Older aging women with depression are one of the most vulnerable population that faces the problem of drug usage especially when it comes to alcohol abuse. Research has shown that older women with depression are more likely to present for treatment with an array of concurrent alcohol abuse patterns (Satre, Sterling, Mackin, & Weisner, 2011). Depression remains a primary factor that drives this segment of the population to alcohol use due to the belief that it has therapeutic value. However, alcohol tends to have debilitating effects on older adults due to the physiological changes that have already taken place.
Blow and Barry (2012) asserted that "older women may be especially at risk for alcohol problems because they are more likely than men to outlive their spouses and face other losses that may lead to loneliness and depression" (para. 1). Research has indicated that depressive symptoms are more common among older women than their male counterparts. Overall, women face almost double the risk of depression as compared to their male counterparts. The exposure to many life losses also increases their chances of experiencing depression, which eventually causes them to engage in alcohol abuse. Studies have shown that many of the older women who participate in alcohol abuse believe that it can remedy their depressive symptoms by acting as an antidepressant. Older women primarily possess a plethora of physical risk factors that increase their chances of experiencing negative impacts of increased alcohol consumption. For example, the reduced muscle mass means that they are more susceptible to the effects of alcohol (Blow & Barry, 2012). Aging also implies that an individual continues to lose their body mass thus further increasing the alcohol-related risks.
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It remains fundamental to note that depression is a common issue affecting older adults. It is accompanied by symptoms that can virtually affect every aspect of life including sleep, appetite, energy, and relationships. Also, research has shown that many depressive symptoms usually go unnoticed. The emotional and physical pain that results from depression can tempt older women to engage in alcohol use. Some studies have shown that this can help an individual take their mind off the problem, feel less lonely, and attract sleep. However, the reality is that alcohol worsens the depression symptoms, especially when continuously used in the long run. Blow and Barry (2012) found that other than the known alcohol-related diseases such as kidney failure and throat cancer, alcohol in older adulthood, especially women, can impair brain function and further inhibit the proper functioning of the antidepressants.
Drug of Choice
As pointed out, alcohol has more negative effects on the older aging women compared to a younger generation due to the physiological degradation that comes with old age. As such, this increases their chances of acquiring cancer, brain and liver damage, and most fundamentally, a deterioration of the body's immune system (Satre et al., 2011). It also increases their chances of high blood pressure, diabetes, ulcers, and in some instances, memory loss. Statistics show that up to two billion people consume alcoholic beverages worldwide. Further, Choi and DiNitto (2011), ascertained that alcohol causes about 3.8% of all deaths worldwide. Research has also shown that 50% of older adults aged 65 years and above drink alcohol.
Alcohol is primarily taken through ingestion by the mouth where it undergoes several chemical processes in the liver leading to the production of harmful metabolites. The action of the metabolites promotes cellular and tissue injuries throughout the body of the user, especially when consumed over a long period. Three categories of older adults are considered some of the riskiest groups of people when it comes to alcohol consumption. They include those taking medications, those with health problems, and heavy drinkers (Blow & Barry, 2012). First, older adults have an increased sensitivity to alcohol more than any other drug. As people age, their tolerance for alcohol reduces. Older adults especially the women experience more effects of alcohol than when they were younger.
Secondly, as previously noted, heavy drinking among older women can result in or worsen conditions such as diabetes, high blood pressure, congestive heart failure, liver, and kidney problems among others (Caputo et al., 2012). Once a person has been diagnosed with depression, they are prescribed with drugs such as anti-depressants and other medical interventions such as psychotherapy. Alcohol use will, therefore, inhibit drug interactions in the body of the older women and further reduce their ability to attend the psychotherapy sessions. Continuous abuse of alcohol among the members of this population increases the chances of psychiatric disorders. Caputo et al. (2012) underpin this through their research which indicated that "almost 20% of individuals aged 65 and older with a diagnosis of depression have a co-occurring alcohol use disorder (AUD)" (para. 1). Alterations in the membrane fluidity and cell functioning in the brain that comes with alcohol abuse mean that an individual will likely acquire psychiatric disorders. Another common risk factor associated with alcohol use includes the bone-joint fracture due to falls induced by alcohol.
