In one of the first studies we conducted under the 1995 program of research on "Barriers to Treatment", 120 service providers were asked about some of the existing barriers that seniors faced. They consistently identified professional attitudes as one of the most important potential barriers. The attitudes that people held affected whether the problem was identified, and whether any help was offered. The attitudes and beliefs also affected policies and practices.
Specific professional attitudes can be crucial in whether a senior gets effective help for an alcohol problem.
In one study (the "Physician Study"), we asked just under 100 physicians from across British Columbia about their experiences with seniors who have alcohol problems. We also asked for their views on a number of treatment related issues. Here's what we found. After each statement, we've noted the reality or the barrier potentially created by the attitude.
It is important to point out that it is not only physicians who express these attitudes. Similar comments and feelings have been expressed in most of the helping professions.
· 66% of the physicians felt that "Most older adults with alcohol problems have long histories of drinking problems"
This is true to some extent. However, one third of seniors with alcohol problems develop the problem in the last few years. By looking for that "long history", professionals may inadvertently overlook the late onset drinker.
Physicians tended to describe the "typical problem
drinker" as "a person who is down and out; someone who
ignoring responsibilities to family; or someone who doesn't want
to work". Using these criteria, it would be easy for seniors who have alcohol
problems to get overlooked.
· 68% of physicians believed that "Nothing can be done for the person, unless he or she takes responsibility for change."
This is attitude is very hard on seniors with alcohol problems. Many seniors don't recognize there is a problem. Others cannot recognize it because of cognitive impairment caused by alcohol use. The attitude also ignores the extremely strong stigma among seniors around acknowledging having a drinking problem.
· 57% of the physicians felt that "If a person drops out of alcohol program, it is probably due to a lack of motivation."
The reality is more complex than that. Many programs are currently not designed with seniors' needs in mind and may not meet their needs. In effect, we may be setting seniors up for failure. We give programs all the credit for when seniors succeed, and place all the blame on seniors if the programs don't work.
· 52% of the physicians believe that "A patient must come to terms with the fact that he or she has an alcohol problem (in other words admit it) before anything can help".
Once again, people who work with seniors emphasize that this may be an unrealistic expectation. Those who work in alcohol programs geared specifically to seniors note that in some of the best "successes", the senior never expressly acknowledged the alcohol problem.
· 42% of the physicians agreed with the statement that "Drinking is often a person's few remaining pleasures in later life."
What a sad statement about people's view of aging. The reality is that for many seniors, problem drinking is not a pleasurable experience. Instead, it is a way of dealing with loneliness, grief, losses or boredom.
· Most physicians (92%) believe that abstinence is the most appropriate goal for seniors with alcohol problems.
This creates a special challenge for seniors and for agencies where the measure of "success" is much more flexible. Professionals can end up work at odds to each other, because they have very different expectations.
Abstinence may not be necessary for all seniors experiencing drinking problems. It will depend on the extent of the problem, the underlying factors behind it, and the way in which it is affecting the person's life.
· 33% of the physicians believed that "The treatment prognosis for older adults is not very good "
There is a sense of discouragement among many professionals even before the senior starts out. The reality is that in programs designed with seniors needs in mind, seniors do as well, if not better than younger adults.
Why do some professionals feel this way?
There are many reasons:
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