Talking About Substance Abuse as a Caregiver

By Anna Ciulla

Talking About Substance Abuse as a CaregiverAs many as roughly one in five older adults (17 percent of seniors) may suffer from drug and/or alcohol abuse, according to research published by the Substance Abuse and Mental Health Services Administration (SAMHSA). For professional caregivers, that means you could be caring for an older client who fits this profile, either now or in the future.
Caregivers are often on the front lines of these issues, after all, by virtue of their duties. It is not uncommon for a caregiver to be in charge of monitoring and administering multiple prescription and over-the-counter medications—so they may be the first to stumble upon the telltale signs of an addiction, such as multiple prescriptions for the same medication from different doctors, or bottles that have been emptied well before their monthly refill is due. It’s also not uncommon for a caregiver to assist regularly with bathing and personal hygiene tasks, so caregivers may also be the first to notice bruises, bumps or cuts from drug- or alcohol-related falls or injuries. A caregiver is more likely to be the first on the scene when a fall or injury occurs, for that matter.
The question thus becomes, do you know how to talk about a suspected drug or alcohol problem with a patient and their family? Here are some tips for having these conversations, including how to spot substance abuse in seniors, things to ask an older person when you suspect they have a problem, and what to say to a patient and family when encouraging them to get help.

How to Spot Drug or Alcohol Abuse

Drug and alcohol abuse can be hard to spot in a senior you’re caring for, because a number of the symptoms can easily be mistaken for normal signs of aging. A senior may become depressed, for instance. They may display a lack of coordination and motor impairment, or mental confusion and poor memory. Fatigue, irritability, insomnia and chronic pain can also mimic symptoms of the natural aging process
One or more of the above symptoms can be a warning sign of substance abuse, but still other warning signs cited by the National Institutes of Health can help you isolate the problem:
  • Rapid increases in the amount of medication needed
  • Frequent requests for refills of certain medicines
  • A person not acting normally (showing a general lack of interest or being overly energetic)
  • “Doctor shopping” (moving from provider to provider in an effort to get several prescriptions for the same medication)
  • Use of more than one pharmacy
  • False or forged prescriptions
  • Mood changes

What to Ask a Client When You Suspect Substance Abuse

If you suspect substance abuse based on the above warning signs, find a time when your client is not under the influence of drugs or alcohol to ask them gently one or more of the following questions. (It’s also possible you will be able to answer some of these questions yourself, by closely observing your client’s behavior.)
  1. Have you felt you ought to cut down on your drinking or drug use?
  2. Have people annoyed you by criticizing your drinking or drug use?
  3. Have you felt bad or guilty about your drinking or drug use?
  4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves, get rid of a hangover, or to get the day started?
These questions are taken verbatim from a short drug and alcohol screening and assessment tool known as “CAGE,” which has been effective at detecting substance abuse in older populations. A “yes” to just one of these four questions can indicate at-risk drinking or prescription drug misuse.

Your tone and approach in asking these questions are also important. Often an ideal time to make these inquiries is when your client is experiencing the negative consequences of their addictive behavior, such as a hangover following a night of heavy drinking. In this context, they will be less likely to engage in denials or to react in defensiveness.

You don’t need to ask all four questions in one exchange, either. You may find that a better, less confrontational approach is to ask these questions over the course of several days or a week, depending on the urgency of the situation. In some cases, such as the imminent prospect of an overdose, it may be better to bookmark one conversation in which you field all of these questions with a view to expressing your concerns as lovingly and directly as you can.

What to Say

When you speak to an older adult client about a suspected substance abuse problem, keep in mind the following suggestions:
  • Share your love and concern, especially what you admire in terms of your client’s values, attributes and the things in their life that would be the most natural motivations to get help for a drug or alcohol problem (such as spending quality time with grandkids, learning a new hobby, leaving a positive legacy, etc.).
  • Speak matter-of-factly about the warning signs and changes in behavior you’ve been noticing and why they are a source of concern.
  • Ask your client whether they have noticed some of these same signs and changes in their behavior and inquire about what feelings and life stressors, in their opinion, may be triggering the substance abuse.
  • Take a learning and listening posture, rather than talking down to the client.
  • Ask them whether they feel drugs and alcohol are working for them as a long-term solution to their problems—and do listen attentively to what they have to say, without talking over them, interrupting them or offering quick fix-it solutions.
  • Wherever possible, empathize with what your client is going through, and normalize what they are feeling: “It’s normal and understandable to seek an outlet for coping with these feelings of loneliness and grief after your wife’s death.”
  • Invite your client to share how you can best support their recovery.
  • Let your client know that treatment has helped many people recover from substance abuse and can do the same for them.
  • Ask whether they would be open to a free phone consultation with an addiction treatment provider. (Sometimes a plea to enter treatment can be intimidating, but a no-strings-attached phone consultation less so.) If they are not open to this next step, a family intervention may be necessary. If they are willing to speak with a prospective treatment provider, then make the call for them. (The National Helpline, a free, 24/7 service of SAMHSA, is a good starting place for treatment referrals.)
Anna is the Clinical Director at Beach House Center for Recovery. She has a passion for helping clients with substance use and co-occurring disorders achieve successful long-term recovery. In her role directing clinical programming, she is responsible for designing, implementing and supervising our delivery of the latest evidence-based therapies for treating substance use disorders. In addition to addiction and mental health disorders, she has expertise in the area of eating disorders and women's issues, both as a Licensed Mental Health Counselor and Registered and Licensed Dietitian.