Older Adult Addiction Treatments

The aging of baby boomers results in a higher number of elderly people and aging adults. Older adults with a history of lifetime drug use, plus different cultural norms and general attitudes about drug use, and increases in the availability of psychotherapeutic medications, may cause a higher number of older adults with substance use problems. Although no drug treatment programs exclusively target older adults, research to date indicates that current addiction treatment programs can be as effective for older adults as for younger adults. However, substance abuse problems in older adults often go unrecognized and therefore untreated.

Naltrexone Blocks Opioids

Naltrexone is a synthetic opioid antagonist with few side effects that lasts a long time. An opioid antagonist blocks opioids from binding to receptors and thereby prevents an addicted individual from feeling the effects associated with opioid use. Doctors prescribe naltrexone as a treatment for opioid addiction in outpatient medical settings, although initiation of the treatment often begins after medical detoxification in a residential setting. To prevent withdrawal symptoms, individuals must be medically detoxified and free of opioids for several days before taking naltrexone. Users take the medication orally either daily or three times a week for a sustained period. When used this way, naltrexone blocks all the effects, including euphoria of other opioids. The theory behind this treatment is that repeated absence of the desired effects and the perceived futility of using an opioid gradually diminish opioid craving and addiction. Naltrexone itself has no subjective effects or potential for abuse and it is not addictive. However, a common problem is patient noncompliance. Therefore, a favorable treatment outcome requires an accompanying positive therapeutic relationship like counseling or therapy and careful monitoring of medication compliance. Many experienced clinicians find that highly motivated recently detoxified patients who desire total abstinence do best when doctors prescribe naltrexone. Professionals, parolees, probationers and prisoners in work and release status exemplify this group. Both behavioral treatment and motivational incentives, like offering of prizes or rewards for maintaining abstinence, suggest the efficacy of naltrexone treatment for opioid addiction.

How Are Sleep Disorders Diagnosed?

Depending on symptoms, some doctors will gather various kinds of information and consider several possible tests when trying to determine a sleep disorder, including:
Sleep history and sleep log. A doctor will ask how many hours a person sleeps each night, how often the person wakes during the night and for how long, how long it takes to fall asleep, how rested a person feels upon waking up and how sleepy a person feels during the day. A doctor may ask subjects to keep a sleep diary for a few weeks. A doctor may also ask if there are any symptoms of sleep apnea or restless legs syndrome, such as loud snoring, snorting or gasping, morning headaches, tingling or unpleasant sensations in the limbs that moving or jerking relieves during sleep. A sleeping partner may respond to some of these questions about symptoms, as some people are not aware of them.
Sleep recording in a sleep lab (polysomnogram). A sleep recording refers to a polysomnogram or PSG test that occurs in a sleep center or sleep laboratory. Subjects will likely stay overnight in the sleep center with electrodes and other monitors placed on the scalp, face, chest, limbs and finger. While sleeping, these devices measure brain activity, eye movements, muscle activity, heart rate and rhythm, blood pressure and how much air moves in and out of the lungs. This test also checks the amount of oxygen in the blood. A PSG test is painless. In certain circumstances, people can take the PSG at home. A home monitor can record heart rate, how air moves in and out of the lungs, the amount of oxygen in the blood and the breathing effort.
Multiple Sleep Latency Test (MSLT). Particularly useful for diagnosing narcolepsy, this test measures how sleepy a person is during the day. In this test, typically conducted after an overnight sleep recording (PSG), monitors sleep stages with devices placed on the scalp and face. Subjects nap 4 or five 5 for 20 minutes every 2 hours during times in which a person would normally be awake. Technicians note how quickly a person falls asleep and how long it takes the person to reach various stages of sleep, especially REM sleep, during these naps. Normal individuals either do not fall asleep during these short designated nap times or take a long time to fall asleep. People who fall asleep in less than five minutes are likely to require treatment for a sleep disorder, as are those who quickly develop REM sleep during their naps.
It is important to have a sleep medicine specialist interpret the results of a sleep-monitoring test (PSG) or MSLT.
A number of factors can make a person susceptible to sleep apnea. These factors include:

• Throat muscles and tongue that relax more than normal while asleep
• Enlarged tonsils and adenoids
• Being overweight--the excess fat tissue around the neck makes it harder to keep the throat area open
• Head and neck shape that creates a somewhat smaller airway size in the mouth and throat area
• Congestion, due to allergies, that can also narrow the airway
• Family history of sleep apnea

Some of the ways to help diagnose sleep apnea include:

• A medical history that includes asking family members questions about the quality of sleep and how daily functioning
• Checking the mouth, nose and throat for extra or large tissues, for example tonsils, uvula (the tissue that hangs from

A Multiple Sleep Latency Test (MSLT), usually done in a sleep center, helps determine quickly a person falls asleep at times when one would normally be awake. Falling asleep in only a few minutes usually means that a person is very sleepy during the day. Being very sleepy during the day can be a sign of sleep apnea.
Once a person completes all these tests, the sleep medicine specialist will review the results and work to develop a treatment plan. Changes in daily activities or habits may help reduce symptoms:

• Instead of sleeping on the back, sleep on one side. Sleeping on one side will help reduce the amount of upper airway collapse during sleep.
• Avoid alcohol, smoking, sleeping pills, herbal supplements and any other medications that cause sleepiness. These substances make it harder for the airway to stay open while sleeping and sedatives can make breathing pauses longer and more severe. Tobacco smoke irritates the airways and can help trigger the intermittent collapse of the upper airway.
• If a person is overweight, he or she should try to lose weight. Even a little weight loss can sometimes improve symptoms.

These changes may be all that are needed to treat mild sleep apnea. However, if a person suffers from moderate or severe sleep apnea, additional, more direct treatment approaches may be helpful.