Indian Journal of PsychiatryIndian Journal of Psychiatry
Home | About us | Current Issue | Archives | Ahead of Print | Submission | Instructions | Subscribe | Advertise | Contact | Login 
    Users online: 3427 Small font sizeDefault font sizeIncrease font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
    References

 Article Access Statistics
    Viewed857    
    Printed25    
    Emailed0    
    PDF Downloaded84    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents    
REVIEW ARTICLE  
Year : 2018  |  Volume : 60  |  Issue : 8  |  Page : 553-558
Interventions in individuals with specific needs


National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India

Click here for correspondence address and email

Date of Web Publication5-Feb-2018
 

   Abstract 


With the growing understanding of substance use problems among special populations like women, gender minority groups, as well as in the geriatric population, there is a drive to develop sensitive interventions catering to their unique needs. This chapter is a short review of psycho-social interventions targeted towards these individuals with specific needs.

Keywords: Women, LGBT, geriatric population, psycho-social intervention

How to cite this article:
Mandal P, Dhawan A. Interventions in individuals with specific needs. Indian J Psychiatry 2018;60, Suppl S2:553-8

How to cite this URL:
Mandal P, Dhawan A. Interventions in individuals with specific needs. Indian J Psychiatry [serial online] 2018 [cited 2019 Nov 12];60, Suppl S2:553-8. Available from: http://www.indianjpsychiatry.org/text.asp?2018/60/8/553/224687





   Introduction Top


Traditionally, substance use has been seen as a phenomenon among adult males. Until recently, addiction research and services suffered a scarcity of intervention and outcome related data for women or sexual minorities like LGBT, extreme age groups and other minorities. These groups often pose unique treatment challenges due to the obvious differences in the interplay of various bio-psychosocial factors relating to substance use. However, with the emergence of evidence on increasing substance use among women, sexual minority groups, decrease in the age of initiation of substance use and problematic substance use among older adults, the specific treatment needs of these groups are being assessed and interventions are being planned during the recent three decades. Apart from the pharmacological treatment for substance use, these population groups in question often benefit from psycho-social interventions. Many of these interventions are developed taking into consideration the theoretical underpinnings and epidemiological evidence related to bio-psychosocial factors associated with substance use among these populations. In this chapter, the psycho-social interventions developed or modified so far for these special population groups for substance use problems would be discussed.

Women

With the emergence of understanding of gender difference in substance abuse, there has been a drive for developing gender-sensitive interventions/programmes for substance use problem among women and sexual minorities. Certain psychosocial antecedents have been found more likely to be associated with substance use by women. These include comorbid psychiatric disorders[1], significantly more physical and sexual abuse and domestic violence, victimization,[2],[3] and deficits in social support.[4] Nearly half of the women treatment-seekers in tertiary addiction treatment centres or community clinics in India also report similar psychosocial issues for initiation of substance use.[5],[6],[7] Treatment seeking and retention are usually poor among women all over the world including India.[5],[6] Studies indicate that women face various systemic, structural, social and individual barriers in treatment seeking and retention in treatment for substance abuse.[8] These include lack of appropriate gender responsive treatment models, lack of services for pregnant women; rigid programme schedules, lack of safety at treatment centres; inadequately trained staff for handling gender sensitive issues; fear of losing custody of children; lack of childcare outside of treatment. disadvantaged life circumstances; stigma, shame and guilt; lack of support from family; decreased perception of need for treatment are few of the socio- cultural and personal barriers reported in the literature.[9]

A gender sensitive intervention ideally should systematically integrate the gender dimension into every step of the process, from defining the problem, to identifying potential solutions, in the methodology and approach to implementing the intervention.[10],[11]

The theoretical underpinnings for gender-sensitive interventions developed for women take into account the addiction theory, women's psychological development, the trauma theory and the factors associated with substance use among women discussed earlier.[10],[11],[12],[13],[14] Apart from the emotional, psychological, spiritual component, the addiction theory takes into account the environmental and socio-political dimensions into the disease model of addiction.[15] The next important component is a theory of women's psychological development, The Relational Model, (developed by the Stone Centre, Wellesley College) which posits that the primary motivation for women throughout life is establishing a strong sense of connection rather than separation. Women disconnected from others, or involved in abusive relationships, experience disempowerment, confusion, and diminished self-worth, all of which predispose them to substance abuse. On the other hand, in a growth-fostering relationship, a woman develops a sense of mutuality that is “creative and empowering” and essential for psychological well-being.[12] Understanding of trauma is also essential. Trauma not only includes suffering violence, but also witnessing violence, and trauma of stigmatization because of sexual orientation or other reasons like poverty etc., Women use substance in order to self-medicate the suffering of trauma which often produces bias in woman's relational experience and poses as barrier for psychological development.[16]

