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Older Women and CoOccurring Disorders

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Title: Older Women and CoOccurring Disorders


1
Older Women and Co-Occurring Disorders
California Women, Children Families (CalWCF)
and The American Society on Aging (ASA)
Technical Assistance Projects funded by the
California Department of Alcohol Drug
Programs present
  • Verda Bradley, PhD, LCSW, M.ED

2
Learning Objectives
  • Recognize the importance of assessment for
    alcohol and drug use and mental health within the
    older women population.
  • Understand older women have unique factors that
    contribute to the effects of co-occurring
    disorders.
  • Understand older women are more vulnerable to
    depression and may attempt to self medicate with
    Alcohol and other drugs.
  • Recognize that COD treatment works.

3
COD Overview
4
  • Co-occurring disorders is a broad term indicating
    the simultaneous presence of two independent
    medical disorders of mental illness and substance
    use.
  • Mental disorder is any clinically significant
    behavior or psychological pattern that is
    associated with present distress/disability or
    with significant increased risk of suffering
    pain, disability, loss of freedom or death.

5
  • Substance Abuse is a pattern of substance use
    causing recurrent and significant adverse
    consequences related to repeated use.
  • Multiple Vulnerabilities is a term used to
    describe other psychosocial factors that may
    exacerbate co-occurring disorders, i.e.., trauma,
    medical problems, financial problems,
    relationships and etc.

6
Multiple Vulnerabilities It can be difficult to
Know What is What
  • AOD use can cause psychiatric symptoms
  • AOD use can initiate or exacerbate
  • AOD use can mask psychiatric symptoms
  • AOD withdrawal can cause psychiatric symptoms
  • Psychiatric Behaviors can mimic AOD Use
    Coexistence compromises management of both
    conditions
  • AND …
  • Health Problems further complicate matters.

7
Current Cost Demographic Projections
  • COD costs accounted for 7.6 percent of all U.S.
    health care expenditures in 2001, 85 billion for
    mental health care and 18 billion for substance
    abuse services
  • Projections indicate persons over the age of 65
    will increase from 13 to 20 by the year 2030
  • In 2030, older adults with substance abuse or
    mental illness is expected to more than double to
    an estimated 15 million individuals

8
Women…
  • with SMI or AOD disorders have higher levels of
    health problems than other
  • with Psychiatric Problems have 3 to 93 chance
    of having medical problems misdiagnosed or
    ignored.
  • What may be even more significant is getting
    appropriate care.

9
Alcohol Use …
  • Telescoping Effect - women do not metabolize
    alcohol as efficiently as men do, and so they
    develop health problems with lower use in less
    timecommonly known as telescoping of
    consequences.
  • When alcohol and prescription drugs are used
    simultaneously, severe medical problems can
    result, including alcohol poisoning,
    unconsciousness, respiratory depression, and
    sometimes death.

10
Post Menopausal
  • Those who had less than one drink a day had a 7
    percent increased risk of breast cancer compared
    to teetotalers
  • Women who drank one to two drinks a day had a 32
    percent increased risk, and those who had three
    or more glasses of alcohol a day had up to a 51
    percent increased risk of breast cancer.

11
Normal Brain
12
The Brain on Alcohol
13
Areas of the Brain
14
Limbic System
  • Bonding/nesting instincts - current research has
    demonstrated that females, on average, have a
    larger deep limbic system than males.
  • This gives females several advantages and
    disadvantages. Due to the larger deep limbic
    brain women are more in touch with their
    feelings, they are generally better able to
    express their feelings than men.
  • They have an increased ability to bond and be
    connected to others (which is why women are the
    primary caretakers for children - there is no
    society on earth where men are primary caretakers
    for children)
  • BUT …

15
Women are Vulnerable
  • Having a larger deep limbic system leaves women
    more susceptible to depression, especially at
    times of significant hormonal changes
  • Women attempt suicide three times more than men
  • Women report that they drink or use drugs because
    they feel bad either psychologically or
    physically, or because they need to keep going in
    impossible life circumstances
  • Depression and shame can interfere with womens
    ability to recognize health problems

16
Health Problems
  • Women with co existing, chronic health problems
    may discontinue clinically effective treatments
    because they appear to increase psychiatric
    symptoms or because self-medication with AOD
    reduces pain and discomfort faster.

17
Screening for Co-Occurring Disorders
18
Prevention programs
  • that screen and address risk factors, promote
    resiliency, and strengthen protective factors can
    help older adults weather the unique
    circumstances that contribute to the development
    and/or deterioration of substance abuse and
    mental health problems.

19
Screening
  • Many geriatric cases are not properly identified
    and present screening and diagnostic methods for
    alcohol use disorders lack adequate validation
    for older persons.

20
Women with COD may Isolate
  • Women are less likely to drink alone in public
    places or be visible in the community with
    alcohol or other drug intoxication they are less
    likely to be identified with an alcohol or
    substance abuse problem and are less likely to
    seek treatment.
  • Many women believe that they are not worthy of
    feeling better or receiving competent medical
    treatment, and thus affect the likelihood of
    their seeking assistance or advocating for
    appropriate care.

