ORTC Articles

What are the barriers to addiction treatment for older adults?

Myths and attitudes

Getting older adults the addiction treatment they need and deserve often means overcoming myths and attitudes we have about older people and the myths that older adults have about themselves.

When talking about an older adult who abuses or misuses alcohol or other drugs, we’re likely to hear comments such as these:

• “My mom lost her husband and her house, and now she’s headed to a home for older people. She’s lonely, and drinking is the one joy she has in life. Why take it away from her?”
• “My dad is sixty-nine years old. Sure, he drinks too much; he always has. He’ll never change.”

Such attitudes from family members or loved ones pose stiff barriers to getting help for this population. The adult son who thinks drinking is his mother’s one and only joy is fooling himself. Chances are the drinking doesn’t make his mom happy at all. Instead, it’s probably causing her misery, depression, and shame and robbing her of the good health she could enjoy for many years to come. In addition, older adults who suffer from addiction may view alcohol or other substance use disorders as a moral weakness rather than a treatable disease. This will keep them isolated and impedes their chances of getting help.

Personal and physical loss

Personal losses can multiply quickly for older people: the death of a spouse or close friends, the loss of a job because of retirement, the loss of a home, the loss of self-worth, or the loss of children who move out of state.

If you are an older adult who has always been active, you may look forward to retiring but then find that it’s not as fulfilling as you expected. Suddenly you may lack a sense of purpose or feel that you’re not needed.

The physical effects of aging also make older adults more susceptible to chemical addiction. One example is the change in body mass and lowered efficiency in processing alcohol or prescription drugs. The result: older adults may drink or use other drugs less and feel a greater effect. Drugs can build to a toxic level more easily in bodies that function more slowly.

What issues should older adults consider in recovery?

Many older adults develop addiction later in life, after suffering losses or health problems. This is called late onset of addiction. Consequently, family members may have a more difficult time identifying addiction. Begin by watching for signs of substance use. Take note, for example, if your loved one undergoes a personality change after drinking, is frequently intoxicated, drinks alone, loses interest in hobbies and activities, neglects his or her personal appearance, or drinks while taking prescription medication in spite of warnings.

If you notice these signs, consider talking to an addiction counselor, psychologist, physician, or clergy member to decide whether further action is necessary. If it is, then you need to express your concern to the person directly. How can you confront this person without offending them? Be gentle and caring. Do not appear condescending, and avoid judgmental labels such as “alcoholic” or “addict.” You might simply state, “I’m concerned about your health and would like you to be assessed and evaluated by a professional.”

When approached in this way, many older adults may admit a need for help. But even if the person reacts negatively, don’t give up. You’ve planted a seed of recovery that can still grow.

Older adults can succeed in recovery; in fact, older adults in general have higher abstinence rates after treatment than their younger peers. Despite the myths, older adults continue to show that they can change and enjoy the benefits of sobriety.

Why are social skills important to your recovery?

Social skills help you connect to others. Living the life of addiction is often equivalent to living in isolation. The deeper you slide into addiction, the less you see and communicate with others. You may lose touch with yourself. Shame and guilt can drive you away from normal day-to-day relationships.

Social skills include communication and etiquette—what you say and what you do in relation to others. Are you able to share pleasantries and make small talk? These are valuable skills for making people immediately comfortable. Are you at ease in gatherings where you don’t know anyone? The ability to connect quickly with strangers can transform situations that could trigger relapse into fun, rewarding experiences. Do you go out of your way to meet the needs of others? Helping others feel comfortable and welcome goes a long way toward enriching and solidifying friendships. Caring about the needs of others also conveys respect for them, a sure way to connect in a meaningful way.

Even passing associations with people can yield meaning for you. For example, when you enter a new Twelve Step meeting, you are surrounded by unfamiliar people. Yet if you listen closely to others, you will find some answers to your problems. You may also find comfort in learning that others have lived through similar experiences. Developing social skills can reduce or eliminate certain triggers for relapse.

What’s your communication style?

Recovering people sometimes struggle with being either too passive or too aggressive. These tendencies can have long-lasting effects on your life and your sobriety. For this reason, assertiveness training is often recommended for people in recovery.

Passive behavior can cause you to

• deny yourself or your rights
• avoid expressing feelings
• remain hurt and anxious
• give up your right to choose
• fail to reach your goals

Aggressive behavior may cause you to

• reach your goals and also create resentment in others
• express your feelings in a hurtful way
• minimize others and put them down
• deny others their rights

Assertive behavior allows you to

• express feelings honestly
• attain your goals
• respect others
• improve your self-image

Once you understand your communication style, you can make some changes to work out trouble spots. For example, if you don’t listen well, practice silence. Make sure you don’t interrupt others. Are you too loud or too soft spoken? Moderate your volume. Do you put your needs first? Or last? Practice ways to ensure that everyone’s needs are recognized and respected.