Based on the theories and available epidemiological data, gender-sensitive interventions, the following gender-sensitive principles have been developed:[14],[18]

  • Gender: Acknowledge that gender makes a difference
  • Environment: Create an environment based on safety, respect, and dignity
  • Relationships: Develop policies and practices that are relational promote healthy connections to children, family, significant others and the community.
  • Services: Substance abuse, trauma, mental health issues addressed in a comprehensive, culturally relevant fashion
  • Socio-economic status: Opportunities to improve socioeconomic conditions
  • Community: Establish comprehensive and collaborative community services


Gender sensitive interventions of varying intensity have been implemented in various settings (Out-patient, residential, mixed-gender and single gender). In general, the women only treatment settings reported better treatment utilization, greater benefit for women with special need. Gender-specific programming, programmes with provision of child care had better rates of treatment retention.[19]

In 2008, Covington developed a comprehensive Women's Integrated Treatment (WIT) model based on the theoretical framework discussed above, and multidimensional therapeutic interventions. Till date, seven theoretically supported and trauma-informed manualized curricula were designed. “Helping Women Recover: a programme for treating Addiction” is one such curriculum which is widely used in addiction treatment programmes, mental health clinics for women. It uses cognitive-behavioural, relational, mindfulness, and expressive arts techniques. It covers self, relationships, sexuality, and spirituality as key triggers for relapse.

The content focuses on self-esteem, sexism, family of origin, relationships, domestic violence, and trauma. Better in-treatment performance has been reported with these models.[20] However, effectiveness of such models is yet to be studied systematically.

Among the behavioural treatment approaches that have amassed empirical support include: cognitive behavioural therapy (CBT), motivational enhancement interventions, and contingency management. Yet most behavioural therapies have been developed generically and they have not been examined to see how they can be specifically tailored to women's treatment. CBT for relapse prevention, interventions using workbook-based psychoeducation approach appear to be promising, encouraging retention while delivered in women-specific group.[20] Brief intervention providing information regarding foetal health hazards among pregnant alcohol users has been reportedly effective in reduction of drinking.[11] Contingency management alone or in combination with BI have some evidence of effectiveness in reduction of substance use and psycho-social needs.[20] During the last thirty years, Therapeutic Community approaches have been modified to incorporate empowerment and supportive rather than confrontational approches for women. However, the effect of such modifications has not yet been tested formally.[1]

LGBT

Emergent research (both cross-sectional and longitudinal) has consistently reported a greater likelihood of substance use among sexual minority youth as compared to heterosexual youth.[21],[22] The odds of substance use among sexual minority youth was found to be at nearly twice than that of heterosexual youth.[23] Similarly, lesbian and bisexual female youth are more likely to exhibit substance use problems when compared to heterosexual females[24],[25] and sexual minority males.[23] Lesbian, gay, bisexual, and transgender (LGBT) populations often enter treatment with more severe substance misuse problems, have a greater likelihood of experiencing a substance use disorder in their lifetime, and initiate alcohol consumption earlier than heterosexual clients. Thus, developing effective treatment programmes that address the specific needs of these populations is critical.[26]

The reasons for higher levels of substance use among sexual minority youth are largely unknown. However, the association between various stigma (related to sexual orientation) –related stressors, including gay-related stressful life events (e.g. identity disclosure), victimization at school, verbal/physical abuse and substance use has been documented.[25] The available evidence of a strong association between sexual behaviours and substance use, and use of substances to cope with marginalisation indicates the need to pay attention to the relationship between sexual behaviour or orientation and substance use treatment.[27]

With regard to substance use among LGBT population, the stages of 'identity development' Fontaine and Hammond (1996)[28] and the disclosure of sexual identity described as “Coming out” have been discussed in literature. Given the higher rates of victimisation amongst LGBT, there are strong arguments that victimization should be addressed for prevention of drug use.[29],[30]

