What is it all about?

Transcription

1 D. Shane Koch Rh.D, CRC, CAADC Rehabilitation Institute SIUC What is it all about? This seems to be a REAL emerging issue The drug culture and drug menu has shifted (again) The populations that are affected are quite diverse I would like to talk about the challenges that seem to be emerging as well as to facilitate some discussion about how this is going to affect our lives My limited direct experience with this issue does not make me feel very optimisic 1

2 Expanding Populations Older Adults Baby Boom Characteristics Individual Characteristics Co-occurring Disabilities Co-existing Disabilities Challenges of Aging BPSS Biological Psychological Social Spiritual 2

3 Biological When is dependence not dependence? Changes in DSM V SUD? Utilization of a continuum rather than a dichotomous framework. When is dependence dependence? Detoxification Medically Assisted Therapy Medical/Physiological Consequences Psychological Progression RX Some studies have revealed that opioid use produces an IMMEDIATE and permanent change in their neurochemistry. Relapse seems to be a much more serious challenge for this population Accessibility Identification Social Permission Mind-body??? 3

4 Psychological Biomedical Assessment Assessment Challenges How are the medications affecting overall mental health? How do we determine causality? What happens in older adults when there are pain management issues? Impairment in Major Life Activities Substantial impairment (DSM?) Psychological and Physical Consequences (DSM) Labels warn that you shouldn t operate. Social Adjustment and Adaption due to aging Subordination of physique Cognitive restructuring Asset vs. Comparative values Global Impact Impact of medical treatment models Impact of changes in vocation, housing, loss-grief, isolation Impact of disability/pain on social functioning 4

5 Spirituality Ground of Being and Value Older Adults Helplessness Loss of control Inability to influence service delivery systems AODA Consumers Acquire a Disability Examples: Traumatic Brain Injury, Spinal Cord Injury, Visual Impairment and Blindness, HIV The individual already has substantial impairment due to the AODA disability It is unlikely that the rehabilitation system will address the substance abuse issues Consumers get buried in the system They then get enmeshed in negative AODA subcultures Callahan 5

6 Co-Occurring Onset Examples: Mental illness, and all chronic degenerative medical disorders Many times these folks get identified in the community mental health system and do receive services (SAMHSA Initiatives) Many of the physical disabilities get buried in the medical and rehabilitation systems No progress is made to failure to address the AODA AODA Occurs After A Disability Temporarily Able Bodied (TAB s) folks acquire a disability and then begin to use AODA to adjust Beardsley These folks often get missed as well because they did not have a prior diagnosis The medical and rehabilitation systems often do not screen for the AODA Often times existing support systems play into negative secondary gains 6

7 Older Adults: An Overview Although persons 65 years of age and above comprise only 13 percent of the population, they are prescribed approximately one-third of all medications in the United States. In addition, older patients are likely to be prescribed more long-term prescriptions, as well as multiple prescriptions, which could potentially result in unintentional misuse. A large percentage of older adults also use OTC medicines and dietary supplements, along with prescription medications, which could lead to dangerous results. Older Adults: An Overview Older Adults are at risk for prescription drug abuse, in which they intentionally take medications that are not medically necessary. Because of high rates of comorbid illnesses among the elderly, changes in drug metabolism with age, and the potential for drug interactions, prescription and OTC drug abuse or misuse can have more adverse health consequences among this age group. 7

8 SAMHSA (2015) Persons over 65 comprised only.6% of the TOTAL admissions in the U.S. In each year from 2005 to 2010, alcohol was the most frequently reported primary substance of abuse for admissions aged 65 or older ******* Adults aged 65 to 69 made up the largest part of the substance abuse treatment population aged 65 or older, increasing from 56 percent of older adults in treatment in 2005 to 59 percent in 2010 Between 2005 and 2010, primary opiate admissions increased from 10% to 22.5% percent of admissions aged 65 or older What are the specific challenges? 8

9 Screening Screening can be a challenge Appropriate instrumentation may not be available Determining medication appropriateness is a serious challenge. Screening: Who? When? How? How often? Assessment Are the DSM V criteria up to snuff? How will the medical community be involved? How will the medical community be affected? How can we coordinate assessment through better utilization of interdisciplinary teams 9

10 Referrals Referrals are necessarily complex due to the difficulties with coordinating services across funding silos and service sectors Atypical referral agents may be involved.instead of our usual suspects Intake staff in AODA Treatment providers will have to become more familiar with both the specific SUDS and the populations A need for more medically managed providers? Detoxification Substance Specific Services? Pharmocological Treatments What kind of van is picking me up? 10

11 What should we consider when making our programs accessible or ask the ape Attitudes How will the program welcome consumers? How do professional attitudes affect the service environment? Programming Is the programming accessible, appropriate, effective? Have reasonable modifications occurred? Environment Does the consumer have equal access? Mobility, safety, and participation Case Management What ancillary services will be necessary for this population? Are there unique characteristics that must be considered for aftercare and relapse prevention? How will families be involved? What about chronic pain? 11

12 NIDA: Pain Management There is a fine balance between under-prescribing and over-prescribing pain relievers, particularly opioids. (2007)----The data available to us so far suggests that the risk of becoming addicted to prescription pain medication is minimal in those who are treated on a short-term basis. The risk for patients with chronic pain is less well understood. Some studies have shown that those most vulnerable to becoming addicted to prescription pain medications have a history of psychological disorders, prior substance abuse problems, or a family history of these disorders. How to find me.. dskoch@siu.edu Rehabilitation Counselors and Educators Journal About handouts and the utility thereof.. 12