| SUBSCRIBER LOGIN |
|---|
| News Briefs | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
||||||||||
| Polls |
|---|
| Older Adult Treatments: The Baby Boomer Effect |
| Feature Articles - Treatment Strategies or Protocols | ||||||||
| Written by Carol Colleran, CAP, ICADC | ||||||||
| Friday, 06 June 2008 | ||||||||
|
The leading edge baby boom generation is inching towards older age, with the oldest turning 61 in 2007. With this population surge comes plethora of advice, literature, statistics and philosophy about how aging boomers will affect our society. Some say Social Security is doomed; others say that the majority of boomers want to work will continue to support the system. The 76 million-strong baby boomer generation — as a whole, born between 1946 and 1964 — think young and will not tolerate ageism. Just how they will face the physical and mental challenges of aging is a script they are just beginning to write. According to a national survey by the Substance Abuse and Mental Health Administration (SAMHSA), between 2003 and 2005 illicit drug use among people in their 50s increased by 63 percent. The “young older adult” addict may be dependent on drugs, alcohol or both. The current cohort of older adult addicts suffer primarily from alcohol and medication abuse. These numbers will become even more daunting, as the over 55 age group will account for 50 percent of the population by 2020. The survey showed that more than three million people in their 50s had used marijuana, hashish, cocaine, crack, heroin, hallucinogens or inhalants. This is expected to double by 2020. Baby boomers also account for 48 percent of drug deaths in 2003, and more than one-third of all suicides in that same year (SAMHSA, 2003). According to a recent study, conducted in part at Hanley Center, the current older adults (especially those who are 65 and older) overall seem to have less severe alcohol-related problems than “middle-aged” or older baby boomers, including: lower consumption rates, less prior outpatient treatment experiences and less psychiatric comorbidity (Oslin, Slaynmaker, Blow, Owen, Colleran, 2005). Successful age-specific treatment for the current or “traditional” older adult is that which addresses generational values. Older adults tend to pass harsh moral judgment on illicit drugs, and even the term “alcoholic” carries shame and blame. Raised to respect authority, to “pull oneself up by one’s bootstraps,” and to certainly “never air your dirty laundry,” the older adult has found it difficult to seek help or treatment for the disease of addiction. However, we have found that after holistic, age-specific treatment, they are also more successful in their recovery than other age groups. Hanley’s Center of Older Adult Recovery alumni follow-up program has found a recovery rate of between 75 and 95 percent. Also, SAMHSA reported that older adults who comply fully with treatment after a brief intervention are more likely to positively change their behavior than younger adults (SAMHSA, 1998). However, traditional older adults may not fully utilize formal aftercare, as other studies have shown (Bernstein, 2005). They may not engage in after care because of a perception that their addiction is not severe enough, or that they may have problems with transportation or other health issues. Understanding the “Me” generation The “Me” generation, catered to by the country’s most self-sacrificing generation of parents, is not impressed with authority. This is the generation of Woodstock, the Vietnam era’s soldiers and protestors, witnesses to the Cold War, civil rights movement and culture of perpetual youth. They came of age with a strong sense of idealism and adventure, and matured as the wealthiest generation in the history of the country, due in part from a continuing inheritance from their parents. The boomers’ divorce rate is three times higher than their parents, and many of them have embarked on second and even third families. The baby boomer generation demands service, spending more than $1 trillion in goods and services annually. They expect their problems, such as erectile dysfunction, to be “fixed.” Some even believe death itself can be delayed well past the age of 100. Led by such health gurus as Dr. Andrew Weil, they aspire to “age well.” They also like convenience in everything. Plastic surgery keeps the perception of youth and beauty alive for many affluent boomers. There also is a pervasive attitude among them that “someone will take care of me,” and they have always felt “unique” as individuals. At the same time, older boomers are searching for purpose and fulfillment, goals that can’t be reached with a quick fix. Chronic pain also will become an issue for many. According to a 2005 USA TODAY/ABC News/ Stanford University Medical Center poll, one in five Americans reported chronic pain. Of the 1,204 respondents, more than half of those who reported chronic pain were aged 55 and older (Sternberg, 2005). Self-medication, as well as use of addictive painkillers, will increasingly become part of this picture. A survey sponsored