For all practical purpose, prevention is set as a priority principle while dealing with substance use problems and its treatment for the LGBT population.[29],[31]

SAMHSA (2001) and recently APA (2012) published treatment guidelines for substance abuse treatment for LGBT (2001). Both these guidelines highlights the importance of 'cultural competence', confidentiality and non-discrimination while dealing with LGBT individuals. APA additionally emphasizes the need for community-based programmes specifically for LGBT adolescents and young adults. These are particularly important given the enhanced need to assist this young group with (1) disclosing their sexual minority identity, (2) issues of family rejection, (3) lack of housing and other stability factors (particularly those experiencing family rejection), and the (4) need for a safe environment given extreme levels of abuse and harassment due to their gender expression. Meagre literature treatment programmes with specialized groups for gay and bisexual clients have shown better outcomes for men compared to gay and bisexual men in non-specialized programmes.[21] However, till date this population is being treated in mixed substance abuse treatment setting that serves both LBT and heterosexual persons.

Apart from the substance use treatment per se, issues like the coming out process; families of origin and families of choice; capacity building among professional have been discussed at length.[31] Factors such as transphobia or homophobia (both internal and societal), violence, family issues, and social isolation, among other problems, may also need to be addressed.[29] Pregnancy and parenting issues should be addressed while treating LBT women.[32]

Regarding the mode of delivery and type of services to this population, the need for a LGBT-informed care has been underscored by various authors.[29],[32] LGBT-informed treatment includes asking clients the pronoun that they prefer to go by and encouraging other clients to use the pronoun of choice. Treatment workbooks and other programme materials generally use heterosexual examples, thus conscious revisions to treatment curriculum materials are called for. The counselling staff may not make assumptions regarding health risks and social norms associated with the identifying as an LGBT person. Avoiding use of disrespectful language is an important aspect of treatment and may enhance treatment retention. A thorough assessment that is non-judgmental, inclusive of sexual orientation for new treatment entrants in a non-judgemental fashion, is the essential pre-requisite of a successful treatment. Enquiry regarding sexual identity alone increases the probability of treatment drop out by 30%. Initial and on-going assessment should also include should also include questions about the positive and negative experiences specifically related to their sexual minority identity. In-depth understanding of these issues helps in developing a comprehensive need based treatment plan.

To address the need of this population, treatment services which are LGBT-sensitive and LGBT-specific services have been developed. Based on the available literature various authors have proposed checklist of requirements for LGBT-sensitive interventions. These include the way in which language is used (partner versus girlfriend/boyfriend); counsellor self-awareness, acceptance and affirmative approach, and engagement of family and significant others.[32] The importance of a non-judgemental, sensitive, 'gay-affirming and respectful attitude of the therapist/clinician have also been underscored.[33],[34].

On the other hand, LGBT-specific services are culturally adapted to address the unique needs of the LGBT population.[35] Cultural adaptation attends to the beliefs, norms and context for the minority group, applies relevant examples and materials that match with the group's norms and values, and attends to sexual behaviour as it pertains to the intervention being adapted. Ratner (1988)[36] described a 12-Step focused model (Pride Institute) with the following LGBT-specific features: positive and affirmative environment that acknowledges the LGBT lifestyle; a focus on self-acceptance and self-awareness; strategies for coping with stigma, discrimination, stress; affirming the non-traditional “family” network, integration of sexuality into the treatment; and the presence of LGBT role models. Many of these interventions are run by LGBT individuals themselves.

Modified CBT to take into account LGBT issues, including case formulation and functional analysis, are considered as helpful therapeutic approaches when working with LGBT individuals.[32] Effectiveness of the Community Reinforcement Approach (CRA) for LGBT youth living on the streets have been reported.[37] Morgenstern et al. (2007) found that four sessions of brief Motivational Interviewing (MI) for alcohol-dependent MSM (Men having Sex with Men) populations with co-occurring problems who are contemplating moderation can reduce drinking for sustained period of time, compared to MI plus CBT (12 sessions).[38] Most of such interventions have been done on people who are HIV positive and gay, among whom the rate of HIV seropositivity is high. Brief interventions have also been found effective in reducing consumption of club drugs over a one-year follow-up period among men MSM using smaller drug amounts. However, it was not effective in reducing club drug use amongst those with moderate levels of drug use. (2009)[39]

