Population
Older women with depression are one of the most significant populations that face 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 et al., 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." Research has clearly indicated that depressive symptoms are more common among older women than their male counterparts. Overall, women are almost twice as likely as men to battle depression. 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 engage in alcohol 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. Also, aging 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 adulthood. 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. 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 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, alcohol causes about 3.8% of all deaths worldwide. Research has also shown that 50% of the older adults aged 65 years and above drink alcohol (Choi & DiNitto, 2011).
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. First, older adults have an increased sensitivity to alcohol more than any other drug. As one age, their tolerance for alcohol reduces. Older adults especially the women experience more effects of alcohol than they were young.
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. Research has indicated that "almost 20% of individuals aged 65 and older with a diagnosis of depression have a co-occurring alcohol use disorder (AUD)" (Caputo et al., 2012). 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.
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 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. Also, "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" (Intensive Outpatient Treatment Programs, IOP). 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.
References
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
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.
Intensive Outpatient Treatment Programs (IOP), Acadia Healthcare. Retrieved from: http://www.acadiahealthcare.com/programs-and-services/iop
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.