by National Institute of Aging showed that Americans in their early to mid-50s today report poorer health, more pain and more trouble doing everyday physical tasks than their older peers reported in the past (Manton, Gu & Lamb, 2006). This may surprise those baby boomers who assume their generation as a whole is more youthful and fit than their parents were at the same age. Having grown up in a self-help, new age and self-actualization era, baby boomers are not adverse to mental health services and therapy. While denial is intrinsically a part of the disease of addiction, seeking support and treatment doesn’t pose the same moral sentence for them that it does with traditional older adults. Denial also adapts to generational values. Many young older adult addicts feel that if they continue to exercise, take lots of vitamins and cut out the fat, they must be leading a healthy life. Some adults in their 50s and older, in the tradition of self-help, may take a break from alcohol by checking into a “health spa.” Often calorie and alcohol restricted, the spa makes up for this sense of self-sacrifice with a milieu of pampering spa treatments. In essence it is a time out before plunging into “life” again. Why is addiction on the rise with the 50 and older age group? Depression and anxiety are common among young older adults who enter treatment. We find that at least 60 percent of our older patients who present to treatment are on some type of psychotropic medication. Overwhelm-ingly, these patients have struggled with issues of losing a sense of purpose. For a generation of idealists and people who felt instrumental in everything from their own career path to changing a nation’s values, this can lead to feelings of being devalued and having no purpose in life. Eating disorders are on the rise among middle age to older women, and often coexist with other addictions: alcohol, chemical addiction, even shopping or cosmetic surgery addiction. Think about this in the context of a youth-oriented generation and culture: the loss of youthful attractiveness often results in women feeling “invisible.” Women tell us this, despite the fact that as a group, women in this generation have significantly more self-esteem and education than their mothers did. Evolving treatment for today’s young older adult After medical stabilization the whole person must be addressed — spiritually, mentally, physically and emotionally, including an individualized wellness program that is implemented to slowly regain the most optimal level of health possible. Individual wellness plans must be developed with great care to integrate moderate exercise, when appropriate, rather than allowing rigorous or compulsive exercise. We often hear from young older adults that their real breakthrough came from exploring spirituality. Really, this large spiritual landscape is what comprises a “way of life.” Everyone has one, and an active addict has an unhealthy way of life. What will make it meaningful, healthy and productive? What values can a person revive and embrace in relationship to self, others and a higher power? Therapists may be faced with a unique challenge in treating the young older adult patients, one that is not found in the traditional older adult population. The young older adults need to be in control of their lives, which can manifest in a desire to have controlling input into the full spectrum of their care, or to be “in control” of their care. Often the element of inflated ego, a common issue in addiction, complicates the challenge. Motivational Interviewing (MI) is often quite an effective and appropriate therapy as part of a 12-Step holistic program for this age group. It authentically answers their need to be heard, because MI strives to engage the individual in his or her own recovery process. Young older adults are more open to journaling and sharing stories than the traditional older adult. A successful structure in group therapy, for example, could begin with posing a topic for conversation, such as, “What is your biggest fear about getting sober?” and then letting the group run with it. This age group responds well to a direct but respectful approach in group or individual therapy, as compared to the current older adult cohort, which is responsive to an indirect approach. The older group’s values skew to reluctance to discuss “private” problems, which are perceived as shameful. We have found that Dialectical Behavior Therapy, or DBT, resonates with the young older adult patient. This Zen-based therapy utilizes mindfulness and other guided practices which promote acceptance and living effectively in the present. Participants also learn to “meet life on life’s terms,” rather than being attached to the past or what could have been, or even what might be. DBT helps patients to disengage from old rigid beliefs that form crippling judgments of relationships and situations. This therapy can be a catalyst to “let go.” As Bill Wilson wrote in the Alcoholics Anonymous text, “Some of us have tried to hold on to our old ideas and the result was nil until we let go