Online Toolbox

The Toolbox is one of the most important intellectual outputs of the European BeTrAD Project.

It incorporates the findings and conclusions of all the project processes into a web format for consultation. It provides tools and guidance to develop, implement and improve services for aging drug users.
These tools are aimed at social service providers, agencies that train professionals, policy-makers and higher education institutions.

The need to create an online tool arises from the lack of a toolbox, as well as a training curriculum, in the previous projects that addressed the issue of aging drug users. Both initiatives should promote the results and recommendations obtained at a European level in a sustainable and applicable way.

About

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Presentation of the Toolbox

The Toolbox is one of the most important intellectual outputs of the European BeTrAD Project. It incorporates the findings and conclusions of all the project processes into a web format for consultation. It provides tools and guidance to develop, implement and improve services for aging drug users.

These tools are aimed at social service providers, agencies that train professionals, policy-makers and higher education institutions.

BeTrAD’s Toolbox is made up of four main blocks:

  • Situation and the context of aging drug users in Europe. The BeTrAD project has evaluated the current state of the target population, and the innovative policies and methodologies that address aging drug users in Europe.
  • Methods detected in the analysis of good practices and presented in the training curriculum implemented for the first time in the European Summer School in Frankfurt. Special attention is given to providing information on methods and instruments for the improvement of detection, diagnosis, care and treatment of aging drug users, and that at the same time measure the quality of life.
  • Examples of best practices of specific and nonspecific interventions for the target group have been compiled and evaluated based on their usefulness, practical application and impact on health and personal self-sufficiency.
  • Database with references, resources and key or relevant web links on the subject.

 

Project Justification & Aims

The need to create an online tool arises from the lack of a toolbox, as well as a training curriculum, in the previous projects that addressed the issue of aging drug users. Both initiatives should promote the results and recommendations obtained at a European level in a sustainable and applicable way.

Furthermore, there are almost no action plans that focus on aging drug users and their specific needs. The few existing ones are available at the European level and only a few at the national level. This project focuses on this special risk group that lives on the margins of society and with vulnerability factors that are intended to be clarified and highlighted by obtaining the expected results.

The previous projects to which we referred earlier are: the project ‘Sucht im Alter’, which provided information on the needs of elderly drug users; the project ‘Elderly people dependent on drugs and care structures’ (SDDCare, 20061), funded by the health program of the European Union and which compiled data and guidelines in four different countries. The SDDCare project concluded that there is currently an increase of population of drug addicts (35/45 years of age and older) in all European countries. Most drug dependents older than 45 are multi drug users, with preference for opiates, often injected.

In this way, BeTrAD’s Toolbox is based on existing evidence and takes into account the previous results of other projects on the same topic, as well as complementary actions and information. Evidence is obtained by carrying out an evaluation at European level and a collection of examples of best practices that serve as sources of information to shape the educational elements of the project. These tools and knowledge should ultimately create learning opportunities for professionals to establish and improve services for aging drug users.

The purpose of a toolbox is to provide guidance and support to training providers for professionals, care and treatment and care providers for the target group, health and social service providers, but also to local or supra-local political authorities and professional advisors or policy makers, researchers and the scientific community, and higher education institutions.

Our main aims are:

  • To train professionals and organizations involved in the care and treatment of drug addiction, as well as provide geriatric institutions and local governments with useful tools and models of best practices.
  • To involve drug users and their representatives in the development and implementation of project results.
  • To provide tools and guidance to develop, implement or improve services for aging drug users.
  • To encourage the improvement of European policies and action strategies, both in the attention to drug addicts and care for the elderly paths.

 

Contributions

We hope to keep this toolbox updated with your input. If you know of any study, effective intervention or project that, in your opinion, should be included in this site, please let us know by sending an email to administration@correlation-net.org

When a reference, please provide as many details as possible: title, type of document, language, year, author(s), name of the contact person, contact information and/or web link.

Please note that the content of this toolbox was last updated on August 2018. From that date onwards, Correlation Network will host and maintain the BeTrAD toolbox. New contributions will only be accepted for publishing in the bibliographic reference database, good knowledge and best practices from the contributions mentioned.

Contact information

Jean Nico Pierre, director
Website: http://www.jdh.lu
Email: jean-nico.pierre@jdh.lu
Telephone 1: +352 49 10 40 – 1
Telephone 2: +352 49 10 40 – 123
Fax: +352 49 10 40 – 110

 

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Situation of Aging Drug Users

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Characteristics of Aging Drug Users

Ageing drug users can be divided into early initiation users (survivors) or late initiation users (reactive users). Whereas early initiation users usually have a long history of substance use that persists in old age, late initiation ones often begin to use drugs due to some stressful life event, such as retirement, marital failure, social isolation or the loss of a loved one (EMCDDA, 2010).

Elderly drug users are defined as those aged above 40 whose recurrent use of psychoactive substances is causing them harm or is placing them at a high risk of suffering it. They have different characteristics and trajectories from younger drug users.