APA also has emphasized the need to enrich service providers, especially psychologists, with regard to their knowledge and understanding of homosexuality and bisexuality. The need for medical providers on the signs and symptoms of AOD abuse and the specific health care needs of LGBT populations through incorporation of chapters in the medical curriculum has also been emphasized in the literature.[26]

Both women and LGBT population using substances are defined by their unique psycho-social needs. Engaging these people in treatment has always been challenging. With advent of emerging research on the nature of their problem and their specific needs, gender-sensitive interventions are being developed and existing interventions are also being modified to address their need. Although the effectiveness of such interventions have not yet been thoroughly examined, these interventions have definitely shows a ray of hope.

Geriatric population

Substance use in the geriatric population is one of the fastest growing health problems and it is probably a silent epidemic. Older substance users can be categorised as early onset users (survivors) or late onset users (reactors). Early onset users typically have a long history of substance use which persists into old age. Late onset users often begin using because of stressful life events, including retirement, social isolation or bereavement. Significant clinical differences resulting from the age of onset in alcohol users have been reported in the literature. The latter group has a better prognosis for recovery. Older adults take more prescribed and over-the-counter medications than younger adults,[40] increasing the risk for harmful drug interactions and dependence. Although illicit drug use is less frequent among older adults than younger people, its prevalence is increasing all over the world and at a higher rate in the western part of the world.[41]

Identification and diagnosis of problematic substance use following the formal diagnostic systems may be challenged by age related biological changes and psycho-social functioning.

There is an overall dearth of literature on effective interventions (both pharmacological and non-pharmacological) tailored towards this population.

As far as the assessment of an old individual about substance use is concerned, some general considerations should apply. Older adults are known to respond more to a supportive, non-judgmental and non-confrontational approach than more assertive styles of assessment and intervention. Discussions of alcohol and other substance use should occur in the context of an overall assessment and in reference to the presenting problem with the goal of health promotion and a complete understanding of their health behaviours.[40],[42]

There is a dearth of rigorous, internally valid intervention studies involving psychosocial interventions for the geriatric population. Based on the little research available, older adults have demonstrated comparable or better treatment outcomes than younger groups[43],[44] and factors like erroneous perception of severity, a foreshortened sense of future, low self-efficacy and physical limitations have posed as common barriers to reduce substance use.[45],[46]

Three psychosocial and psychotherapeutic approaches, namely cognitive-behavioural therapy (CBT), supportive therapy models (STM)[47],[48],[49],[50],[51],[52] and Brief Intervention (BI) have been studied for this population. CBT focuses on identifying and altering sequences of thinking, feeling, and behaving that lead to problem drinking or drug use.[53] There is strong evidence for positive outcomes across populations and age groups including older adults.[48],[49],[50],[51],[52] The Substance Abuse and Mental Health Services Association published a CBT treatment manual specific to substance-using older adults. The highly structured, didactic approach taken in CBT may be particularly helpful to older adults because of the tendency to present with memory difficulties.[54] Finally, CBT interventions have outperformed nicotine replacement therapies among older adults participating in a smoking cessation programme.[55]

Traditional STM approach has been reframed to address the unique issues faced by older individuals, including health conditions, depression comorbidity, and social isolation. STM focuses on developing a culture of support and successful coping for older-adult substance abusers. Treatment is planned taking a holistic bio-psychosocial approach through addressing multiple issues in the individual's life. Supportive therapies concentrate on building social support and improving self-esteem.[56] There is at least some evidence that older adults demonstrate better outcomes in these settings than in non-adapted settings.

The most common brief intervention practised for older adults is a combination of normative feedback, in which a patient's drinking is compared with his or her peers and brief advice and seems to be highly effective for them.[44],[57],[58] Most of the brief interventions use either motivational interviewing (MI)[59] or motivational enhancement therapy (MET) as the key element.[60] Both MI and MET takes a non-confrontational, non-judgemental supportive approach to discussing substance use and healthy changes in the individual's life. However, there is little evidence to suggest that formal MI works with older adults with regard to substance use.[60],[61]

Apart from the interventions discussed above, case and care management models have been indicated as important tools in working with this population. These models work through the primary care settings or community-based agencies[56] and address the array of psycho-social problems common in this population in a comprehensive manner.[62],[63] Besides, they also attempt to connect isolated older adults to community resources.[54]

Traditional Self-help groups like Alcoholics (AA) or Narcotics Anonymous (NA), if modified keeping in mind the cognitive changes and physical limitations of the aging population, may be useful in reducing isolation, shame, and stigma.[56] However, there have been no systematic studies regarding this.

