Terry Macho, Orenda Primary Therapist, is a veteran clinician with decades of experience at Florida’s premier treatment organizations. For much of his career, Terry was inspired by his experiences helping older adults find recovery from problematic use of alcohol and prescription medications.
Terry’s own recovery journey and his experiences with career and family helped him to relate deeply with his patients and to form a strong and effective therapeutic alliance with them. This Orenda Perspective discusses the prevalence of substance use disorders among older adults — a problem that often goes overlooked — and features thoughts and commentary from Terry that explains why the Orenda program is well-suited to addressing their needs.
Much of today’s addiction-related news focuses on the opioid epidemic and actions to reduce the supply and misuse of prescription drugs. While informing the public about the problems posed by opioids and highlighting the fact that drug overdose deaths have recently declined somewhat, it is important not to create the impression that the problem of addiction is going away. Many indications suggest just the opposite—increases in polysubstance use disorders, a resurgence in stimulant misuse, and a doubling of deaths related to alcohol misuse.
Often overlooked in the public discussion are the many older adults suffering from long-term active addiction and the effects on their family members and loved ones.
While the Centers for Disease Control and Prevention, reports that people 65 and older have the lowest incidence of overdose deaths, this does not mean that they do not suffer from substance use disorders in significant numbers. Problematic alcohol and drug use among older adults can often persist for years or decades, exacerbating physical conditions including liver disease, neurological problems, cancers, and heart disease that can cause years of pain and despair for sufferers and loved ones.
Identifying substance use disorders among older people can be problematic. Friends, colleagues, and loved ones sometimes dismiss problematic substance use in older adults as a retirement privilege or a harmless indulgence.
“When speaking of an aging parent’s use of alcohol and medications, many people commonly mistake addiction for pleasure,” wrote Carol Colleran and Debra Jay in Aging & Addiction. “Confusing the pleasure of having a glass of wine at dinner with the devastation of addiction is most prevalent when we talk about people in the retirement years.”
Misusing substances is not one of your dad’s “last pleasures in life”—nor that of anybody’s mom or grandparent.
“Addiction isn’t a reward, and it isn’t one of life’s last pleasures. Addiction is a thief. It robs older people of the most important years in their lives,” warned Colleran and Jay. “If you are concerned about an older person with an addiction, don’t let his age lull you into thinking his life is over, and what he does doesn’t really matter.”
Problematic substance use can begin or worsen in retirement. Many Orenda patients are business leaders, public figures, and executives who drink socially or use medications to cope with the demands of high-stress professional life. For these individuals, personal identity and meaning can be closely tied to one’s professional persona and the trappings of a fast-paced, demanding lifestyle. Retirement for these people can result in a sudden loss of mission, relationship, stimulation, and structure that can lead to depression, anxiety, and other mental health disorders. Struggling to redefine oneself in retirement, find meaning, and quell mental health problems can lead to self-medicating with alcohol or drugs.
Orenda understands the importance of seeking treatment at any age and offers treatment services that address the unique needs of older adults. Here, experienced staff and an integrated program of advanced medical services, family involvement, wellness services, and privacy make an important difference for older adult patients.
Working with a seasoned Orenda therapist who can appreciate the life experience of the patient typically results in a stronger therapeutic alliance. According to the late psychologist Edward Bordin, the therapeutic alliance consists of three main elements: agreement on the goals of the treatment, agreement on the tasks, and the development of a personal bond made up of reciprocal positive feelings. That reciprocal personal bond is easier to establish when the patient and therapist belong to the same generation, and the counselor can dedicate a lot of time to his patient.
“I think that our older patients find that they can really relate to us,” says Terry Macho, Orenda Primary Therapist. “This is a team of very experienced professionals who are passionate about helping people and have honed skills through years of clinical experience. We are also a group of full, rounded individuals who each bring experiences of career, family life, and in some cases, recovery to our work. We often find a great deal in common with our patients, and this common ground can become the foundation for the authentic rapport that is essential to fostering trust, openness, and aspiration.”
We often find a great deal in common with our patients, and this common ground can become the foundation for the authentic rapport that is essential to fostering trust, openness, and aspiration.Terry Macho, Primary Therapist
Orenda assesses and addresses one’s total quality of life. Recognizing the far-reaching physical, mental, and spiritual declines caused by substance misuse can be a challenge for patients and family members. Older adults often present with chronic pain, reduced executive functioning, and stunted emotional affect without realizing that these conditions are brought on or exacerbated by problematic substance use. Helping patients understand the pervasive effects of these conditions and developing a holistic, individual program of care that includes adaptable therapies and adequate time can dramatically and quickly increase the patient’s quality of life. “Remarkable change can often be seen in a patient’s physicality and demeanor in the first few days of treatment. When you take the time to do thorough assessments, apply the right combination of coordinated therapies, and take the time needed to truly educate and work with each patient, you can see an immediate positive response. Light dawns for patients when they begin feeling better and come to understand the direct linkage between their mental, physical, and spiritual health. They begin to see the promise of a drastically better way of living and engage even more deeply in treatment,” says Macho.
Including family members in treatment is also crucial. “It is important to understand the complex role that families can play in substance abuse treatment. They can be a source of help to the treatment process, but they also must manage the consequences of the identified patient’s addictive behavior. Individual family members are concerned about the identified patient’s substance abuse, but they also have their own goals and issues. Providing services to the whole family can improve treatment effectiveness,” explains a detailed study published by the Center for Substance Abuse Treatment (CSAT) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
Orenda team members have experience working with older adults and family members to help patients access care and to achieve good treatment outcomes. The program is located in a licensed medical facility that offers accessibility, on-premise medical suites, and comfortable, private accommodations. Orenda provides a wide range of advanced medical assessments, testing, and therapies to address a comprehensive range of physical health conditions resulting from long-term substance misuse.
Programming also includes physical therapy and other fitness and wellness services that address underlying pain without the use of substances. Individualized wellness services, including yoga, acupuncture, massage, and more, are typically scheduled in the mornings to help patients feel relaxed and energized throughout their day. The Orenda medical team can also coordinate care with some of the nation’s leading specialists when necessary. Integrated family therapy is a core component to making treatment effective and contributing to lasting recovery. Family members are encouraged to take part in the treatment and to learn how to support their loved one’s recovery following treatment. Orenda is a private campus that affords the space, time, and tranquility in which to focus on treatment.
“Older people often need to feel that they have support close at hand to become comfortable, open, and engaged in treatment,” says Macho. “Our excellent on-site medical and nursing team, patient concierge, wellness team, and high staff-to-patient ratio make it apparent to our patients that they are truly being cared for and have our undivided attention. In my experience, Orenda’s team, programming, and resources make it an excellent resource for older adults and families.”
To learn more about how Orenda is suited to the needs of older adults or to refer a patient, please contact an informed member of the Orenda admissions team.