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Choosing to Change: A Client-Centred Approach to Alcohol and Medication Use by Older Adults

Section 2: The Client - Identifying the Problem

Older adults’ problems with alcohol and/or psychoactive medications can generally be divided into three groups with distinct profiles and challenges: early onset, intermittent and late onset.

Early Onset

• Early onset refers to problems with alcohol or psychoactive medication that a person first experiences early in life and which continue over time. Typically, counsellors report that people with early onset problems come to treatment between 50 and 60 years of age, although these clients may have been involved with the treatment system over the years.

People with early onset problems include those who are often referred to as “chronic alcoholics.” Characteristically, they have tried to stop using many times. However, they may feel overwhelmed by current problems and hopeless about the future. They may lack confidence in their ability to change and see the odds as stacked against them. In addition, based on previous experiences during withdrawal, they may fear they will die the next time they try to quit.

•  The challenge with people who have early onset problems is often to help build successes and hopefulness into a life where the consequences of years of substance use problems have taken a significant toll.

The negative consequences that are associated with long-term substance use may need attention. For example, the client may require better housing, improved nutrition, adequate medical attention or help in organizing finances. For a counsellor, it can be a challenge to stay hopeful and resourceful when there are serious chronic issues.

Intermittent

• Intermittent refers to problems with alcohol or psychoactive medication that a person experiences in episodes throughout his or her life, often separated by long periods without problem use. Typically, clients with intermittent problems seek treatment because of a crisis in their lives.

Generally, those with intermittent problems have been able to control their psychoactive medication and alcohol use. On occasion, however, family problems, legal problems or work-related stresses would result in increased use and subsequent problems related to that use. When each episode or problem ended, the problematic use of alcohol and/or medications would usually end as well.

• The challenge is to help people with intermittent problems recognize that physical sensitivity to alcohol and medication increases with age and that the risk associated with periodic heavy substance use also increases with age.
• Other challenges with intermittent problems (which are also challenges with late onset problems) include identifying and addressing the underlying issues that have prompted change in the client’s former pattern of use, and finding ways to educate the client about the effects of alcohol and/or psychoactive medication use.

Intermittent users may see no relationship between their substance use and their current problems. They may state correctly that they use the same amount or less medication and/or alcohol than they once did. For a counsellor, the intermittent nature of problems can make identification and treatment difficult (see also Late Onset).

Late Onset

• Late onset refers to problems with alcohol or psychoactive medication that a person first experiences late in life. Typically, counsellors say that late onset problems begin after age 65.

In younger years, people with late onset characteristics may have used psychoactive medications periodically or alcohol socially, but they did not experience problems related to that use. Alcohol or psychoactive medication problems developed in their senior years as a result of increased levels of consumption and/or increased sensitivity to these substances. Generally, they can recall clearly why they began to increase their substance use.

Their reasons are often age-related (i.e., changes in lifestyle following retirement or losses associated with aging). At the point of seeking help, most have suffered fewer physical, emotional or financial losses than people with early onset problems. Thus, their habits are not well entrenched. Their support systems are likely to be intact.

• The challenges with late onset problems (which are also challenges with intermittent problems) include identifying and addressing the underlying issues that have prompted change in the client’s former pattern of use, and finding ways to educate the client about the effects of alcohol and/or psychoactive medication use.

Often, the cause of the change in substance use is easily recognized. The personal history of the late onset client will often show a fairly recent loss, change in role or change in health status. It is important to listen to the client’s feelings about recent changes in his or her life over the past few years (i.e., the past five years) and how he or she is dealing with those changes. Is the client, for example, dealing with unresolved grief issues by drinking or taking psychoactive medication?

Clinicians have found that people with late onset characteristics are generally most receptive to lifestyle change directed to problem resolution. While they may not initially recognize their problems as being related to substance use, they have recent memories of feeling better and operating at a higher level. They often have higher self-esteem and self-confidence than users whose problem use began earlier in life. For the counsellor, the dual challenge is to address the crisis that triggered the change and to help the client understand the harmful effects of alcohol and/or medication use.