One of the most controversial topics regarding substance abuse is how to deal with people who have the problem. If they use illicit drugs, should they be treated or jailed? If treatment is the choice, should they be placed in inpatient facilities or in outpatient programs? These decisions have become both political and sensitive. Many politicians have built their careers on being perceived as "tough on drugs" and have voted to curtail or eliminate treatment
options for drug offenders.

The rise of health management organizations has resulted in the near elimination of inpatient treatment facilities in favor of the less expensive outpatient programs and community treatment centers.

A very enlightening exercise is to find out what treatment options are available in your area for people who have substance abuse problems.

Find out whether there are any inpatient programs, which outpatient programs and
community treatment centers are available, and how long one has to wait to receive treatment. Also, find out the costs of the various programs and whether various health insurance policies cover the treatments.

Gather the information from several geographic regions, and compare program availability. Think about what you would do if you were poor and needed help in your area. What do you think should be done to address the problem?

middle-aged adults are the most likely group to seek treatment for their problem.

Drinking among older adults presents a more complicated picture. Even older adults who drink only modest amounts may experience dangerous interactions with medications they may be taking. Additionally, they metabolize alcohol much more slowly, meaning that it remains in the bloodstream longer. As a result, older adults are at higher risk for abusing alcohol if they simply continue habits of drinking from earlier points in their lives, even if their consumption when they were younger was only moderate. Diagnosing alcohol dependence in older women can be especially difficult given the higher likelihood that they live alone.

Treatment for substance abuse in all age groups focuses on three goals (Smyer & Qualls, 1999): stabilization and reduction of substance con­sumption, treatment of coexisting problems, and arrangement of appropriate social interventions.

Which treatment approach works best depends on the age of the person in question (National Institute on Alcohol Abuse and Alcoholism, 2008). Younger adults tend to respond best to short-term programs tailored specifically to them; traditional programs such as Alcoholics Anonymous are less effective. On college campuses, these programs tend to target high-risk groups (e. g., fraternities, sororities, athletes) and focus on DUI preven­tion. Middle-aged adults respond to a variety of approaches, but individual differences are quite large, meaning that it may be necessary to try several different treatments. Older adults often respond better to education programs rather than direct confrontation to reduce their denial of their problem and to make sure they understand the age-related changes in alcohol metabolism.

Addressing other problems, such as depression and anxiety, may be effective in helping people use substances more appropriately. Training in

self-management techniques to improve coping skills can also help, especially in cases of sub­stance abuse involving pain medications (Dupree & Schonfeld, 1996). Although adults of all age groups can respond to treatment, success rates often are low, and older adults take longer to withdraw from sub­stances than younger adults (Lisansky, Gomberg, & Zucker, 1999). Take the time to complete the Discovering Development feature. Finding out the treatment options in your area may enable you to help a friend; the lack of certain types of treatment options may also surprise you.

Concept Checks

1. What are the major symptoms and treatment options for anxiety disorders?

2. What are the primary characteristics of psychoses? How do they differ with age?

3. What are the major considerations concerning substance abuse in older adults?

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