CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Staffing Considerations

The following principles should guide staffing choices in substance abuse treatment programs:

• Whenever possible, employ staff with training in gerontology.
• Employ staff who like working with older adults.
• Provide training in empirically demonstrated principles effective with older adults to all staff who will interact with these clients.

Credentials and Training for Program Staff

Staff working with older adults need to understand the developmental tasks of aging and the basic principles of educational gerontology—how older adults learn and process material. Therefore, any program that treats even a few older adults should have at least one staff person who is trained in the specialization of gerontology within his or her discipline. This training should consist of at least a graduate certificate program (6 to 12 months) in the subfield of aging commonly called social gerontology.

Staff with professional degrees should have a specialization in gerontology, geriatrics, or psychogeriatrics. If staff lack appropriate credentials, it can be difficult for the program to receive reimbursement from insurance companies or funding from other sources.

Any program that seeks to serve older adults should also have a registered nurse on staff. Ideally, this nurse will have a background in physical health, addictions, and gerontology. In freestanding programs that assign only one person to older clients (common in rural areas), a master’s degree in nursing with a specialty in gerontology is preferred.

Large programs with interdisciplinary teams should include a registered nurse, a social worker, and chemical dependency counselors. All staff should have master’s-level training with specialties in gerontology. The social worker should be prepared to carry out case management roles, including liaison to community agencies.

Some programs in isolated areas may serve only a few older adults in a mixed-age setting. They may be unable to retain staff members with optimal training. In such cases, the staff person who works with older clients should have a strong desire to do so. Also, he or she should have some knowledge of the developmental tasks of aging, through experience or, ideally, formal education. When possible, programs that have no appropriately trained staff should encourage at least one staff member to attain certification.

Programs with linkages to layers of services–large addiction programs or programs linked to hospitals, health care systems, or multiservice agencies–are common in urban settings. The following professionals should ideally be available to a treatment program. They can be members of the program’s treatment teams or resources available through the program’s linkages with other services:

• A geriatrician
• A geriatric psychiatrist
• A geropsychologist
• A gerontological counselor
• A nutritionist
• An activities director or recreational therapist (to make home visits, increase socialization, and teach activities to fill leisure time)
• A chaplain or other member of the clergy
• Occupational therapists
• Social workers (clinical, community, administrative)
• Peer counselors (particularly valuable because they have many life experiences in common with clients)

Orientation and training of all staff are necessary. Staff should understand and believe that the prognosis for recovery for older adults is favorable. They should understand that older adults can learn and change, and they should be capable of showing respect to older clients. Ongoing training on counseling skills and their application with older adults should be available to peer counselors and other program clinicians.

Attributes and Personal Traits

The following qualities have been found to be useful in staff of treatment programs for older adults.

• Interest in and special training in social gerontology and common medical and psychiatric problems of older adults
• Temperament suited to a slower, more relaxed and emotionally supportive approach to treatment vs. a more confrontational approach often used with younger clients

Facilities should project the attitude that they want to serve older adults. It is important that all staff who work with older clients actually like adults in this age group. When hiring, program staff should try to determine how older adults fit into the applicant’s life. For example:

• Does the applicant interact with an older person by choice, as a friend?
• Does he or she interact with older family members on a regular basis?
• Does he or she interact with older adults on a regular basis through volunteer activities or other activities in the community?

Staff need a sense of the issues involved in aging. This understanding can be gained through training, empathy, or the personal experience of growing older. With this understanding comes a willingness to listen and to be patient with the older adult’s pace of movement and speech. A sense of humor is also important.

Nonconfrontational personalities typically work better with older adults. People who prefer an emotional or confrontational approach to therapeutic interaction are not appropriate candidates for work with older adults. Staff should be able to work in groups as trainers or teachers. Staff who work with older adults also need to be flexible and willing to carry out tasks that may not be considered "professional."

Staff members and volunteers need to be open to multiple avenues to recovery. If recovering staff see their own route to recovery as superior or the only way, it may limit their ability to work effectively with older adults. Older people tend to require more flexible approaches in order to find their path. Effective treatment for the older adult is more holistic, more supportive, and often a great deal more complicated than standard addiction treatment.