Special Populations: The Elderly

1
Special Populations The Elderly

• Substance use (Rx and alcohol/street) is very
  under-recognized in the elderly
• May present as chronic or develop de novo
• Polypharmacy is common opioid/sedative
• 12-step model may be less relevant for some, but
  treatment can be highly effective
• Aging may contribute to reverse tolerance so
  may clinically worsen at same dose

2
Special Populations LGBT

• Sexual orientation may yield prejudice additive
  with racial, socioeconomic, other issues
• Gay/lesbian community often is itself prejudiced
  against bisexual or transgender
• Many real issues and myths around drug use and
  sexuality in various subgroups
• Methamphetamine and men who have sex with men
• Sex workers of both genders
• Sex risk may be greater than needle risk, may
  infect both within and across groups (eg bisexual
  behavior)

3
Special Populations Homeless and/or Disabled

• Addiction as cause or result of disability?
• High incidence of medical and psychiatric
  co-occurring disorders, may be multiple
• Often major barriers to treatment access or
  efficacy (sensory/cognitive/mobility)
• Addiction often ignored by other specialty
  providers/service agencies
• Family involvement augments success

4
Special Populations Cultural/Racial/Religious
Groups

• African-American racial bias in criminal codes
• Hispanic language may limit treatment access
• Asian very heterogeneous cultures, religions
• Native American considerable variability
• Islamic/Mormon/Catholic/Orthodox Jewish, etc.
• Abstinence or normative drinking as part of
  religious or cultural mandate/tradition
• Milieu may impact choice of substance more than
  total incidence of addictions

5
Special PopulationsHealth Professionals

• Similar incidence to general population
• Choice of drug influenced by access, often in the
  workplace (Rx opioids, benzos)
• Ego/identity very associated with license
• Huge shame issues are common
• Fortunately, many treatment and monitoring
  options with excellent results, confidentiality,
  and ability to save career exist in most states.

6
Special Populations Clergy, Law Enforcement,
Other Professionals

• Spiritual component of addiction strikes at the
  core of clergy spiritual professionals
• Law enforcement types find 12-step mtgs very
  challenging (see their clients there!)
• Teachers, public figures, many others find
  exposure to/in group treatment intolerable
• Specialty treatment identification with peers,
  but risk of elitism