Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
143 Doctors are Online

What is the treatment for the people with depression and drug abuse?

User rating for this question
Answered by

Practicing since : 2003
Answered : 2189 Questions
If I was a consulting psychologist for a large retirement community, while speaking with some of the residents, I realize that many of them appear to be depressed, many of them have not had their medication reevaluated in years, many have confided in you that they use alcohol and other drugs as a coping mechanism, and many of the residents routinely take sleeping pills at night. How would you determine the extent of substance abuse use, what steps will you take to begin to deal with depression, alcohol, tranquillizer, barbiturate, and prescription medication problems, and ethical issues.
Posted Tue, 12 Mar 2013 in Mental Health
Answered by Dr. Jonas Sundarakumar 9 hours later

Substance abuse in the elderly is an often underestimated problem. Especially, in deprived communities, substance abuse is highly prevalent among the elderly. Unfortunately, it often goes undetected and unattended to.

In the case scenario, you are the consulting psychologist of a large retirement community and you are beginning to realize that many of the elderly clients are depressed and may be abusing a variety of substances.

Firstly, in this scenario, the problem seems to be more that just substance abuse. In fact, the substance abuse may be just the tip of the iceberg or in other words, merely one of the outward manifestations of more serious underlying issues.

Since it is a retirement community, it is very likely that there could be economic and social deprivation and isolation. This implies that the access to healthcare facilities is also likely to be poor. This is evident by the fact that many of them have not had their prescriptions changed for years together. So, a combination of factors such as poor socio-economic status, isolation, multiple health problems (which is common in the elderly age group) and the lack of adequate medical facilities, could be major underlying causes for the high prevalence of depression in this community. The substance abuse is very likely to be a coping mechanism in the midst of these adversities. That is why I had mentioned that the substance abuse is probably just the tip of the iceberg.

Now, how do you go about tackling this complex scenario?

Well, the first step would be to make a detailed assessment about the extent and severity of the problem, so that an appropriate management plan can be drawn. This assessment should include an in-depth analysis into various factors like:

-     Prevalence and patterns of substance abuse
-     Morbidity patterns, especially the psychiatric morbidity pattern in the community
-     Socio-demographic profile of the community
-     Current healthcare access pathways and the effectiveness / levels of utilization of the same
-     Existing social and cultural support structure – for example NGOs, religious organizations and support groups, etc.

Once you have a clear idea about the extent and severity of the substance abuse problem and also about all the other associated contributing factors, then the next step would be to formulate a management plan. Since resources are likely to be scarce in this fringe population, the management plan should first see how to effectively make use of the existing resources.

You should liaise and work together with the primary health centres and GPs catering to this area. You can formulate a brief assessment questionnaire which will enable healthcare provides or social / community workers to easily screen and detect people who are in need of professional help. You can put in place a referral system, where complicated cases, which require specialist care, can be referred to the nearest psychiatrist. Since, it is unlikely that the referring psychiatrist would have the time and resource to be able to deal with every case, you should probably take up the major role is assessing, screening and managing uncomplicated cases. You should also liase with the psychiatrist in following-up and monitoring the more the complex patients who are under intensive treatment from the psychiatrist.

Local bodies and NGO /religious groups can be involved actively in order to be more effective in delivering better community services. For example, providing better social support, better recreational facilities and improving the overall quality of life can all go a long way in preventing depression and substance abuse problems.

Last but not the least, it is important to keep following up and monitoring your interventions – 1) to ensure that the planned strategies are being implemented, and 2) to see in further improvements or positive changes can be made.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
Share on Facebook
Share on Twitter
Share on Google+
Question is related to

The user accepted the expert's answer

Ask a Psychiatrist

© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor