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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

It is most useful to think about problems with substance use as being on a continuum. The earlier that you can intervene in the development of problems, the greater the likelihood that the client will be able to make the necessary life changes. Problem use of alcohol or psychoactive medications can affect many systems of the body, as well as many other aspects of a person’s well-being — psychosocial (e.g., relationships, memory), spiritual and environmental (e.g., living conditions in the home).

Although the risk of a person developing problems increases with a higher volume and/or frequency of substance use, problems can and do occur at very low levels of use (e.g., a few drinks a day, combined with a psychoactive medication). For some clients, the effects of substance use will be very visible and easily identified (e.g., they have a long history of heavy drinking, which has resulted in multiple physical and psychosocial problems).

For others, it may be difficult to determine whether their use of substances is contributing to the difficulties they are experiencing (e.g., they may be combining a therapeutic dosage of psychoactive medication such as a tranquillizer with one or two drinks during the evening and experience some confusion, dizziness or falls).

Here is a simple definition of problem substance use:

A problem exists when the use of a substance(s) results in negative consequences for the person, and the person continues to use the substance(s) despite these negative consequences. Negative consequences may affect physical health, environment, relationships, spirituality, legal status or other areas of the person’s life.