WHEN IS TOO MUCH?
Addiction problems in old age increase due to demography. In the first place alcohol is important, but often also an unadjusted drug consumption plays an important role. How is the canton of Basel-Stat dealing with this topic? We talked to Eveline Bohnenblust, Head of the Addiction Department."Not infrequently begins a problematic alcohol consumption only in old age"
On the subject of addiction in old age, alcohol addiction seems to be clearly in the foreground of the problem in quantitative terms. Do you share this assessment?
Eveline Bohnenblust
In practice, we share the view that alcohol is the number one addict in old age. Representative samples of the Swiss population show that besides alcohol, tobacco and drugs also play a role beyond the age of 60. Among the drugs, it is especially the painkillers, sleepers and sedatives. The intake is often associated with sleep disorders and restlessness as well as nervousness.How can "alcoholic" be defined quantitatively?
As a low-risk alcohol consumption for men are two standard drinks per day and for women a standard drink per day. In addition, consumption-free days are recommended because they counteract the emergence of a habit. For Switzerland, 1 standard drink = 10 g of pure alcohol, this corresponds approximately to:
3 dl beer (5 vol.%)
1 dl of wine (12.5% by volume)
2 cl schnapps (55 vol.%)
4 cl of liqueur (30 vol.%)
From a high-risk consumption can be spoken from over 60 g per day for men and 40 g per day for women.
What is your estimate of the number of elderly people in Switzerland who are likely to have a serious alcohol problem?
The results of the national survey on addiction monitoring in Switzerland 2012 show that in 7.6 percent of the age groups 65 to 74 must be spoken of a chronic high-risk consumption. That's 5.6 percentage points more than the boys (15 to 19-year-olds). Binge drinking, on the other hand, decreases significantly with age and is highest in younger age groups (20-24 y.). But it is also important to say that the vast majority of people do not consume any addictive substances or occasionally treat alcohol or tobacco as a stimulant without being "addicted".
The authorities want to educate about the risks. But let's be honest
we all know long ago that too much alcohol or smoking is not healthy. What should enlightenment eg with brochures still use, especially at a higher age?Basically, "knowledge" about substances and their risks is of great importance. Only through information can a self-responsible handling of addictive substances be learned. It is also important to draw attention to the connections. Not infrequently begins a problematic alcohol consumption only in old age, which is often related to the changed conditions such as the termination of professional life, boredom or diminishing performance, etc.
Which starting points do you pursue?
One starting point is to look at and change exactly these conditions in the context of a consultation. For example, a day structure against boredom, the embedding of single persons in social networks to counteract the isolation. Maintaining health and improving the quality of life are worthwhile at any age. In particular, falls or accidents due to consumption of alcohol or medicines can be prevented at a higher age.
How do you even reach addicts? Are not they even ashamed to claim help?
Certainly, feelings of shame are common - not only in people dependent on addicts, but also in other mental or social problems and are very human. The way to admit that you need help can take longer. Persons who come into the addiction counseling report themselves mostly or appear on the advice of relatives. Experience shows that the first step is the most important one. Anyone who feels accepted and understood in counseling sessions has less shame and is better at working on a change.
Suppose an addict overcomes this limit of shame
how should he proceed if he wants to effectively combat his addiction? Which institutions in Basel can he turn to?A first point of contact is the family doctor, who can be trusted, who can offer support and who can, if necessary, pass it on to a specialist. In addition, there are various offers in the canton Basel-Stadt in the addiction help, which support affected persons on their way out of addiction. The aid offer ranges from information on addiction and addiction to outpatient consultation and treatment, to substitution treatment or inpatient therapy, and is aimed both at people with an addiction problem as well as at their relatives and third parties (eg employers).
What help is provided by these institutions?
Specialists in counseling and treatment centers offer advice on all issues relating to the addiction problem. They help sufferers begin therapy, organize withdrawal and accompany them during and after treatment. They also offer assistance in solving social and financial problems. It is always discussed the entire life situation together. This includes addressing the issues where changes are desired or necessary. Such a change may, for example, include the goal of establishing and maintaining social contacts; and aims to change addictive or sustaining conditions.
To what extent do you draw relatives into the problem?
For relatives, worrying about the health of the addicted person, but also living with her often can be very stressful. Addiction counseling services also provide support to relatives and the social environment. In addition, there are also group offers for relatives, where they can exchange with people in a similar situation and relieve each other. These can be self-help groups or groups led by a specialist. In the counseling and treatment centers, the family situation and the relationship should always be inquired and actively involved as needed or on request.
The intake of medication is a daily "must" for many people to be able to endure the everyday life. Would you also call such people addicted?
There are drugs with dependency potential. For example, sleep and sedatives are widely used. Here too, there are various institutions in the canton that offer help: These include the Addiction Department of the Basel City Health Services, the University Psychiatric Clinics Basel. A decisive role is played by the doctors who prescribe the medication and accompany the time while taking it. Here, the topic can be recorded together with the doctor.
The combination of alcohol and medications should pose an above-average problem in old age. How do you deal with this challenge?
For the treatment of ailments such as high blood pressure, heart problems or pain, more medicines are often taken in old age. Often different medicines have to be taken at the same time. Many medications show interactions and change their effects in combination with alcohol. In the consultation it is therefore important to check whether the clients take their medication according to medical prescription and are sufficiently informed about whether alcohol may be drunk and if so, how much.
And if that is not the case?
If there is a discrepancy between the recommended use of alcohol and the actual consumption of alcohol, information and motivational counseling in the addiction counseling service will encourage a change in behavior. If other caregivers such as Spitex services are involved, collaboration is important. Especially for people with health problems, close cooperation among the caregivers is important.
Last question
Does the gambling addiction really belong to the definition of "addiction in old age"? If so, what are the services provided by the instances?In recent years, it has been shown that even excessively exercised rewarding behaviors have an addictive potential, which includes the gambling and shopping addiction. As far as these "behavioral fancies" are concerned, only gambling addiction has so far had internationally recognized diagnostic criteria. Shopping addiction, but also eg Internet addiction are widely discussed and known from practice "addictions", which, however, require further research. Behavioral fears know no age limits. However, to what extent they will play a role in the older population will become clear.