  • Older adults are frequent users of prescription drugs with and without a prescription. The problematic use of these medications can be intentional or involuntary and of greater or lesser severity.
  • Although illicit drug use is less frequent in older adults than in younger ones, its prevalence is increasing. Recreational drug users are getting older and, since maintenance programs have more patients in treatment, the number of elderly patients is increasing.
  • The figures indicate that older adults have a relatively high risk of drinking problems. The combined use of alcohol and other drugs increases the risk of social, psychological and physical problems, and can cause difficulties even when the consumption of alcohol is light or moderate.
  • Aging can cause psychological, social and health problems that act as risk factors for substance abuse, but can also be aggravated by substance use.
  • Physical and mental health problems are more prevalent in older drug users; However, most older adults have regular contact with primary care services or with other health services.
  • Relatively little is known about drug use treatment in the elderly. However, older patients take therapeutic programs seriously and can achieve satisfactory results with treatment.

 

Drug Use Trends

The total number and the proportion of older chronic and problem drug users in Europe has increased significantly over the past decades. According to recent studies, the proportion of ageing drug users in Europe will continue to grow.

Data on drug users entering treatment
Most European countries are observing an increasing number of older drug users entering treatment. The data from EMCDDA from 2008 (EMCDDA 2010) reported the treatment demand indicator on more than 450,000 drugs users entering treatment in specialised facilities – 82,000 were aged 40 years or older. On a European level, this age group represents between 1,6% and 28% of treatment entrants in the countries providing data.

Only countries with at least 10 years of available data were included. In each of these 22 countries, older drug users entering into treatment increased between 2006 and 2014/2015 and will increase as expected. Some countries already reported mean ages of opioid users above 40 years.

Drug induced deaths
The mean age of drug-induced deaths increased in Europe from 34 in 2006 up to 39 years in 2015, as well as the proportion: In 2006 one of three drug-induced deaths happened among drug users aged above 40 years, in 2015 it was already every second death (EMCDDA 2017i).

The existence of an ageing cohort is confirmed by data from the EMCDDA drug-related death indicator, which indicate an increase in the average age of drug-induced deaths (which are mainly related to opioids) from 33 years to 37 years between 2006 and 2013. Over the same period, the proportion of all overdose deaths occurring among those aged above 40 years increased from 30% to 44%.

Problem Opioid Use

In the whole of European Union countries, there are around 510,060.000 people (15 to 64 years) and around 1,300.000 problem opioid users. This target group accounts for 0.4 % of the European population (EMCDDA 2015).

 

Problem Opioid Users aged 40 Years and older
Opioids, mainly heroin, were reported as the primary drug by the great majority (65%) of elderly drug users (aged above 40 years) in the European Union in 2008 (EMCDDA 2010). The part of this 40 year-old and older opioid users is estimated through a sample from 2015 at about 36.3% throughout Europe. While the proportion of opioid clients aged above 40 years entering treatment was one out of five in 2006, in 2015 there was already a proportion of two in five persons entering considered as an elderly drug user (EMCDDA 2017i).

Many long-term opioid users in Europe are ageing and in their 40s or 50s. The number of opioid users of 40 years and older already accounts for a large part of drug users in most of the European countries and by virtue of the trajectory in the past and the expected ‘over ageing’ in the future, the number might increase. Some European countries are already reporting mean ages of 40 years and older for treatment entrants with opioids as the primary drug (EMCDDA 2015).

The smallest percentage of the target group is reported in Romania with only 11%.

The highest percentages are reported in Portugal (57%) where the mean age of problem opioid users is already 41 years, Greece (58%) and the Netherlands which reported about 83% opiate users over 40 years (in 2016).

In other countries, there is a lack of data about drug use among older people. From some countries, data could not be obtained (Malta, Denmark or Bulgaria). For Poland for example, it was hard to obtain data because use is mainly concentrated among young adults (15-34 years). In Spain, there is no data on percentages of ageing drug users available but a mean age of 42 years for opioid drug users has been reported in 2015. In Czech Republic, for example, there is a loss of data but the trend of ageing drug users applies, too.

 

Effects of opioid use in 40 year and older users
Physical ageing processes may be accelerated by the cumulative effects of polydrug use, overdose and infections over many years. Older people with opioid problems have higher rates of degenerative disorders, circulatory and respiratory problems, pneumonia, breathlessness, diabetes, hepatitis, and liver cirrhosis than their peers and younger people who use drugs. They may also be more susceptible to infection, overdose and suicide.

In addition, their social networks may be reduced because of premature death and stigma, which can further increase social exclusion and isolation from families. The stigma and shame of still using drugs may also act as a barrier to help-seeking.

Most of this group of older opioid users have received or still receive methadone or buprenorphine treatment. Little is known about the interaction and efficacy of opioid medication and treatments of physical disorders and impaired liver condition.

 

 

Opioid Substitution Treatment

Historically, problem opioid users, mainly injectors, have always represented the largest client group receiving specialised drug treatment in the European Union. The needs of large cohorts that started heroin injecting during the 80s and 90s have shaped and characterised current European specialist and low-threshold treatment systems. Opioid substitution treatment is one example of this. With nearly 700.000 Europeans receiving this treatment, OST clients currently represent a substantial proportion of the European treatment population.

