Introduction
Addiction is a compulsive and chronic need for a substance, behavior, or activity that is associated with harmful effects and adverse symptoms upon withdrawal. Examples of items that can cause addiction include tobacco, alcohol, and drugs of both the prescription and illicit varieties. The condition can lead to self-destructive behaviors and cause permanent harm as a result of the person’s failure to control their impulses. As such, healthcare systems have to have policies for the recognition and treatment of addiction in place. It can take place in all populations, but there are specific factors that predispose some groups to be more likely to develop some habits. As such, those groups warrant particular attention and the development of specialized treatments for addressing their specific issues. An understanding of the associated factors associated with the emergence of addictions would be beneficial to the determination of these groups.
The predictors of addiction can be broadly divided into four groups based on their origin: individual, relationship, community, and society as a whole. On the individual level, genetic predisposition, early childhood aggression, and mental health disorders can create it. In a relationship, parental substance use and mental disorders, as well as child abuse or neglect, can lead the person to develop an addiction later on in life. On a community level, poverty and violence can push one to develop a habit, especially if a peer group engages in the practice. Lastly, broader societal issues such as stigmas, racism, and sexism can create stress that the person will relieve through harmful practices and become addicted. Substance prohibition laws warrant a separate mention because, as the 1920 alcohol prohibition law in the United States showed, they motivate people to abuse substances rather than the opposite.
Based on these factors, it is possible to identify several groups that are at increased risk of developing addictions, namely homeless people, women, teenagers and young adults, trauma survivors, and seniors. The last category presents a particular area of interest and will be discussed in this paper. Seniors often have to deal with an excess of spare time and feelings of loneliness and loss of loved ones. As such, they can indulge in substances to temporarily numb these feelings, and they also often rely excessively on prescription medications to deal with health issues such as pain. With that said, the size and needs of the population are still not well-understood, which makes the provision of appropriate treatments challenging. This paper will critically review the literature about the services that can be provided to seniors with addiction.
Rationale for the Subject and Its Importance in the Field of Addiction and Healthcare
Recently, attention from addiction researchers and healthcare providers has been increasingly directed at what is known as special populations. They have unique health concerns with regard to addiction that warrant careful investigation and the development of special treatments. Traditional interventions for the problem may be ineffective at addressing the special populations’ issues, either failing to treat the addiction or leading to relapse once the patient is no longer in a controlled environment. For example, veterans are prone to developing PTSD and have very high rates of substance abuse disorders as a result. As such, an intervention that does not address the underlying mental issues will be unlikely to achieve long-term success. Evidence suggests that a similar situation is taking place in the treatment of senior patients, and a problem is emerging as a result.
Between 2002 and 2010, the percentage of older adults admitted to substance abuse treatments in the United States increased dramatically, going from slightly above 6% to approximately 12%. It should be noted that this increase coincided with a similar rise from 2.75% to 5.75% in the percentage of the U.S. population with substance abuse issues, but it still presents cause for concern. Older adults are at a high risk of developing an addiction because of their various associated comorbidities, which include late-onset mental conditions. Moreover, their often compromised health can make an overdose highly damaging and possibly fatal. As such, they must become able to control their habits with the assistance of the healthcare system.
Type of Service and how You Will Go Around Planning It
This paper describes a specialized service that targets older adults in the Erada Center for Treatment & Rehab, which is located in Dubai. It will target individuals of both genders that are 60 or more years old, which are referred to as Senior Emiratis per government policy.
Initially, it is necessary to conduct a needs assessment, which is mixed research that aims to determine what health and social issues are prevalent in the population as well as how well it can deal with them. To that end, it will be necessary to estimate its size, identify any subgroups, analyze the incidence of addiction in the group, and explore its needs qualitatively. After obtaining a profile of all critical stakeholders’ views, the service’s management can review evidence and recommendations for interventions and develop an implementation plan. The Center will then repeat the procedure regularly to check whether the intervention meets the needs of the population.
The first step in the needs assessment will be to collect demographic characteristics to assess the size and prominent characteristics of the population category. The Ministry of Health and Prevention, located in Dubai, as well as the more specialized Dubai Health Authority, could provide a considerable amount of useful knowledge. The author would request data about the ages, genders, religions, marital status, education levels, and nationalities of the populations from them. Local information would also be helpful, and to obtain it, it is necessary to contact Erada Center for Treatment & Rehab. The Center can provide the age, nationality, and place of residence distributions (separated by gender) as well as statistics on specific substance addictions that are found among seniors.