With increase in life expectancy, geriatric substance use problems have gradually became emergent along with obvious psycho-social issues of old age. However, attention to the aging population is a relatively emerging area. Developing holistic, age appropriate services for the older population to cater to their physical and mental health needs under one umbrella is currently in focus and expected to expand further in the coming years.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Brady T, Ashley O. Women in Substance Abuse Treatment: Results from the Alcohol and Drug Services Study (ADSS); 2005. Available from: http://www.drugabusestatistics.samhsa.gov/womenTX/womenTX.htm. [Last accessed on 2017 Sep14]  Back to cited text no. 1
    
2.
Green CA, Polen M R, Dickinson D M, Lynch FL, Bennett M D. Gender differences in predictors of initiation, retention, and completion in an HMO-based substance abuse treatment program. J Subs Abuse Treat. 2002; 23: 285-95.  Back to cited text no. 2
    
3.
Murthy P. Women and Drug use in India: Substance, Women and Highrisk Assessment Study. New Delhi, India: Ministry of Social Justice and Empowerment and United Nations Office on Drugs and Crime; 2008.  Back to cited text no. 3
    
4.
Niccols A, Milligan K, Sword W, Thabane L, Henderson H, Smith A. Integrated programs for mothers with substance abuse issues: A systematic review of studies reporting on parenting outcomes. Harm Reduction. 2012; 9:14  Back to cited text no. 4
    
5.
Grover S, Irpati AS, Saluja BS, Mattoo SK, Basu D. Substancedependent women attending a deaddiction centre in North India: Sociodemographic and clinical profile. Indian J Med Sci. 2005; 59:28391.  Back to cited text no. 5
    
6.
Nebhinani N, Sarkar S, Gupta S, Mattoo SK, Basu D. Demographic and clinical profile of substance abusing women seeking treatment at a deaddiction centre in North India. Ind Psychiatry J. 2013; 22: 126.  Back to cited text no. 6
    
7.
Dayal P, Balhara YPS. Profile of female patients seeking in-patient treatment for prescription opioid abuse from a tertiary care drug dependence treatment centre from India. Indian J Med Res. 2016; 143 (1): 95–100. doi: 10.4103/0971-5916.178616  Back to cited text no. 7
    
8.
United Nations Office on Drugs and Crime. Substance abuse treatment and care for women: case studies and lessons learned. United Nations Publication Sale No. E.04.XI.24 ISBN 92-1-148194-5; 2004.  Back to cited text no. 8
    
9.
Lal R, Deb KS, Kedia S. Substance use in women: Current status and future directions. Indian J Psychiatry. 2015; 57: 275-85.  Back to cited text no. 9
    
10.
Tang Z, Claus RE, Orwin RG, Kissin WB, Arieira C. Measurement of gender-sensitive treatment for women in mixed-gender substance abuse treatment programs. Drug Alcohol Depend. 2012;123 (1-3):160-6. doi: 10.1016/j.drugalcdep. 2011.11.003. Epub 2011 Dec 3.  Back to cited text no. 10
    
11.
Grella CE. From Generic to Gender-Responsive Treatment: Changes in Social Policies, Treatment Services, and Outcomes of Women in Substance Abuse Treatment. J Psychoactive Drugs. 2008; 40:((sup5):327-43  Back to cited text no. 11
    
12.
Covington S, Surrey J. The relational theory of women's psychological development: Implications for substance abuse. In: Wilsnak, S.and Wilsnak, R., editors. Gender and alcohol: Individual and social perspectives. Piscataway, NJ: Rutgers University Press; 1997. P. 335-51.  Back to cited text no. 12
    
13.
Herman J. Trauma and Recovery: The aftermath of violence – from domestic abuse to political terror. New York. Basic Books; 1997  Back to cited text no. 13
    