How can you improve your social skills?

First, remember that most people aren’t born with great social skills. Most of us have to develop those skills by watching others and modeling what we see. You can do the same thing. Pick out a person you resonate with from your circle of family, friends, or Twelve Step group members. Analyze what that person does that makes you feel welcomed. Why do you trust that person?

Chances are you’ll find that the person you chose to observe has some specific social skills that you can model. Does he or she reach out a hand to greet you? Smile? Remember your name immediately and ask about what you discussed the last time you met?

The basic skills of putting others at ease are really quite simple.

• Make eye contact—but remember that eye contact is a culturally specific behavior. Native Americans and Asian Americans, for example, might use eye contact differently than European Americans do. For example, Native Americans may sit in an AA meeting and look at the floor instead of the person talking. This is their culturally accepted behavior.
• Care enough to remember names and personal details, and ask about them.
• Offer your hand to shake.
• Imagine what that person might need and ask to provide it, whether it’s a place to sit or a beverage.

These basic kindnesses show respect and care for someone—it may be someone you just met or someone you see every day. Acquaintances, friends, co-workers, and family members all deserve the same respect and care.

Another aspect of recovery involves learning when to say no. Refusal skills are a must, because you need to feel comfortable doing it. What are some ways to say “no thanks” without offending others? The trick is to respect both your own needs and your host’s. If you are offered an alcoholic drink at a party, a simple “No thanks, I prefer soda,” will do. What are some other likely situations you should prepare for? Plan for those situations and think about how you’ll respond. You can always role-play refusal skills with a friend or another AA member.

How can you celebrate your recovery milestones?

AA members often celebrate the anniversary of their last drink. In some meetings these celebrations are called birthdays. In other meetings they are called anniversaries. Either way, this celebration can help you recall the very important day that really is a rebirth into your new life in recovery.

Historically, many people in AA have carried personal mementos to remind themselves of the importance of sobriety. Medallions have been found that date back into the mid-1940s, if not before, with markings representing up to forty-six years of sobriety for some early AA members. Sister Ignatia, the nurse who helped Dr. Bob work with alcoholics at St. Thomas Hospital in Akron, gave medallions to patients upon release. The medallion signified a commitment to God, to AA, and to recovery. Sister Ignatia gave the medallions with one stipulation: if the recovering person was going to drink, he or she was required to return the medallion to her before taking that first sip.

You may want to use a medallion to celebrate the very important day that marks the start of your life in recovery. As you progress in ongoing recovery, medallions can be used to commemorate the number of years you have been clean and sober.

What is sobriety?

Sobriety is the state of being sober and abstaining from using alcohol or other mood-altering drugs. In early recovery, staying clean and sober should be your top priority. It will be a daily challenge that you will have to prepare for.

As a recovering person, you will be faced with many types of high-risk situations that could contribute to a relapse. You will have to decide how to avoid these situations on a daily basis. For instance, any setting that has the potential for “bad news”—such as a doctor appointment, a court proceeding, or a meet- ing with someone who has “pushed our buttons” in the past—can be a problem. Anticipate this, and plan ways to handle them without using. In early recovery you do not yet have all the skills to handle some high-stress situations safely. Relapse prevention planning is a proactive way to protect your sobriety: for example, deciding not to associate with certain people or not attend certain events. Remember that no attitude, person, or event is worth a return to chemical use.

How does sobriety affect your lifelong recovery?

Abstinence from alcohol and other mood-altering drugs is the critical first step on your way toward lifelong recovery. By remaining free of substances, you stop the vicious cycle of use that results in negative consequences, only to be followed by more use. Embrace Step One—make a conscious decision to admit that no matter how strong your willpower, it alone can’t stop you from using. This is your admission of powerlessness.

Step One defines the disease of active addiction:

• You have a body that can’t handle alcohol or other drugs.
• You have a mind that can’t give them up.
• In active addiction, you had no spiritual connection to a Higher Power that could help you.

In early recovery, sobriety should be your number one priority. But it’s important to recognize that while sobriety is absolutely necessary to your recovery, it’s repairing your spiritual nature that will allow you a lifelong recovery from addiction.

Spirituality is discussed in Step Two:

When you admit powerlessness, you admit that you can’t control everything in your life. But you are responsible for the effort you make.