The services provided by the new intervention will be targeted toward the specific considerations that are likely to be prevalent in seniors. These treatments will feature individualized guidance or group sessions that feature people from similar age categories or backgrounds, which should enable them to discuss their issues more freely. Therapy sessions for prevalent issues such as those of loss, depression, and loneliness will also be featured. Additionally, a more complex and customizable treatment program will be developed based on the findings of the needs assessment. It will aim to address the specific circumstances of seniors in the UAE, particularly those served by the Center.
The service will have both inpatient and outpatient treatment options, depending on the severity of the patient’s issues. The inpatient components will constitute detoxification treatments as well as therapy with medical professionals, which will involve social and recreational activities such as gardening or arts and crafts. The outpatient treatments will involve family and care support, relapse prevention groups, and one-to-one support programs. The inpatient aspect of the service will aim to treat patients with current addiction issues. In contrast, the outpatient part will aim to prevent them from developing addictions or returning to them after rehabilitation.
Improved accommodations will be necessary because of the variety of impairments that can manifest in older adults. In particular, wheelchair ramps and lifts will be necessary to secure the ability of people with movement impairments to access the building. A car service can be useful to ensure that patients can drive to the entrance and leave the car in the facility’s care instead of having to find a parking spot and walk from there. Lastly, to protect the privacy and health of the inpatients, safe washrooms that minimize the risk of incidents such as falls and enable personal space will be necessary.
Concerning accommodations, a nutrition specialist will be particularly necessary to guarantee the well-being of the patients. Seniors often develop significant health issues, such as diabetes, which require specialized diets to remain healthy. As such, one-on-one interactions with a professional will be required to create a suitable diet for every patient. The service can seek out a senior care facility with a nutritionist on staff and request their assistance on the matter rather than seek to hire a professional whose services will not be required constantly.
The measures that are taken after a patient’s treatment concludes are also critical to consider. Follow-up programs such as counseling and other initiatives that are offered by the treatment center are critical for ensuring that the dependence is eliminated. 12-step meetings can be beneficial in helping seniors manage their lives after treatment, and the service will refer people to Narcotics or Alcoholics Anonymous groups (with which it is not associated) if the patients want to expand their support network. It is particularly important to watch for signs of relapse, such as recalling the addiction fondly or starting to use the substance again. To avoid the long, painful, and expensive (for the Center; treatment is free for UAE citizens) rehabilitation process, it is critical that these indicators are recognized early and addressed.
The service will incorporate community outreach programs to improve its ability to contact seniors that may not currently be receiving the treatments that they need. It will provide education and support regarding addiction in seniors, counseling services, both at the Center and people’s homes, and referrals to service networks and treatment. It is essential to find older adults who are at risk of addiction or affected by one, both through their concerns and those of the people around them. Outreach programs accomplish these goals by spreading awareness of the problem and educating people about the signs and dangers of addiction.
One likely reason why seniors sometimes do not refer to addiction services despite the existence of the problem is that they either underestimate its seriousness or do not know where they can ask for help. To address the issue, the initiative will cooperate with local open-access services and create them where needed. These facilities provide non-intervention help to patients who have specific concerns, referring them to more in-depth services if needed. It is possible to identify two prominent varieties of such an organization: “drop-ins” that provide consultations for visitors and telephone hotlines that provide anonymous advice. The service will cooperate with them, ensure that their information is up-to-date and relevant, and ensure that they refer people with severe addiction cases.
The cost of constructing the framework can be roughly estimated at $100,000, but it does not include ongoing costs or the salaries of the professionals that will be conducting the interventions. The government of Dubai, represented by the Dubai Health Authority, is likely to be a significant source of funding, as it is interested in improving the health outcomes of the city’s residents and addressing any issues. The Erada Center for Treatment & Rehab is likely to provide funding or other resources to improve the quality of the interventions that it provides. Combined, these two sources should be adequate to finance the project and ensure that it succeeds.
The staff that will conduct the service will consist of various addiction specialists, who will apply themselves to combat the issue in seniors. However, due to the unique concerns of the senior population, they will also have to understand various physical and mental health issues that can cause addiction in its members. Some of the professionals who currently work at Erada Center for Treatment & Rehab will be trained in the necessary competencies and transferred to the program. Initially, supervision will also be necessary to ensure that they are addressing the issues of their patients appropriately, though in-depth monitoring will likely become unnecessary as performance improves.
Partnerships with other entities will be necessary to achieve the highest quality of community-centered care. The Community Development Authority would be a highly beneficial partner, as it has numerous social services for Senior Emiratis. The Ministry of Community Development also has numerous facilities that are intended to benefit older adults and could improve the quality of care. Lastly, the Dubai Culture and Arts Authority could provide recreational activities for the inpatient service, as described above. By engaging in cultural events, they can participate in group activities and overcome their isolation and loneliness through the creation of new connections.