21
3 Questions for Mental Health
  • Have you ever been worried about how you are
    thinking, feeling, or acting?
  • Has anyone ever expressed concerns about how you
    were thinking, feeling, or acting?
  • Have you ever harmed yourself or thought about
    harming yourself?

22
3 Questions for Alcohol Drug Use (Health Canada
Best Practice Report)
  • Have you ever had any problem related to your use
    of alcohol or other drugs?
  • Has a relative, friend, doctor, or other health
    worker been concerned about your drinking or
    other drug use or suggested cutting down?
  • Have you ever said to another person, No, I
    dont have (an alcohol or drug problem, when
    around the same time you questioned yourself and
    felt, maybe I do have a problem?

23
3 Questions for Trauma/Domestic Violence
  • Have you ever been in a relationship where your
    partner has pushed or slapped you?
  • Before you were 13, was there any time when you
    were punched, kicked, choked, or received a more
    serious physical punishment from a parent or
    other adult?
  • Before you were 13, did anyone ever touch you in
    a sexual way or make you touch them when you did
    not want to?

24
Scoring
  • If participant answers two questions Yes (1
    mental health and 1 substance abuse or 1
    substance abuse and 1 trauma), complete
  • GAIN Short Screener (SS) or other assessment
    tool.
  • Adapted from Collaborative Care Project, Canada
    and Co-Morbidity Screen, Boston Consortium

25
Considerations for Treatment
26
Appropriate Assessment
  • MAST-G in packets
  • Need to know big picture health, mental health,
    alcohol/other drug, supports
  • Strengths and resources
  • Priorities
  • Incomplete assessments can prevent meaningful
    services.
  • Reassess after detoxification from alcohol and
    illicit drugs

27
Be Wary of Assumptions and How they Affect
Treament
  • For example, psychiatrists often do not ask women
    about medication side effects, especially those
    of a sexual nature (eg, vaginal dryness),
    although they frequently ask men about
    ejaculation and other sexual performance issues.

28
Cultural and Age Sensitivity
  • Asking questions in a respectful manner.
  • Acculturation
  • Relationship between client and service
  • Gender and family roles
  • Historical experiences and trauma
  • How do you refer to your client? How do you want
    her to refer to you?

29
Psychotropic medications
  • Often a critical component of treatment for
    mental health disorders
  • BUT …
  • May also complicate medical diagnoses
  • Have health related side-effects
  • Should not be mixed with alcohol
  • Effectiveness and side-effects may change as
    women age

30
Quality of Life and Wellness Goals
  • Housing
  • Life Purpose
  • Feeling of Contribution
  • Close relationships
  • Case Management

31
Appropriate Services?
  • Most older women with COD benefit from individual
    counseling, and case management. Other services
    may or may not be appropriate -
  • Detoxification
  • Medication
  • Case Management
  • Therapeutic or Educational Groups
  • Family Counseling
  • Recovery Support

32
Challenges to Integrated Care
33
Stigma
  • When medical treatments are not given to or are
    not effective in stigmatized groups, clients may
    be perceived as the source of the
    problemrelabeled as having psychiatric problems
    or being noncompliant.
  • Stigma and discrimination are common for both SMI
    and AOD disorders.

34
Categorical Treatment
  • Stigma and discrimination associated with these
    disorders are exacerbated by categorical
    treatment.
  • SMI and AOD problems are often not eligible for
    insurance reimbursement and are seriously
    underfunded with public monies as well.

35
Separate Systems
  • Treatment for more serious, chronic, and
    disabling mental health and AOD problems is
    provided through separate systems of care, and
    streams of public funding, usually on a
    restricted or limited basis, and often separated
    from general health services
  • The differences in their approaches to care and
    cost reimbursement among AOD, mental health, and
    health care agencies that many clients do not
    receive the assessment or assistance they need

36
Working Together
  • This conference is an example of progress towards
    breaking down barriers to working together.
  • Be aware of womens multiple vulnerabilities
  • Ask questions
  • Screen for more than just your specialty service
  • Listen
  • Get to know other service providers and resource
    organizations in your area

37
Summary
  • What did we accomplish?
  • Defined COD/Mental illness, Addiction, Multi
    vulnerabilities, Stigma
  • Reviewed Womens Limbic system
  • New Screening Tool from COJAC
  • Treatment considerations
  • Barriers …
  • Heard the Voices of Women

38
Contact Information
  • American Society on Aging
  • Patrick C. Cullinane, MS, Director
  • 833 Market St, Ste 511
  • San Francisco, CA 94103
  • 415-974-9642 pcullinane_at_asaging.org
  • www.asaging.org/aod
  • California Women, Children Families TA Project
  • Children and Family Futures
  • Marta Ortegón Davis, MSW, Program Associate
  • 4940 Irvine Blvd., Suite 202
  • Irvine, CA 92620
  • 714.505.3525 calwcf_at_cffutures.org
  • www.cffutures.org/calwcf
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