Archive for September, 2011

Just Breath

“Just Breath”

Holistic Health Practices in Substance Abuse Treatment for Seniors

The Substance Abuse and Mental Health Service Administration (SAMHSA) in their publication, “Substance Abuse Among Older Adults, Treatment Improvement Protocol (TIP) Series 26” say the standard of care for older adults is motivational counseling that “meets people where they are at.”  In my experience as a behavioral health counselor, this has been a way of helping clients by acknowledging strengths, and these help the person heal.  I remember my training in motivational interviewing with Dee Dee Stout, a nationally recognized motivational interviewing trainer and a professor at City College of San Francisco’s Alcohol and Drug Studies Program.  She reminded us to “roll with resistance” in our classes.  My professional dilemma working with “motivational counseling” is just that, it relies on a minimum of ambivalence to be effective (D. Stout, personal communication, Fall semester 2007).  A person must be able to minimally acknowledge that they are contemplating a change for motivational counseling to be applied.  For some clients this will never be the case.  I have sat in clinical staff meetings and discussed what is getting in the way; was it culture, honesty, low self-esteem, or pride interfering with the process.  The problem remains, the client is struggling with talk therapy.  The solution always suggested by my supervisors has been to work with holistic health practices.

Marietta Arroyo a senior case manager at Asian American Recovery Services, Inc. Project ADAPT, an outpatient behavioral health program in San Francisco’s Panhandle district describes holistic health as a connection of mind, body, and spirit.  Ms. Arroyo believes that “not everything can be accomplished through a verbal process.” She explains that practices we might take for granted are vital in treatment.  “Just learning to breath” is something Ms. Arroyo teaches her clients.  She uses an example of a client speaking about the past, which brings not just emotional, but also physical symptoms. Reminding and helping a client to breath can settle their body and emotions (M. Arroyo, personal communication September 19, 2011).

Ms. Arroyo believes that community connection is vital in holistic treatment because people feel socially isolated through substance abuse and often as an impact of the aging process. Seniors in recovery carry shame and want to be able to provide value to others. By using the treatment community and having the members participate in roles such as cooking lunch for the community, working together on a project, or even cleaning the facility, clients can gain a sense of worth (M. Arroyo, personal communication September 19, 2011).

Garrett Chinn, an Instructor of Tai Chi Chuan, and a member of the Older Adults Department at City College of San Francisco has been working with seniors for 30 years.  For addiction, he talks about the need for balance.  Mr. Chinn cites research that shows 30 percent of seniors over 65 have at least one fall a year in emphasizing how physical balance affects emotional and spiritual balance.  He discusses the symbol of Ying and Yang, and says it is not two opposites, as he believes most people understand it, but the connection of both sides.  “A higher way” he says, is that “we can learn from both halves.”  In Chinese medicine the key is internal as well as external balance.  Mr. Chinn says, “Stress leads to relapse, …so physical balance may neutralize extreme emotions.” He talks about how clients go from tired to more positive feelings, including increased energy and relaxation by the end of his group.  He believes “more clarity upstairs will help resolve their issues (G. Chinn, personal communication September 16, 2011).”

Mr. Chinn sees Tai Chi as more appropriate for seniors than jumping jacks or pushups.  Additionally Tai Chi challenges their memory, as they must remember the movements.  He likens it to a “crossword puzzle.”  Tai Chi can be a “healthy habit, a substance free way to get high (G. Chinn, personal communication September 16, 2011).”

Cynthia Chang, Licensed Acupuncturist and the creator of the Tara Healing Center in San Francisco says that wellness is in us.  “We have a divine pattern of wholeness, a divine plan of perfection.”  She too describes holistic health as the connection of the mind, body, and spirit (C. Chang, personal communication September 19, 2011).

With substance abuse it is not about drugs, says Ms. Chang, but about why we use drugs.  Acupuncture helps clients listen to “your higher self-speak.”  This opens the door for forgiveness and healing.   Acupuncture helps the energy in our bodies flow.  Needlepoints are like “gates,” describes Ms. Chang.  When part of our energy is not flowing, it also keeps our thoughts from flowing.  Acupuncture lets you be in the present.  Being in the present brings clarity and allows us be “more fully ourselves (C. Chang, personal communication September 19, 2011).”

It was interesting that in my search for techniques aside from talk therapy I was brought back to them.  Ms. Chang says that if we have worked on the body and the illness continues, the question should be, “What is our core belief that causes this pain (C. Chang, personal communication September 19, 2011)?”