While you were in active addiction, you tried to fill your spiritual void with alcohol or other drugs, money, relationships, material things, or compulsive behavior of one type or another. But you found these external answers didn’t resolve your internal needs. You had to search for another solution. Steps Two and Three ask us to seek the spirituality that will give our life meaning.

Personal recovery Story

“Is there anything that can help me? By the time I came into the program, I was down on nearly everyone and everything. I decided it was crazy to believe anything could help me. My sponsor pointed out that for quite a while I’d been believing booze could help me. I had to admit she was right. So I figured if I’d been willing to trust a lower power for so long, I might as well give a Higher Power a whirl. That was my awakening. It didn’t mean anyone mistook me for Mother Teresa; it just meant I was willing. Nowadays I’ve come to see my life as one long, gradual spiritual awakening.”

—Valerie, recovering alcoholic

What is anger?

Anger is a normal, healthy emotional response to situations in which you feel threatened, unfairly treated, or violated. Strong emotions like anger, fear, or anxiety shouldn’t be seen as negative feelings because every emotion you feel is related to your well-being. For example, loneliness is a feeling that brings people together. Guilt helps to keep order and restrain you from behaviors that could hurt others. Fear signals danger. Anger is not inherently destructive; it can be very useful, helping you with many functions, including survival and regulating the social culture. Anger can cause you to communicate things that should be said, and it can motivate you to make big changes. Don’t fear your anger—learn to express it in healthy ways.

How can you express your anger in healthy ways?

Expressing Anger

1. Remember that you are responsible for your own feelings. You got angry— no person or place made you angry.

2. Don’t wait and let anger build up to resentment. Be direct. Avoid sarcasm and innuendo. Use honest, expressive language instead of name-calling, put-downs, and physical attacks.

3. Get to know yourself better. Identify events and behaviors that trigger your anger. Finding your own “hot buttons” will help you deal with anger when they’re pushed.

4. Take care of your needs. Know when you are hungry, angry, lonely, or tired (HALT). Putting yourself on a regular schedule for meals, exercise, and rest will help keep you balanced and connected, which will make you less likely to react to life’s challenges with anger.

5. Deal with frustrating issues as soon as possible, not after hours, days, or weeks of stewing about them.

You might have anger issues if

• You are often impatient.
• Others seem to always do things the wrong way.
• You feel that to do something right, you’ll have to do it yourself.
• You feel consistent pressure to prove yourself.
• You complain a lot.
• You’re often frustrated.
• It’s hard for you to “go with the flow.”
• You’re often disrespectful of those with less power than yourself.
• You consistently have outbursts of temper.
• You feel your needs are often minimized or ignored.

How does anger affect addiction?

Anger plays a major role in addiction because unresolved anger, or resentment, can disrupt your life and leave you spiritually void. You may think that other people, places, and things make you angry. You think that these external factors cause your feelings of anger. Blaming others enables you to hold on to resentment and avoid having to make changes in yourself. It lets you deceive yourself into thinking you’re morally superior: “I’m good, you’re bad.”

When you were actively addicted, you may have resented things you couldn’t control. Things never happened quickly enough. The world seemed to be against you. You wanted life at your convenience. You may have used anger to cover feelings of grief, hurt, loss, or fear.

It’s important to realize that the feeling of anger is not the real issue. It’s unresolved anger that is the real problem. If you allow your anger to go unresolved, you will be prone to relapse and may eventually return to use. To protect your ongoing recovery and live a healthy life, you will need to remind yourself that you are responsible for how you feel—not other people, places, things, or situations.

How can you deal with unresolved anger?

Make sure that you’ve worked Step Four: perform an adequate assessment of all of your assets and liabilities. This requires you to take a hard look at who you’ve been, who you are, and who you’d like to be in the future. Taking time to complete this moral inventory will allow you to take stock of your personality traits and examine them honestly and fearlessly.

What is enabling?

Enabling is helping someone avoid the natural consequences of bad behavior. Anyone who covers for an addict or removes him or her from the consequences of his or her use is enabling the addict’s behavior. Family members, friends, bosses, neighbors—lots of people fall into the enabling trap by thinking they are being helpful or empathetic. In fact, most enabling results from good intentions.

Family members often enable because they need and want to keep the household and family life operating as if everything were fine. To do this, they must block the consequences of the addict’s behavior as much as possible. Family members may cover for the addict, lie, and deny, all to avoid the shame they would feel if the outside world knew what was really happening inside their four walls.

If others enable you, will it slow your recovery?

Yes. The Big Book says to admit “to God, to ourselves, and to another human being the exact nature of our wrongs.” As a recovering person, you are called by this Fifth Step to realize and recall the negative consequences of your alcohol and other drug use. When others enable you, they protect you from feeling or seeing those consequences clearly. When consequences are blocked or minimized, the cause-and-effect method of learning appropriate, healthy behavior is absent. You are then able to continue with erratic, unpredictable, irresponsible, insane behavior because, to some extent, the path has been cleared for you to do so.