The outcome measures for the project will involve the health of the senior population, particularly concerning addiction. One measure would be the readmission rate of patients who have been treated for their addiction but relapsed at a later time. Another would be the number of complications that develop in patients as a result of their addictions. Lastly, the LDQ dependence measure that is used at Erada Center could be beneficial for assessing the overall levels of substance abuse among the population. All of these should improve considerably after the introduction of the service, which makes them excellent outcome measures.
Structured Critical Review
Epidemiology
Adults over 50 years of age are increasingly engaging in substance abuse, though it is challenging to determine the specific rates due to a lack of data. Men, who predominantly abuse alcohol and illicit drugs, appear to be more at risk than women, who are prone to overuse of sedatives and anxiolytic medication. Marijuana appears to be predominantly used among illicit substances at 54%, with prescription drug misuse also being prevalent at 28%. Tobacco overuse is also concerningly high, particularly because most care providers do not treat it with the same caution they apply to other addictions despite the dangers of extensive smoking. With that said, the topic of addiction, including that among seniors, is currently attracting increased attention from medical workers and researchers.
The various comorbidities that are associated with substance use disorders are their primary threat to health. 50 to 70% of patients who undergo treatment for their addiction have multiple SUDs and accompanying mental conditions. Examples include schizophrenia, post-traumatic stress disorder, and anxiety and mood disorders, all of which frequently occur in seniors. Moreover, it is challenging for an addicted person to overcome their problems because of the withdrawal symptoms such as tremors, depression, and seizures. These issues complicate the treatment of addiction and require significant medical effort for successful rehabilitation.
Research and Ethical Subjects: “Literature Search”
Models for the treatment of addiction in senior populations worldwide tend to be incorporated into the broader framework of care without being given particular distinctions. Most of the services reviewed, such as Aurora Project Lambeth, rely on peer experience and support to understand and address the patient’s issues. As such, many of the workers who interact with the patients are either currently affected by addiction or have been in the past. The service proposed in this paper will incorporate a similar approach in its treatment of outpatients and people who have been successfully rehabilitated.
A variety of formal treatments for addiction have been developed, many of which focus on its social aspect as well as physical dependence. Contingency management and cognitive behavioral therapy were among the interventions found to be effective. The service will use those where appropriate, drawing on the current expertise of Erada Center for Treatment & Rehab. Recommendations to determine the social network of the patient and use it to understand the context of substance abuse were also found. The service will engage in the practice, as it is particularly important to obtain support from seniors, who are often isolated. Lastly, services are evolving and improving, particularly in Dubai, whose ruler, His Highness Sheikh Mohammed bin Rashid Al Maktoum, has signed a mental health law that aims to improve the quality of care that people with mental conditions receive through a variety of innovations.
Strengths and Weaknesses of the Undertaken Literature Review
The review has found numerous and varied current frameworks for treating addiction that are used by successful organizations in developed countries. It has succeeded in identifying critical determinants and barriers to the provision of care, such as the stigma often associated with addiction. Initiatives such as the law mentioned above can be conducive to the development of services and eventually shift the social consensus. Moreover, the findings can be used to improve the design of the services at the Center.
However, the review has also demonstrated significant gaps in the understanding of the issues that affect older adults, particularly in the UAE. There was no information about female patients above 60 years of age in the Center’s archives, which suggests that the population may be ignored. This tendency is prevalent throughout the broader research, which contains a notable lack of statistics. Moreover, the literature rarely mentions specific accommodations that are aimed at older adults and does not analyze the usefulness of current methods in addressing them.
Possible Practical or Academic Implications for the Review
The most significant implication for research that has emerged for this review is that specific research into the determinants of addiction is necessary. To that end, practical intervention designers must reach out to communities and try to find and assist the older adults who are affected by addiction but do not report it. The effectiveness of specific interventions for the treatment of seniors is also a vital topic for research because they may require specialized or individualized approaches. Practice facilities should introduce accommodations for them, which include accessibility measures and specialized facilities that target the factors that cause addiction in seniors. Loss and isolation are particularly important, and therapists should be prepared to address them alongside any mental issues that may be present in the patient. The service’s individualized treatment program can become an example for other facilities if it evolves to become successful.
Summary and Concluding Remarks
Due to a lack of attention to senior patients as well as various social concerns, they have increasingly been developing addictions and not having them treated. They are a risk group for developing a set of issues, but the medical system also underserves them. Healthcare providers have started recognizing the existence of the issue, but pertinent research and statistics are still lacking. The project that is proposed in this paper is intended to introduce a new service that will engage seniors throughout the community and help them overcome their issues while minimizing the likelihood of a relapse. It will introduce improved accommodations and individualized psychosocial and community-based treatments for older adults to improve their outcomes. The program will improve awareness of the addiction situation among senior patients in Dubai and provide a model for their treatment if it succeeds.
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