“The ability to be in the present will give you permission to follow your heart.” She too reminds us to breath, saying if people can breath easier, she believes they can work towards healing and the idea that “everything I need, I have,” in terms of the ability to heal (C. Chang, personal communication September 19, 2011).


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 Substance Abuse Among the Elderly

“A Hidden National Epidemic”

Substance abuse among the elderly is a “hidden national epidemic” according to The New York State Office of Alcoholism and Substance Abuse Services (OASAS).  In a recent article titled “Elderly Alcohol and Substance Abuse” they describe that an estimated 10 percent of the total population of the United States abuses alcohol, yet up to as many as 17 percent of adults over 65 years of age are abusing alcohol.

Treatment Improvement Protocol (TIP) 26” from the Substance Abuse and Mental Health Services Administration (SAMSHA) in 1994 foreshadows what we see today in America.  They report that only recently the subject of substance abuse in the elderly has been discussed in literature.  The report warns that as the baby boomer generation in our country approaches the age of 65 this fact will no longer be avoidable. Christine L. Himes writes in “Elderly Americans” that United States census data from the year 2000 saw 35 million Americans over 65 in our total population, which is one out of every eight people. By 2030 that number is estimated to rise to one in five Americans.

In a Summary Report from 2005 titled “Substance Abuse Prevention and Treatment: Senior Forums” New York Sates OASAS cites a brief written by Cynthia Morley that is included in “Project 2015, The Future of Aging in New York State, Articles and Briefs for Discussion.” The article cites that five percent of those entering treatment for alcohol and other drug (AOD) problems in New York State are 55 or older.  The concern is a study done in 2000 showed that staff trained with the proper skills to recognize AOD problems at a hospital intake identified 20 percent of that age group screened with AOD problems.  The majority of the time these AOD issues had been undetected and more importantly untreated in these patients.

Studies are also showing the types AOD problems in this age demographic are changing. “The TEDS (Treatment Episode Data Set) Report” by SAMSHA cites data from 1992 till 2008 to show that the patterns for those 50 years of age and over are changing in regards to substance abuse in the United States.  For those 50 years of age and over admissions had risen from 6.6 percent in 1992 to 12.2 percent in 2008.  Admissions for alcohol dropped from 84.6 percent in 1992 to 59.9 percent in 2008.  Heroine use went from 7.2 percent in 1992 to 16 percent in 2008.  Poly substance use increased from 13.7 percent in 1992 to 39.7 percent by 2008.

The TEDS Report” goes on to say that the number of admissions that presented as beginning their abuse in the past five years was fairly constant, going from 3.2 to 3.8 percent from 1992 to 2008.  What did change was the drug of abuse for this group.  In 1992 alcohol was at 42.9 percent, in 2008 it dropped to 9.9 percent.  Methamphetamines rose from 1.3 to 8.6 percent in the time period.  Also prescription medication abuse went from 5.4 percent in 1992 to 25.8 percent in 2008.

There are a number of factors to consider when you look at drug abuse and why it is happening in the elderly.  Some have been abusers all their lives and they take this problem into their later years.  This is evidenced by the “The TEDS Report” data that just fewer than four percent began use in the last five years of their lives.  Other factors that often accompany aging also may play a role.  In their article “Elderly Alcohol and Substance Abuse” OASAS gives us insight into some risk factors in this population.  The reasons OASAS reports for the “late onset” of alcohol abuse are major life changes.  One big change is retirement.  Losing a loved one, perhaps a partner, a close friend, or even a beloved pet could have a tremendous impact.  Family conflict is also cited as a concern.  Health concerns and the challenges that they can present also create risk factors.  Nora Volkow, the director of The National Institute on Drugs and Alcohol (NIDA) writes in her article “Prescription Drugs, Abuse and Addiction” that the elderly are prescribed more medication than the younger population, leaving them at risk for abuse from the medication.

The evidence is clear and demonstrates substance abuse in the elderly warrants serious concern.  Further research in this area could be instrumental.  For example, finding information about gender, cultural, and class differences and how they impact the demographic of seniors who abuse drugs proved unsuccessful in researching this blog.  The impacts to individuals, families, health care, and the communities as a whole are all areas that will undoubtedly be touched by this epidemic.  We could all benefit, and perhaps help our elders, by raising our awareness to this “hidden national epidemic.”


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