However, there are some signs that may indicate a drinking or drug problem, such as:

• Solitary or secretive drinking.
• A ritual of drinking before, with, or after dinner.
• A loss of interest in hobbies or pleasurable activities.
• Drinking in spite of warning labels on prescription drugs.
• Immediate and frequent use of tranquilizers.
• Slurred speech, empty liquor and beer bottles, smell of alcohol on breath, change in personal appearance.
• Chronic and unsupported health complaints.
• Hostility or depression.
• Memory loss and confusion.

Consider consulting a counselor, psychologist, doctor, social worker, or other professional if you suspect that an elderly loved one has a substance abuse problem. If possible, list the person's medications, doctors, family members and friends, and your observations in preparation for your meeting.

Always be gentle and loving with older persons and avoid shaming words or labels such as "alcoholic" or "drug addict," because they may retreat even more if they feel they are "bad" and their abuse could worsen. Be direct and specific, using "I" phrases such as "I'm concerned your drinking alcohol may be interacting with your medications."

Because older people may live alone or far away from family, it is often a mail carrier, a meter reader, a church friend, a neighbor, or a local storekeeper who observes behavior changes. Programs like Gatekeeper (253-756-3988) are valuable community resources that train those who come in contact with high-risk older adults to identify and refer problems. The U.S. Postal Service's "Carrier Alert" notifies mail carriers about older persons or shut-ins who are enrolled in the program. If mail accumulates, carriers alert the appropriate social service agency.

Substance abuse treatment for older adults not only improves their quality of life, but also helps family members, friends, caregivers, and the community. Relationships can deepen, making whatever years remain richer and more meaningful. We also know that treatment for substance use disorders is as effective as treatments for other chronic conditions, such as high blood pressure, asthma, and diabetes.

According to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), the following features are most important in treating older persons who have substance abuse problems:

• Age-specific group treatment that is supportive and non-confrontational and aims to build the patient's self-esteem.
• A focus on coping with depression, loneliness and loss.
• A focus on rebuilding the client's social support network.
• A pace and content of treatment that is appropriate for the older person.
• Staff members who are interested and experienced in working with older adults.
• Linkages with medical services, services for the aging, and institutional settings for referral into and out of treatment, as well as case management.

If age-specific treatment is not possible or practical, it is important that facilitators and members in a mixed-aged program take care to address the special needs and issues of the older participants. 

While it is crucial to identify and treat older substance abusers, it is even more important to provide an environment that promotes healthy behavior by empowering individuals to manage life events without drugs or alcohol. SAMHSA identifies these protective factors:

• Access to resources, such as housing and health care.
• Availability of support networks and social bonds.
• Involvement in community activities.
• Supportive relationships.
• Education (eg, wise use of medications) and skills.
• Sense of purpose and identity.
• Ability to live independently.

Bereavement, pre-retirement, wellness, smoking cessation, drug and alcohol education, and life skills programs encourage healthy coping skills. Alternative activities such as volunteer work, Foster Grandparent programs, arts programs, post-retirement work activities, and cultural activities (such as community gardening) develop self-assurance, facilitate healthy interactions, and relieve boredom.

The U.S. Substance Abuse and Mental Health Services Administration (http://www.samhsa.gov/) offers a wide range of information and resources to help identify, treat, and prevent substance abuse among older adults. The pamphlet "How to Talk to an Older Person Who Has a Problem With Alcohol or Medications" is available on the Hazelden Web site or a free printed copy can be obtained by calling 1-800-257-7810.

--Published March 6, 2006