Enabling also allows deep anger and resentment to build within the family, in the workplace, or with friends. On one hand, the enabler eagerly rescues or helps the addict. On the other hand, the enabler may develop and harbor deep resentment at having to cover for someone else frequently. Feelings of self-pity and righteous anger build. The addict, however, is oblivious to the enabler’s growing resentment. Instead, he or she is completely focused on using and protecting the supply of chemicals.

Enabling happens in many ways. A critical first step to stop enabling behavior is to understand it. Once you know how you enable—and how you are enabled—you can take steps to change your thoughts and actions.

What are some ways you can avoid enabling others who have an active addiction?

As you move forward in your recovery, you are learning how important it is that you not enable others. You are learning to set new boundaries with those you love, asking them to hold you accountable for your actions.

At the same time, you may have people in your life who still have an active addiction. It is very important that you not “take on” these people and try to help them while you are still in early recovery. Doing so may set you up for a relapse.

Here are specific ways that you can avoid enabling others in active addiction:

Don’t . . .

• call in sick for the addict
• provide the addict with money or a place to stay
• provide excuses for the addict to avoid social events
• promise yourself that you “won’t put up with it” and then back down
• make excuses for the addict’s inappropriate behavior
• make excuses to yourself or others for the addict’s broken promises
• deny, rationalize, or minimize the problem either to yourself or others

Do . . .

• continue to stay in touch with extended family members, friends, neighbors, or anyone else who might have already figured out the problem
• talk to others about what’s happening
• continue to attend social events, outings, and other activities that are important to you
• find an Al-Anon group or other support group
• get family and/or couples counseling
• keep active with your own hobbies, interests, and friends

The best thing you can do for yourself and this person is to put some distance between you and him or her. Later, when you have more experience and time in recovery, you may be able to reach out and offer help. Until then, keep your distance and avoid enabling as much as you can.

Of course, it is even more difficult to do this when the person with the active addiction is a spouse or significant other. In this case, you must always put your sobriety first. It must be your highest priority. Seek counsel from your sponsor and others in your Twelve Step group. You may even want to consider removing yourself from the living situation, at least on a temporary basis, until your sobriety is stronger.

How can you help your family and friends quit enabling you?

While you were actively using, you may have had family and friends who enabled your use. It is important now to create new patterns of relating to one another that don’t involve enabling. Just as addicts or alcoholics need to focus on their recovery, friends and family need to focus on themselves and their growth.

Maintaining your recovery is a lifelong process that will challenge you spiritually, physically, and emotionally. Make sure you take time to laugh, play, and celebrate your successes. Laughter helps break tension and stress. It can help you maintain a healthy mental outlook and enjoy the ongoing journey of recovery. Laughter can also help you celebrate recovery and remind you how grateful you are for sobriety and for the priceless camaraderie of other people in Twelve Step programs.

What is Al-Anon?

Alcoholism is a disease that not only affects you, the alcoholic, but also your family and loved ones. While you are dealing with addiction, your family and friends need support just like you do. Lois W., the wife of Alcoholics Anonymous cofounder Bill W., recognized this and created Al-Anon in the 1940s for this very reason. Al-Anon is a Twelve Step fellowship that offers hope and help to families and friends of alcoholics. It doesn’t matter if the alcoholic is currently seeking help, is in recovery, or even admits that there is a problem. Family members or friends can still get help for themselves.

What is Alateen?

Alateen is for teenagers affected by alcoholism. It is sponsored by Al-Anon and operates the same way as Al-Anon does. If you have children who are teenagers, they might be more comfortable in this type of meeting than a regular Al-Anon group.

Can people attend Al-Anon if they are family or friends of drug addicts, not alcoholics?

There is an organization called Nar-Anon specifically for people affected by someone else’s drug use. However, Nar-Anon meetings aren’t as easy to locate as Al-Anon meetings. For this reason, many Al-Anon meetings welcome family and friends of drug addicts. The words “drug addict” can be substituted for “ alcoholic” when people are talking about their needs at a meeting.

Who attends meetings?

Parents, children, spouses, partners, siblings, other family members, friends, employers, employees, and co-workers of alcoholics attend Al-Anon meetings. All these people have something in common: their lives have been affected by someone else’s drinking.