14.
Covington S. “Chapter IV: Understanding and Applying Gender Differences in Recovery.” Dawn Drug Alcohol Woman Network: Promoting a Gender-Responsive Approach to Drug Addiction (a Collection of Good Practices). Turin, Italy: United Nations Interregional Crime and Justice Research Institute (UNICRI), 2013  Back to cited text no. 14
    
15.
Covington, S. 1999, rev. 2008. Helping Women Recover: A Program for Treating Addiction (with a special edition for the criminal justice system). San Francisco: Jossey-Bass; 2008  Back to cited text no. 15
    
16.
Covington S. 1997. Women, addiction, and sexuality. In: L. Straussner and E. Zelvin Editors. Gender and Addictions: Men and Women in Treatment. London: Jason Aronson Inc; 1997.  Back to cited text no. 16
    
17.
Bloom B, CovingtonS. Gender-Specific Programming for Female Offenders: What is it and Why is it Important? In proceedings of the 50th Annual Meeting of the American Society of Criminology: 1998 November 11-14; The Center for Gender and Justice La Jolla, CA.  Back to cited text no. 17
    
18.
Bloom B, Owen B, Covington S. Gender-Responsive Strategies: Research, Practice, and Guiding Principles for Women Offenders. Washington, DC; 2003. National Institute of Corrections, US Department of Justice. Accession Number: 018017  Back to cited text no. 18
    
19.
Greenfield SF, Brooks AJ, Gordon SM, Green CA, Kropp F, McHugh RK et al. Substance abuse treatment entry, retention, and outcome in women: A review of the literature. Drug Alc Depend. 2007; 86 (1):1–21.  Back to cited text no. 19
    
20.
Messina N, Calhoun S, Warda U. Gender-responsive drug court treatment: A randomized controlled trial. Criminal Justice Behav. 2012; 39(12):1536–55.  Back to cited text no. 20
    
21.
Duncan DT, Hatzenbuehler ML, Johnson RM. Neighbourhood-level LGBT hate crimes and current illicit drug use among sexual minority youth. Drug Alcohol Depend. 2014; 135 (1): 65–70. doi: 10.1016/j.drugalcdep. 2013.11.001.  Back to cited text no. 21
    
22.
Corliss HL, Rosario M, Wypij D, Wylie SA, Frazier AL, Austin SB. Sexual orientation and drug use in a longitudinal cohort study of U.S. adolescents. Addict Behav. 2010; 35:517–21. [PubMed: 20061091]  Back to cited text no. 22
    
23.
Marshal MP, Friedman MS, Stall R, King KM, Miles J, Gold MA, Bukstein OG, Morse JQ. Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction. 2008; 103:546–56. [PubMed: 18339100]  Back to cited text no. 23
    
24.
Needham BL. Sexual attraction and trajectories of mental health and substance use during the transition from adolescence to adulthood. J. Youth Adolesc. 2012; 41:179–90. [PubMed: 22076077]  Back to cited text no. 24
    
25.
Russell ST, Fish JN. Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth. Ann Rev Clin Psychol. 2016 28; 12: 465–87. Doi: 10.1146/annurev-clinpsy-021815-093153.  Back to cited text no. 25
    
26.
Stevens S. Meeting the substance abuse treatment needs of lesbian, bisexual and transgender women: implications from research to practice. Subst Abuse Rehab. 2012:3 (Suppl 1) 27–36  Back to cited text no. 26
    
27.
Senreich E. Are specialized LGBT program components helpful for gay and bisexual men in substance abuse treatment? Subst Use Misuse. 2010; 45 (7-8): 1077-96.  Back to cited text no. 27
    
28.
Fontaine JH, Hammond NL. Counselling issues with gay and lesbian adolescents. Adolescence. 1996; 31 (124):817-30.  Back to cited text no. 28
    
29.
American Psychological Association. Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients. The Division 44/Committee on Lesbian, Gay, Bisexual, and Transgender Concerns Guidelines Revision Task Force. 0003-066X/11/$12.00 Vol. 67, No. 1, 10–42 DOI: 10.1037/a0024659 2012  Back to cited text no. 29
    
30.
Padilla Y, Crisp C, Rew D. Parental acceptance and illegal drug use among gay, lesbian, and bisexual adolescents: Results from a national survey. Social Work. 2010; 55 (3), 265-75.  Back to cited text no. 30
    
