Best Practices - Treatment and Rehabilitation for Seniors with Substance Use Problems

2. Review of the literature (continued)

2.10 Barriers to Treatment

2.10.1 Practical Considerations

Segal et al. (1996) list the following practical barriers to accessing treatment:

• physical infirmity;
• hearing or vision problems that interfere with ability to participate;
• not having the treatment centre in a convenient location;
• having no mode of transportation; and
• programs that require a live-in stay may be a deterrent to seniors who do not want to leave their own home.

Someone "who is in poor health, cannot get around, is living in unhealthy circumstances, or is confused, will not be able to deal with alcohol and drug use until these immediate problems are addressed" (Baron & Carver, 1997, p. 279).

2.10.2 Mis-diagnosis

Health professionals have differing views as to what constitutes alcohol or substance dependence. According to Solomon et al. (1993), the lack of specific definitions, of age sensitive screening tools and of consistent criteria by which to diagnose a problem in seniors may lead to under-diagnosis (failure to detect a problem) or mis-diagnosis. Co-morbid conditions, for example, physical symptoms such as gastritis or dizziness, or psychiatric symptoms such as dementia, depression or insomnia, further complicate diagnoses.

2.10.3 Denial

Some seniors do not want to admit that they have a problem and will use denial, rationalization, defocussing and minimization to explain their behaviour (Solomon et al., 1993). Many assessment tools are based on self-reports, and therefore depend on accurate and honest responses. Overt denial and forgotten episodes of substance use can contribute to underdiagnosis (Buchsbaum et al., 1992; Solomon et al., 1993).

2.10.4 Social Stigma

Depending on the age of seniors, they may have been raised during the prohibition era. This era was followed by a period of time in which alcoholism was viewed as immoral and some seniors may view their substance dependence as a moral weakness (Rush & Ogborne, 1992). Shame and guilt often prevent this cohort from admitting publicly to a problem (Blow & Barry, 2000).

2.10.5 Fear of Failure

Many people are afraid to try something new for fear they will not succeed. This type of thinking maintains patterns of behaviour, despite negative or harmful consequences. According to Segal et al. (1996), for late-onset heavy drinkers, fear combines with discouragement over previous unsuccessful attempts to attain sobriety, and may create a sense of hopelessness. Individuals may believe that they are incapable of changing and therefore stop trying (Baron & Carver, 1997).

2.10.6 Enabling Attitudes and Behaviours

Enablers include family, friends, caregivers and physicians who believe that the senior does not have much left in life to enjoy, so should be allowed to drink. Enablers shield them from the consequences of their actions (Baron & Carver, 1997; Mellor et al., 1996; Segal et al., 1996; Tabisz, Jacyk, Fuchs & Grymonpre, 1993). Whereas younger adults often decide to seek treatment as a result of pressure from family members, lack of education about the harmful effects of substance use in seniors and misguided intentions may stop enablers from encouraging the senior to change (Segal et al., 1996). As well, family members who want to protect the senior from embarrassment may misrepresent the substance use problem (Buchsbaum et al., 1992).

2.10.7 Attitudes of Heath Professionals

Parette, Hourcade and Parette (1990) investigated attitudes of medical health professionals toward patients with alcoholism. Health professionals were observed adopting a moralistic perspective toward alcoholism with these patients. They tended not to pay as much attention to them and attributed complaints and behaviours to the alcoholism, even when such judgments were not warranted. The researchers suggested that such attitudes may interfere with treatment and recovery.

The "ageist" bias exists among some health professionals who believe that seniors are too old to learn something new, especially if it requires change. Corresponding to this is a belief that ingrained patterns of behaviour are too resistant to change (Mellor et al., 1996; Tabisz et al., 1993). Danzinger and Welfel (2000) examined age bias by devising theoretical case studies (with age, gender and health as variables) and submitting them to mental health counsellors for assessment and diagnosis. Counsellors were also asked to judge the theoretical client for competence and prognosis. Results showed that the seniors were seen as significantly less competent and their prognoses were more negative (Danzinger & Welfel, 2000). This attitude that senior people are resistant to change, and therefore more difficult to work with, may account for some of the enabling behaviour of health professionals who do not encourage treatment for their substance dependent patients (Danzinger & Welfel, 2000).