Despite the numerous regulations on the availability of alcohol that have been put in place to moderate alcohol use and problems caused as a result, the use of alcohol among adults is still vast. Alcohol is a drug that is considered “too available,” this is because it can be easily acquired from shops, bars, restaurants, supermarkets, etc. Compared to other drugs, alcohol is not only easy to access but it is also cost-effective, there are numerous brands in the market, and with each seeking to make sales, the cost of alcohol is therefore relatively low. Most of the regulations that have been put to control the use of alcohol are aimed at underage populations, with the focus being on restricting the use of alcohol among teenagers. This makes it easier for the older population to acquire the alcohol as they can easily find it and are of the standard drinking age. The potential for abuse due to depression is therefore heightened due to the ease of acquisition
Treatment Setting
The most appropriate treatment setting that could be used in this case is the intensive outpatient. It is important to note that depressed women of over 65 years of age are a delicate group of people that can respond slowly to treatment based on various factors. An intensive outpatient would be particularly vital because it creates an appropriate environment the empowerment of the older adult patient becomes possible. It also gives them the impetus to cope with the health and behavioral challenges that come with conditions such as depression among others. Intensive outpatient goes hand in hand with the use of cognitive behavioral therapy. Other than counseling, individuals acquire an interaction space where adults can share their problems.
When using the intensive outpatient method, it remains critical to note that the two essential conditions that require remedy include depression and alcoholism. The intensive outpatient is a simple process that might only require making occasional visits to a treatment center and leaving once the appointment has been completed. Outpatient programs that target older aging women seek to address a plethora of issues including the emotional, physical, and spiritual ones. It might also attempt to solve the interpersonal problems that older women might face such as stressful situations and emotional difficulties. Acadia Healthcare (n.d.) notes, "this treatment option allows individuals to receive thorough treatment that fully addresses their needs in a less restrictive environment than that which is offered in partial hospitalization programming" (para. 1). Also, the therapeutic environment is more structured compared to the one provided in the traditional hospital setting. In an intensive outpatient system, psychosocial assessment precedes any form of treatment.
The process of assessment begins by first reviewing the history of the individual. Here, more focus will be put on the presenting symptoms and the way they inhibit the individual’s ability to undertake their daily roles. In gathering additional pertinent information, an individual’s physical and psychological background will also be assessed. The importance of this treatment setting is that it gives older women the impetus to reveal express their problems without any shame or fear of victimization. The less restriction that comes with it ensures that the older women can receive treatment and continue with their day to day endeavors. However, caution should be taken to ensure that the women adhere to their medication and therapy and that the chances of relapse are severely minimized.
According to Forman (2006), another program offered by the IOT is the Group and Counselling Therapy, the patients are placed in several different types of groups which may include psychoeducational, support, skills-development or interpersonal process groups. Group therapy is essential for advancing personal recovery; this is possible through group members who are further along in the recovery assisting other members. It also allows the patients to develop communication skills through the socialization experience as they help, support and comfort one another. Another attribute of group therapies is that they introduce structure and discipline I the lives of the patients which usually are chaotic due to their way of lives. They also offer a channel for patients to talk out their issues with other patients who may be going through the same, providing positive therapy that is crucial for recovery. It is much easier for patients when they identify people who are going through the same issues as them to make recovery
Treatment Model
The most appropriate treatment model, with regards to this population, is the woman treatment way. This model is the most suitable since it provides a comprehensive, detailed and intensive form of treatment that creates an intimate environment allowing patients to receive personal attention. Woman’s way is a gender-responsive and trauma-informed treatment model that is highly used for chemically dependent adult women. While receiving personal care, the women become a member of a healing community of women.