absolutely” (AA, 1939). Gender-specific treatment for young older adults may be especially beneficial for women in this age group. Most have experienced the physiological and usually emotional aspects of major hormonal life changes such as menopause, and they participate in a hormonal shift assessment and care plan that addresses those emotional upheavals, such as cravings, or in some cases, depression, as well as physical symptoms. Care plans are individualized and include healthy coping strategies. Eating disorders — since they can affect women in midlife — may be diagnosed as well, and treated concurrently. Men’s issues in addiction and recovery often stem from societal and family structures and expectations. Leading edge baby boomer men grew up in an era of emotionally distant fathers. Competition was very highly valued, and men were supposed to fix things, take care of business and the family, and on top of all that, “stuff” their emotions. Anger was the exception, but expressing that anger was and is often dysfunctional and destructive. Although treatment for males has traditionally been presented in a confrontational style, it makes sense that a safe, emotional environment in which to explore male issues, such as relationships, anger, power and identity can help men to establish more positive beliefs and behaviors. Self-care and the concept of services Self-care and nurturing, such as personal grooming and appropriate exercise, can help to build damaged self-esteem. Each individualized care plan that includes wellness and self-care is developed within the context of the 12-Step philosophy, treating the mind, body and spirit. Therapeutic massage can be as physically therapeutic as it is “pampering.” For example, the therapeutic massage takes place in an atmosphere that is serene and pleasing rather than medicinally sterile. This will go a long way towards addressing the person as an individual and client, not just as an alcoholic or patient. When young older adults partner and are guided by their therapy team in choosing therapies/services that are appropriate, they are apt to benefit more from them. These therapeutic services also may include techniques for chronic pain management, learning meditation and gentle mind/body exercise such as yoga, gentle aquatic exercise or Qi Gong, equine therapy, pet therapy, acupuncture or acupressure. At the same time, they learn how to practice the 12-Step program, which is fundamental to recovery. Finding purpose Persons in early recovery who are medically and psychologically stabilized can begin exploring more fully what a purposeful, meaningful life may mean to them. This may be a component of outpatient continuing care, depending on the individual. There are several programs that train counselors to facilitate such exercises, in group therapy or in a continuing workshop form. The counselor may guide participants to explore these questions: •What gives you a sense of satisfaction, inspiration, joy or openness? The exercises explore how the subjects of joy, satisfaction and inspiration can be translated into living with new peace, passion and tuning in to life. Options cover the gamut from the exciting to the sustaining, and may include: a new career or part time job; embracing an old talent or hobby; diving into a cause close to one’s heart; committing to a mentorship; creating a new life with family or writing one’s life story. Some people may take an interest in learning more about managing their personal finances, and some even decide to return to school. Overall, planning for an emotionally healthy retirement becomes just as important as financial planning. All of these avenues are goals with a step-by-step approach, in part, because quick disillusionment with something rashly embarked on can be a risk factor for relapse. Early recovery is also a time when biomedical and/or psychological care may be needed, and strong support from family and a recovery support group such as Alcoholics Anonymous (AA) is vital. The baby boomers, who are generally more open to therapy and participation in support groups than the traditional older adult, are more apt to engage in support groups. The baby boomer generation has touched and changed the American landscape, creating its own icons with its distinctive flair, enthusiasm and idealism. Treatment for alcohol and chemical dependencies as well as other addictive behaviors will need to adapt in order to successfully reach a growing population. The challenge in addiction treatment for this group is to engage baby boomers, yet provide the treatment they need, not necessarily what they may initially want. Style without substance will not work, and does not demand behavioral change or help a person reclaim or restructure a life; it is only that elusive “quick fix.” C References Alcoholics Anonymous (1939). The Big Book. AA World Services.
Powered by !JoomlaComment 3.26
3.26 Copyright (C) 2008 Compojoom.com / Copyright (C) 2007 Alain Georgette / Copyright (C) 2006 Frantisek Hliva. All rights reserved."             |
||||||||
| < Prev | Next > |
|---|