31.
USA. Department of Health and Human Services. Substance Abuse and Mental Health Administration. A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals. Rockville, MD: The department; 2001. Available from: https://store.samhsa.gov/shin/content/SMA12-4104/SMA12-4104.pdf  Back to cited text no. 31
    
32.
Ritter A, Matthew-Simmons F, Carragher N. (2012). Monograph No. 23: Prevalence of and interventions for mental health and alcohol and other drug problems amongst the gay, lesbian, bisexual and transgender community: a review of literature. Drug Policy Modelling Programme Monograph Series 23. Sydney: National Drug and Alcohol Research Centre.  Back to cited text no. 32
    
33.
Coker T R, Austin S B, Schuster M A. The health and health care of lesbian, gay, and bisexual adolescents. Ann Rev Pub Health. 2010; 31 (1): 457-77.  Back to cited text no. 33
    
34.
Israel T, Gorcheva R, Walther W A, Sulzner J M, Cohen J. Therapists' helpful and unhelpful situations with LGBT clients: An exploratory study. Prof Psychol-Res Pr. 2008; 39 (3): 361-68.  Back to cited text no. 34
    
35.
Satterfield J M, Crabb R. Cognitive-behavioural therapy for depression in an older gay man: A clinical case study. Cognitive Behav Pr. 2010; 17 (1): 45-55.  Back to cited text no. 35
    
36.
Ratner E. A model for the treatment of lesbian and gay alcohol abusers. Alcohol Treat Q.1988; 5 (1): 25-46.  Back to cited text no. 36
    
37.
Grafsky E L, Letcher A, Slesnick N, Serovich J M. Comparison of treatment response among GLB and non-GLB street-living youth. Children Youth Services Rev. 2011; 33 (5):569-74.  Back to cited text no. 37
    
38.
Morgenstern J, Irwin T, Wainberg M L, Parsons J T, Muench F, Bux DA Jr, et al. A randomized controlled trial of goal choice interventions for alcohol use disorders among men who have sex with men. J Consult Clinical Psychol. 2007; 75 (1):72-84.  Back to cited text no. 38
    
39.
Morgenstern J, Bux DA Jr, Parsons J, Hagman B T, Wainberg M, Irwin T. Randomized trial to reduce club drug use and HIV risk behaviours among men who have sex with men. J Consult Clinical Psychol. 2009, 77 (4): 645-56.  Back to cited text no. 39
    
40.
Kuerbis A, Sacco P, Blazer DG, Moore AA. Substance abuse among older adults. Clin Geriatr Med. 2014; 30 (3): 629–54. doi: 10.1016/j.cger. 2014.04.008.  Back to cited text no. 40
    
41.
Degenhardt L, Dierker L, Chiu WT, Medina-Mora ME, Neumark Y, Sampson N, et al. Evaluating the drug use “gateway” theory using cross-national data: consistency and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys. Drug Alc Depend. 2010; 108 (1–2):84–97.  Back to cited text no. 41
    
42.
Schonfeld L, Dupree LW, Dickson-Fuhrman E, Royer CM, McDermott CH, Rosansky JS et al. Cognitive-behavioural treatment of older veterans with substance abuse problems. J Geriatr Psychiatry Neurol. 2000; 13:124–28.[PubMed: 11001134]  Back to cited text no. 42
    
43.
Brennan PL, Nichol AC, Moos RH. Older and younger patients with substance use disorders: outpatient mental health service use and functioning over a 12-month interval. Psychol Addict Behav. 2003; 17 (1):42–8. [PubMed: 12665080]  Back to cited text no. 43
    
44.
Kuerbis AN, Sacco P. A review of existing treatments for substance abuse among the elderly and recommendations for future directions. Subst Abuse. 2013; 7:13–37. [PubMed: 23471422]  Back to cited text no. 44
    
45.
Rodin J. Aging and health: effects of the sense of control. Science. 1986; 233:1271–76. [PubMed: 3749877]  Back to cited text no. 45
    
46.
Gecas V. The social psychology of self-efficacy. Am Rev Sociol. 1989; 15:291–316.  Back to cited text no. 46
    
47.
Dupree LW, Broskowski H, Schonfeld L. The Gerontology Alcohol Project: a behavioural treatment program for elderly alcohol abusers. Gerontologist. 1984; 24:510–16. [PubMed: 6500273]  Back to cited text no. 47
    
