What problem and/or population in substance abuse will your intervention program address?
The program is intended to address the problem of alcohol abuse among the elderly population. Problem drinking that is severe is known as Alcohol Use Disorder or AUD in medical diagnosis. AUD is a chronic relapsing brain disorder, is manifested by addiction to alcohol, uncontrollable alcohol consumption, and impaired emotional state when not consumed. In the proposed program, older adults are defined as individuals aged 65 and above. According to the Center for Substance Abuse Treatment and the National Institute on Alcohol Abuse and Alcoholism, older men should not drink more than one drink in any single day and should not exceed seven drinks per week. Moreover, the older men should not consume more than two drinks per occasion. On the other hand, older women should consume less alcohol than men. Specifically, they should not take more than four per week and less than one drink per day. Older adults who exceed these guidelines are at a higher risk of problem drinking and alcohol use disorders. Older individuals who exceed five drinks per day are at the highest risk of alcohol use disorders. Therefore, in the proposed program, the number of drinks per day will be measured to determine if the participants have alcohol disorders or not.
What is the scope of this problem? (Think about whether the problem is growing, or addressing a potentially underserved population.)
The problem of alcohol drinking and AUDs have been increasing over the past several decades. According to the National Center for Biotechnology Information (NCBI), alcohol use was less prevalent from the 1930s to 1950s due to cultural beliefs and prohibition. However, from the 1960s, the problem of alcohol consumption and alcoholism has been growing (NCBI, 1998). The changing attitudes towards alcohol and increased longevity is also associated with the increasing prevalence of alcohol abuse in older people (Nadkarni, Murthy, Crome, & Rao, 2013). In the United States, AUDs prevalence is predicted to reach unprecedented levels as the United States population ages (DiBartolo & Jarosinski, 2017).
What is the definition of the target population? What are the criteria for admission? (That is, what screeners will you use to make sure that you select the correct clients for treatment?
CAGE questionnaire. The main criteria for admission will be patients drinking history. The participants drinking history will be assessed using CAGE Questionnaire, an instrument which measures alcohol disorders. It is easy to use and screens for problem drinking and potential alcohol problems. The questionnaire is comprised of four questions: Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? and Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)? Responses to the items are scored either 0 or 1 based on a No or Yes answer. The higher the score on the item and the overall questionnaire, the more likely that a person has an alcohol problem (Platt, Sloan, & Costanzo, 2010).
Short Michigan alcohol screening test-geriatric version (SMAST-G). AUDs among the elderly population will also be assessed using SMAST-G. The instrument asks questions that measure different signs of drinking problems in older adults. Examples of the items include: When talking with others, do you ever underestimate how much you drink? Does alcohol sometimes make it hard for you to remember parts of the day or night? and Has a doctor or nurse ever said they were worried or concerned about your drinking? SMAST-G has a total of ten items which are scored as either 1 (for Yes) and 0 (for No). The composite score is obtained by total the responses to the questions. A score of 2 and above indicates the presence of AUDs. Only individuals with scores of over two will be eligible to be enrolled in the program.
Diagnostic and statistical manual of mental disorders (DSM-5). Lastly, to be diagnosed with AUD, a person must meet certain criteria defined in DSM-5. For a person to be diagnosed with AUD, he or she must meet any two of the eleven criteria during the past 12-month period of diagnosis of the condition. AUD severity is classified as either mild, moderate, or severe depending on the number of criteria met. To assess for the presence of AUD, questions which measure the symptoms of AUD in an individual are asked. If an individual has signs indicated in the questions, his or her drinking may be a cause for worry. The more the symptoms one has, the higher the severity of the condition (National Institute on Alcohol Abuse and Alcoholism, 2015).
Income and demographic characteristics. The demographic characteristics of interest in the proposed program include age, gender, race, income, and education. This will be measured using demographic questionnaire.
Approximately how many people fall into your target population?
It is approximated that the target population will comprise of 200 adults aged 65 and above.
What is the prevalence and/or the incidence of the problem/population?
Over 76 million people in the world have alcohol-related problems. These problems include alcohol dependence and harmful drinking, which can be defined as intake of more than 14 drinks every week or more than four drinks per any occasion for men and over seven drinks every week or three per event for women (Lewis, Tamparo, & Tatro, 2012). In the United States, about 16 million individuals have UAD. AUDs are prevalent in developed countries and are more common in men than women. It is estimated that more than 15.1 million individuals aged 18 and over had UAD in 2015 (National Institute on Alcohol Abuse and Alcoholism, 2015). In men, the risk of AUDs in a lifetime is over 20%. Among the older population, 65 years and above, it is estimated that about 50% of them consume alcohol and are thus at a risk of AUDs. However, in older adults aged 85 and above, alcohol drinking is about 25%. The prevalence of AUDs among older adults (aged over 65) is 1-3% (Caputo et al., 2012).