Is Al-Anon for your family and friends? Think about it. You’ve made some pretty big changes in your life. It’s going to take some time for your family and friends to get used to the new you. Just as joining a Twelve Step group such as Alcoholics Anonymous (AA) is a way to support your own sobriety, your friends and family members need support too. Al-Anon is a fellowship where your friends and family can interact with people who are in the same situation as they are—they are affected by someone else’s drinking.

Recovery Action Step

Invite friends or family members to an Al-Anon or Alateen meeting. If they attend the meeting, be sure to ask them what they thought of it. Be aware that, just as with the confidentiality you experience in AA, you should respect their desire for confidentiality as well.

What goes on at meetings?

Basically, Al-Anon or Alateen meetings use the same format as other Twelve Step meetings, such as AA or Narcotics Anonymous (NA). They are an anonymous fellowship where people are only recognized by their first names and last initial. They are usually held at churches or other public buildings.

Meetings typically open with an introduction to the Twelve Steps. The Twelve Steps are then recited by the group. Then a member may read one of the Twelve Traditions. The meeting begins after the Serenity Prayer is read.

People at meetings share their experiences. They do not lecture, preach, instruct, or advise others. Also, people do not interrupt each other when someone else is speaking. The meeting chair is the only exception; he or she may remind people to bring their sharing to a close.

Although there are no dues required, a basket is passed around. People can contribute any amount, although most people give a dollar or two. This money helps pay the room rent; buy coffee, snacks, and literature; and support the local and national offices of the fellowship.

How can you locate a meeting?

Contact Al- Anon, Nar-Anon, or Alateen by phone or check their website to find a meeting in your area. You may also try the white pages in your local phone book.

What are sexually transmitted diseases?

Sexually transmitted diseases (STDs) are infections that are spread from person to person through sexual contact. These infections are often spread through blood, semen, urine, and vaginal fluids. Many STDs can be cured or managed if treated early. If not treated early, some STDs can cause severe and permanent damage, including blindness, sterility, heart disease, or even death. Examples of a few STDs include gonorrhea, HIV/AIDS, syphilis, chlamydia, and genital herpes.

Are people under the influence of drugs at higher risk for STDs?

Research has shown that people addicted to alcohol or other drugs are more likely than the general population to contract HIV (the human immunodeficiency virus that causes AIDS). This is because alcohol and drug addiction is often associated with high-risk sexual behaviors and can be associated with injection drug use, which are two major modes of HIV transmission.

A history of heavy alcohol use has been correlated with a lifetime tendency toward high-risk sexual behaviors, including multiple sex partners, unprotected intercourse, sex with high-risk partners (such as injection drug users or prostitutes), and the exchange of sex for money or drugs. Alcohol acts directly on the brain, reducing inhibitions and diminishing risk perception.

Why are adolescents and young adults at higher risk for STDs?

Adolescents and young adults are more likely than older adults to engage in unprotected sexual intercourse. They are also more likely to select partners who are at higher risk for STDs. According to the Centers for Disease Control and Prevention (CDC), females fifteen to nineteen years old have the highest rates of gonorrhea, while twenty- to twenty-four-year-olds have the highest rate of primary and secondary syphilis.

Substance use among adolescents is associated with early sexual activity, an important factor in the prevalence of STDs and HIV infection. The use of substances combined with sexual activity significantly decreases the likelihood that a condom will be used during sex. Substance use also can decrease an individual’s discrimination in choosing sex partners and can increase the number of partners and the likelihood of risky sexual practices (including anal intercourse), thereby heightening the risk of STDs

How can you lower your risk for STDs?

One way is to stay clean and sober. A relapse could put you in a position to engage in high-risk behaviors that could result in an STD. Another important way you can lower your risk is to limit your number of sex partners. The more partners you have, the higher the risk for becoming infected. If you do have regular sexual contact, consider following these guidelines to lower your risk:

Guidelines for lowering your STD risk

• Stay clean and sober. Be aware that a relapse could put you in a position to engage in high-risk behaviors.
• Don’t ever share needles, syringes, or other equipment (“works”) for any use. STDs from an infected person can stay in a needle and then be injected directly into the next person who uses the needle.
• Abstain from sexual intercourse, or engage in a mutually monogamous relationship with a partner who has been tested for STDs, including the HIV virus. (The more sex partners you have, the greater your chances of getting diseases passed through sex.)
• If your sexual behaviors place you at risk for STDs, correct and consistent use of the male latex condom can reduce the risk of transmission of some STDs. However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD.
• Don’t share razors or toothbrushes because of the possibility of contact with blood.

Where can you get more STD information or counseling?

To find out where to go in your area for STD counseling and testing, contact your local health department or the CDC National AIDS Hotline.

For more information about STD education and prevention, contact the American Red Cross.