48.
Kofoed LL, Tolson RL, Atkinson RM, et al. Treatment compliance of older alcoholics: an elder specific approach is superior to “mainstreaming”. J Stud Alcohol. 1987; 48:47–51. [PubMed: 3821118]  Back to cited text no. 48
    
49.
Rice C, Longabaugh R, Beattie M, Noel N. Age group differences in response to treatment for problematic alcohol use. Addiction. 1993; 88:1369–75. [PubMed: 8251874]  Back to cited text no. 49
    
50.
Schonfeld L, Dupree LW. Treatment approaches for older problem drinkers. Int J Addict. 1995; 30 (13–14):1819–42. [PubMed: 8751320]  Back to cited text no. 50
    
51.
Schonfeld L, Dupree LW, Dickson-Fuhrman E, et al. Cognitive-behavioural treatment of older veterans with substance abuse problems. J Geriatr Psychiatry Neurol. 2000; 13:124–8.[PubMed: 11001134]  Back to cited text no. 51
    
52.
Schonfeld L, Dupree LW. Age-specific cognitive behavioural and self-management treatment approaches. In: Gurnack AM, Atkinson RM, Osgood NJ, editors. Treating alcohol and drug abuse in the elderly. New York: Springer Publishing Company; 2002. p. 109-30.  Back to cited text no. 52
    
53.
Rotgers F. Cognitive-behavioural theories of substance abuse. In: Rotgers F, Morgenstern J, and Walters ST Editors. Treating substance abuse: theory and technique. 2nd edition. New York: The Guilford Press; 2003. p. 166-89.  Back to cited text no. 53
    
54.
Centre for Substance Abuse Treatment. Substance abuse among older adults: Treatment Improvement Protocol (TIP) Series 26. Rockville (MD): Substance Abuse and Mental Health Services Administration; 1998.  Back to cited text no. 54
    
55.
Hall SM, Humfleet GL, Munoz RF, Reus VI, Robbins JA, Prochaska JJ. Extended treatment of older cigarette smokers. Addiction. 2009; 104:1043–52. [PubMed: 19392908]  Back to cited text no. 55
    
56.
Sacco P, Kuerbis A. Older adults. In: Vaughn MG, Perron BE. Editors. Social work practice in the addictions. New York: Springer; 2013. p. 213-29.  Back to cited text no. 56
    
57.
Conigliaro J, Kraemer KL, McNeil M. Screening and identification of older adults with alcohol problems in primary care. J Geriatr Psychiatry Neurol. 2000; 13:106–14. [PubMed: 11001132]  Back to cited text no. 57
    
58.
Fink A, Elliot MN, Tsai M, Beck JC. An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol. J Am Geriatr Soc. 2005; 53:1937–1943. [PubMed: 16274375]  Back to cited text no. 58
    
59.
Miller WR, Rollnick S. Motivational interviewing: preparing people for change. 2nd edition. New York: The Guilford Press; 2002.  Back to cited text no. 59
    
60.
Miller WR, Zweben A, DiClemente CC, Rychtarik RG. Motivational enhancement therapy manual: a clinical research guide for therapists treating individuals with alcohol abuse and dependence. Project MATCH Monograph Series v. 2 (DHHS Publication No. (ADM) 92- 1894. Rockville (MD): National Institute on Alcohol Abuse and Alcoholism); 1992.  Back to cited text no. 60
    
61.
Cummings SM, Cooper RL, Cassie KM. Motivational interviewing to affect behavioural change in older adults. Res Soc Work Pract. 2009; 19 (2):195–204.  Back to cited text no. 61
    
62.
Arndt S, Clayton R, Schultz S. Trends in substance abuse treatment 1998–2008: increasing adult first time admissions for illicit drugs. Am J Geriatr Psychiatry. 2011; 19:704–11. [PubMed: 21785290]  Back to cited text no. 62
    
63.
Barry KL, Oslin DW, Blow FC. Alcohol problems in older adults. New York: Springer Publishing Company; 2001.  Back to cited text no. 63
    

Top
Correspondence Address:
Anju Dhawan
Professor, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_23_18

Rights and Permissions




 

Top