Don’t Rule Out Substance Abuse
When Screening for Dementia
By: Sandra M. Stimson CALA ADC CDP CDCM

It is estimated that by the year 2020 the baby boomers (55 and older) that are using
some kind of illicit substance will increase to 5 million per the Substance Abuse and
Mental Health Administration 2009 report. When screening your patients who exhibit
dementia symptoms, don’t rule out substance abuse. Substance abuse questions
should be a part of your initial assessments.

Staff educators should provide training to the staff on recognizing abuse with alcohol,
medications and illicit drugs. Assign a staff member to be in charge of implementing a
substance abuse program that will provide training and resources not only for the staff,
but also clients, family members and the community. The designated staff member will
also develop community resources for referral not only for your patient but also for
family members who are affected indirectly or directly by the family member substance
abuse.  This would include, educational materials, locations of  community support
groups and treatment facility locators. There are several web sites that provide
treatment facility locations such as
www.samhsa.gov or www.mentalhealth.org.

One recommended training guide is called Promoting Older Adult Health Aging
Network Partnership to address Alcohol, Medications and Mental Health and the web
address is
http://www.jointogether.org/resources/promoting-older-adult-health.html and
the tool kit is located at
http://www.ncoa.org/improving-health/mental-health/mental-
health-resources.html

The Substance Abuse and Mental Health Services Administration and the National
Council on the Aging asked service providers across the country to identify local and
state programs that addressed medication, alcohol, and mental health problems
among seniors in effective and unique ways. The guide provides information about how
the programs work, how they got started, and the resources needed for operation

Staff education should include the following topics: an understanding about how the
substance abuse happened that lead from life transitions, warning signs of substance
abuse, physiological changes, other medications impact on substance abuse,
generational attitudes, acceptable levels of alcohol consumption and why it is hard to
detect in older adults and awareness regarding screening and prevention, challenges
caregivers face in interceding once aware of substance abuse.

“Each individual in treatment will have specific long- and short-term goals. However, all
specialized substance abuse treatment programs have three similar general goals.
  • Reducing substance abuse or achieving a substance-free life
  • Maximizing multiple aspects of life functioning
  • Preventing or reducing the frequency and severity of relapse
  • For most patients, the primary goal of treatment is attaining and maintaining
    abstinence. The exception is methadone-maintained patients. It may take
    numerous attempts and failures at "controlled" use before sufficient motivation
    is mobilized.

Until the patient accepts that abstinence is necessary, the treatment program usually
tries to minimize the effects of continuing use and abuse. This goal is achieved through
education, counseling, and self-help groups that stress:
  1. Reducing risky behavior
  2. Building new relationships with drug-free friends
  3. Changing recreational activities and lifestyle patterns
  4. Substituting substances used with less risky ones
  5. Reducing the amount and frequency of consumption, with a goal of convincing
    the patient of his or her individual responsibility for becoming abstinent. Total
    abstinence is strongly associated with a positive long-term prognosis.
  6. Becoming alcohol- or drug-free, however, is only a beginning. Most patients in
    substance abuse treatment have multiple and complex problems in many
    aspects of living, including:
  • Medical and mental illnesses
  • Disrupted relationships
  • Underdeveloped or deteriorated social and vocational skills
  • Impaired performance at work or in school
  • Legal or financial troubles
  • These conditions may have contributed to the initial development of a substance
    use problem or resulted from the disorder. Treatment program staff  need to
    assist patients in addressing these problems so that they can assume
    appropriate and responsible roles in society. Goals include:
  • Maximizing physical health
  • Treating independent psychiatric disorders
  • Improving psychological functioning
  • Addressing marital or other family and relationship issues
  • Resolving financial and legal problems
  • Improving or developing necessary educational and vocational skills
  • Many programs also help participants explore spiritual issues and find
    appropriate recreational activities.

Increasingly, treatment programs are also preparing patients for the possibility of
relapse and helping them understand and avoid dangerous "triggers" of resumed
drinking or drug use. Patients are taught how to:
  • Recognize cues;
  • Handle cravings;
  • Develop contingency plans for handling stressful situations; and
  • Handle "slips."
Relapse prevention is particularly important as a treatment goal in an era of shortened
formal, intensive intervention and more emphasis on aftercare following discharge.”
Source CSAP  Prevention Pathways.

One recommendation is that for Social Worker or AA community volunteer begin AA
meetings for your customers and residents. Think about the number of residents you
have coming into your facilities as rehab or sub acute patients who have substance
abuse and need to get to an AA Meeting. You can offer this service via phone for AA
meeting that is called Sober Voices as well as having an onsite meeting.  If you are
hesitant about starting a facility AA meeting try to determine the reasons that are
stopping you and then consider the positive aspects for providing an onsite AA meeting.
The positive reasons will definitely outweigh the negative reasons that are holding you
back. Provide the AA 12 steps either by download or provide a computer so the resident
can access the AA 12 step book that is posted on line.  
AA Call In Meetings: Sober Voices for dates and times
http://sites.google.
com/site/aatelephonemeetings/home
AA View 12 Steps on line
http://www.aa.org/1212/
AA for times and locations http://www.aa.org/lang/en/meeting_finder.cfm?origpage=29
Michigan Alcoholism Screening Test-Geriatric Version (MAST-G)
The Regents of the University of Michigan 1991
http://www.ssc.wisc.edu/wlsresearch/pilot/P01-
R01_info/aging_mind/Aging_AppB5_MAST-G.pdf
Free:  Instructor Guide:  Linking Older Adults with Medications, Alcohol and Mental
Health Resources FREE Tool kit
http://store.samhsa.gov/shin/content/SMA03-
3824/SMA03-3824.pdf
Video: It Can Happen To Anyone: Problems with Alcohol and Medications Among Older
Adults. Available
http://www.asaging.org/asav2/aod/bibliography.cfm
Free Publication: Substance Abuse Among Older Adults: A Guide for Social Service
Providers
http://store.samhsa.gov/product/SMA04-3971
Free Publications: How To Talk to an Older Person who Has a problem with alcohol or
medications.
http://www.hazelden.org/web/public/document/ip_talkolderperson.pdf
See article regarding Illicit Drug Use Among Older Adults http://www.nccdp.
org/resources/168OlderAdultsHTML.pdf
Why Every Nursing Home and Assisted Living should Host AA meetings
http://www.ltlmagazine.com/ME2/dirmod.asp?
nm=&type=Blog&mod=View+Topic&mid=67D6564029914AD3B204AD35D8F5F780&tie
r=7&id=1D39BFAA0C9A4D8B84676802D4ECB0D8
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Pathways to the Past
by Sandra Stimson ADC, CALA, CDP
Executive Director,
Alternative Solutions in Long Term Care
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ABOUT SANDRA

Sandra Stimson has
experience as a corporate
consultant, Corporate Trainer
and National Speaker. Her
experience is in long term
care, as Activity Director,
Director of Alzheimer's Units
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550 bed long term care county
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is a Life Replay Specialist.  
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