The women’s treatment way takes into consideration the co-occurrence of chemical health and mental health disorders. By understanding that women who often face alcohol addiction issues are prone to face conditions such as depression and anxiety, the treatment method involves concurrent and integrated services. The fact that the disorders occur at the same time means that their symptoms are more severe and complicated. Integrated services can provide better overall outcomes and are very cost efficient for the clients. Traditionally, treatment offered for substance abuse and mental disorders had been profoundly isolated for each other. However, recent professional guidelines state that addressing these co-occurring disorders is better by taking an integrated approach. An integrated approach is one whereby both the substance abuse and mental disorders are treated simultaneously while taking into account the specifications of both issues (Brousselle, Lamothe, Sylvain, Foro, & Perreault, 2010) . The reasoning behind this is because people who mainly abuse drugs face a particular mental condition, e.g. stress or depression. They indulge in drugs to escape from reality as they offer a therapeutic feeling. To understand a problem and solve it after that, it is essential to understand its source/ genesis; integrated approaches get deeper into understanding why a patient may be abusing a specific drug and try to solve the underlying issue. Once the problem has been eradicated, it is much easier for a particular patient to refrain from the use of alcohol.
The woman’s way treatment method aims at helping the patients abstain from mood-altering drugs and enhancing an individual’s personal motivation towards attaining long-term recovery. It also helps the patient build necessary skills such as emotional coping skills, relational skills, and recovery maintenance skills while building a support system within her family and community (RiverRidge, 2019).
Conclusion
It is clear that older aging women facing depression are highly prone to alcohol use and abuse, the main reason being that they believe that alcohol use is therapeutic. Alcohol, however, has proven to have devastating effects on this population mainly because of the fact that they have already undergone physiological changes. It worsens the depression symptoms and may also lead to alcohol abuse related diseases such as throat cancer and kidney failure. One of the reasons why most depressed old adults chose alcohol is because of how easily it can be acquired compared to other drugs. Alcohol, however, alters the functioning of the brain and may lead to psychiatric disorders when abused. Intensive outpatient offers the most appropriate treatment setting that will allow the adults to acquire counseling and an interaction space where they can share their problems. The outpatient setting places psychosocial assessment at the forefront as it attempts to solve the interpersonal issues that the older women may face including stress and emotional difficulties. For the treatment model, the most appropriate is the woman’s way, this model provides an intensive way of treating older women by creating an intimate environment that allows patients to receive personal attention. The model is gender responsive and is highly advocated for chemically dependent adult women. With the adverse effects caused by the abuse of alcohol by older women, it is necessary for people to be aware of the causes of abuse, treatment setting, and methods that would be most appropriate to help prolong the lives of this population.
References
Acadia Healthcare, (n.d.). Intensive Outpatient Treatment Programs (IOP), Acadia Healthcare. Retrieved from: http://www.acadiahealthcare.com/programs-and-services/iop
Blow, F. C., & Barry, K. L. (2012). Use and misuse of alcohol among older women. Alcohol Research and Health, 26(4), 308-315. Retrieved from: https://pubs.niaaa.nih.gov/publications/arh26-4/308-315.htm
Brousselle, A., Lamothe, L., Sylvain, C., Foro, A., & Perreault, M. (2010). Integrating services for patients with mental and substance use disorders. Health Care Management Review , 35 (3), 212-223. doi:10.1097/hmr.0b013e3181d5b11c
Caputo, F., Vignoli, T., Leggio, L., Addolorato, G., Zoli, G., & Bernardi, M. (2012). Alcohol use disorders in the elderly: a brief overview from epidemiology to treatment options. Experimental Gerontology, 47(6), 411-416.
Choi, N. G., & DiNitto, D. M. (2011). Heavy/binge drinking and depressive symptoms in older adults: gender differences. International Journal of Geriatric Psychiatry, 26(8), 860-868.
Forman, R. F. (2006). Services in Intensive Outpatient Treatment Programs. In Substance Abuse: Clinical Issues in Intensive Outpatient Treatment . U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 2006.
RiverRidge. (2019). A Women's Way Residential Treatment - River Ridge. Retrieved January 24, 2019, from https://www.riverridgemn.com/programs/a-womens-way-residential-treatment/
Satre, D. D., Sterling, S. A., Mackin, R. S., & Weisner, C. (2011). Patterns of alcohol and drug use among depressed older adults seeking outpatient psychiatric services. The American Journal of Geriatric Psychiatry, 19(8), 695-703.
