated for ongoing evaluation processes. Consultation with qualified research experts is important in the development of an evaluation program component.