What ideas do you have about the etiology of this problem/population? (That is, what causes this problem to emerge or evolve?)
Elderly alcohol abuse has many causes. First, studies have found out that alcohol population among the older population is caused by depression. According to Sacco, Bucholz, and Spitznagel (2009), depression is significantly linked to drinking problems among the aged population. Alcoholism is highly likely to increase with age because of the increased problem of depression which is associated with increasing age. Additionally, parental alcoholism history has been reported to be a significant predictor of alcohol abuse among the older adults. Individuals with a history of parental alcoholism have a higher risk of being problematic drinkers (Sacco, Bucholz, & Spitznagel, 2009).
Studies have also reported a relationship between a history of problem drinking and alcohol behaviors in late adulthood. Individuals with a history of drinking, especially before age 50, are more likely to have alcohol abuse problem in late adulthood. Most of the alcohol addicts, aged 65 and above, are diagnosed with alcohol drinking problem in early adulthood. Some of them use alcohol for self-medication and proceed to use alcohol to serve this purpose throughout their lives (Platt, Sloan, & Costanzo, 2010).
Moreover, increased alcohol consumption in this age group may be linked to growing number of healthy life years and improved socioeconomic conditions characterized by a higher average income. Further, the problem of alcohol abuse has been related to cigarette and cannabis use. Early initiation of cigarette and cannabis are significant predictors of alcohol dependency in late adulthood (Geels et al., 2013).
Gender has also been reported to predict alcohol abuse in older adults. Specifically, older men have been reported to have rates of problem drinking compared to older women. Most of these adults have been found to have a history of problem drinking. Among women drinkers, most of them have been reported to be widowed or divorced, to be depressed, or to have a spouse with a drinking problem. Also, older women problem drinkers have been found to have higher vulnerability to social pressure than men. Another etiological factor of alcoholism is ethnic background or race. Whites have been reported to be at the highest risk of heavy drinking than Hispanic/Latino Americans and African Americans (Kirchner et al., 2007).
Studies have also reported that socioeconomic status is a significant causative agent of alcohol abuse among the elderly. Individuals with high socioeconomic status, as assessed by the level of education and salaries, was positively related to alcohol use. According to Platt, Sloan, and Costanzo (2010) increased income increase alcohol demand r consumption.
Among the elderly, the onset of problem drinking has also been found to be related to social isolation. Specifically, people whose friends supported their drinking behavior are at a higher likelihood of developing drinking problems later in life. On the contrary, people who obtained help from friends or family members in stopping their drinking habits have decreased the risk of developing the drinking problems. Also, adverse health events have been associated with problem drinking. For instance, individuals diagnosed with diabetes and stroke have a higher likelihood of being alcohol addicts by 65%.
Life events, such as divorce are also linked to an increased drinking (Platt, Sloan, & Costanzo, 2010). AUDs are more common among older adults who are divorced and among older men who are widowed. Increased alcoholism among the divorced and widowed older adults may be linked to increased depression following divorce or death of a spouse. As a people age, they also lose their kin and friends to death and separation. Other losses which can lead to AUDs in older adults include loss of income due to retirement and diminished mobility. Further, AUDs are associated with cognitive impairment in older adults. Specifically, people who are mildly impaired have increased alcohol use as a reaction to decreased self-esteem and perceived memory loss.
Caputo, F., Vignoli, T., Leggio, L., Addolorato, G., Zoli, G., & Bernardi, M. (2012). Experimental gerontology, 47(6), 411416. https://doi.org/10.1016/j.exger.2012.03.019DiBartolo, M. C., & Jarosinski, J. M. (2017). Alcohol use disorder in older adults: challenges in assessment and treatment. Issues in Mental Health Nursing, 38(1), 2532. https://doi.org/10.1080/01612840.2016.1257076Geels, L. M., Vink, J. M., van Beek, J. H., Bartels, M., Willemsen, G., & Boomsma, D. I. (2013). Increases in alcohol consumption in women and elderly groups: evidence from an epidemiological study. BMC Public Health, 13(1), 207. https://doi.org/10.1186/1471-2458-13-207Kirchner, J. E., Zubritsky, C., Cody, M., Coakley, E., Chen, H., Ware, J. H. ... & Llorente, M. D. (2007). Alcohol consumption among older adults in primary care. Journal of General Internal Medicine, 22(1), 92-97.
Lewis, M. A., Tamparo, C. D., & Tatro, B. M. (2012). Law, ethics, & bioethics for the health professions. F.A. Davis.
Nadkarni, A., Murthy, P., Crome, I. B., & Rao, R. (2013). Alcohol use and alcohol-use disorders among older adults in India: a literature review. Aging & Mental Health, 17(8), 979991. https://doi.org/10.1080/13607863.2013.793653National Institute on Alcohol Abuse and Alcoholism (2015). Alcohol use disorder. Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alc...
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