On a European level, there are approx. 680,000 opioid users in opioid substitution treatment which means a coverage of about 50% of all users (Avert 2018). On a national level the percentages of problem opioid users in the different countries range between 10% in Latvia and 91% in Spain. Drug users aged over 40 years represent more than 50% of new admissions in opioid substitution treatment in some European countries and more than 60% of users in treatment are above this age (Kastelic 2014).

There are no specific data available on a European level about older opioid users (40 years+) in opioid substitution treatment (EMCDDA 2010, 2017i). In most European countries no age-specific data data is available.

 

Problematic Use of Other Drugs.

Data on PDU of other drugs in Europe:
Regarding the problem use of other illicit drugs and ageing users there is almost no data available, neither on a European nor on a national level. However, there are data from Hungary, Croatia, Luxembourg, France, the Netherlands, Italy, Spain, Sweden, Finland and Czech Republic available on other illicit drugs than opioids.

According to TDI data collection, the number of drug users starting drug treatment in Hungary in 2016 with a primary drug other than opiates/opioids are 3.900 persons. In nearly every European country there is no data available on older users of MDMA. It can be assumed that MDMA is not an issue for the target group of ageing users.

On a European level cocaine was the next most frequently reported primary drug for drug users over 40 years (17%) (EMCDDA 2010).

Regarding the problematic use of amphetamines in the target group we can identify a very large group of 57% in the Czech Republic, Sweden also shows a very high percentage of 45%, too, as well as Finland with a medium-high rate of 24% in 2015.

 

 

Needs & Assessment

This section discusses the qualitative results of the expert consultations from Germany, Luxembourg, Spain, Netherlands and Austria. They are representatives of the local drug aid services in the respective countries – as they are working with drug users and seeing the trajectory and the needs and barriers as part of their daily work – they are able to provide indepth and current insights on the target group and the services available to them.

The available information suggests that specialised treatment and care programmes for older drug users are rare in Europe. Seeing as the proportion is older drug users is increasing rapidly, treatment and care services for this specific group need to be developed and accelerated

Treatment and support have to follow the changing needs because the increasing speed of ageing in the group of drug users adds to this problem and makes fast-acting solutions even more important.

AUSTRIA
Representative from the Ministry of Health, Pshychiatrist from VNN
Ministry of Health and Addiction

GERMANY
Manager of DROBS Bielefeld
Low-thershold Drug Aid Institution

LUXEMBOURG
Manager of AbrigadoLow-threshold Drug Aid Institution

THE NETHERLANDS
Representative from the Ministry of Health, Pshychiatrist from VNN
Ministry of Health and Addiction

SPAIN
Medical Doctor at Creu Roja and PHhD at University of Barcelona
Internal Medicine

 

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Public Policy

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Health Policy

There are a lot of new and significant medical, psychological and social challenges for policymakers, the drug treatment services and mainstream healthcare as well as support services because of the increasing number and proportion of older problem drug users and the effects of chronic drug use (risk behaviours and ageing).

The European Union Drugs Action Plan (2009–2012) requested Member States to enhance the quality and effectiveness of such services whilst also taking into account the specific needs (incl. those related to age). However, in 2010, none of the Member States had created a clear strategy (within a national, regional or local drug strategy or other national drug policy documents) to deal with older drug users. In the recent EU Action Plan on Drugs 2017-2020, ageing and drug use are mentioned as part of drug demand reduction:

Questions surrounding ageing problem drug users are relevant but have not yet been raised in many Member States. Some specific points about the provision of welfare and the funding of care for the group of ageing drug users (EMCDDA 2010, 2013) need to be clarified.

Most European welfare systems are based on improving the financial situation of people in need or to improve their chances of employment or any other aspects, e.g. health or mental health.

 

Different policies in Europe. Some examples

Germany

Financial support for treatment is covered by pension funds. The expenditure for drug treatment is supposed to be recovered by the beneficiaries’ future re-entering the labour market. Read its assessment report for more information.

Poland

Persons aged 30 years and older need to have at least five years of social insurance to receive disability benefits. So older drug users mostly don’t have the entitlement to these social benefits. Read its assessment report for more information.

United Kingdom

The existing welfare models and drug policies poorly serve the needs of older drug users. The principle of social integration through participating in the labour market requires a sufficient health of the individual. Read its assessment report for more information.

Austria

There are regulations on rights and applications of specific nursing care and support for elderly opioid-dependent persons in opioid substitution treatment as well as planned guidelines for inpatient and outpatient care and addiction. Read its assessment report for more information.

Luxembourg

Measures for elderly drug users are included in the national drugs action plan. There are stricter regulations for the prescription of benzodiazepines, tranquilizers etc. from a certain age limit. Read its assessment report for more information.

Portugal

Ageing of problem drug users has deserved particular attention in national policies but there are still no specific responses. The need of continuous and palliative care for the target group is starting to emerge in health and social services. Read its assessment report for more information.

Spain

Within the new Spanish National Strategy for Addictions, special attention will be given to data collection on ageing population, its characteristics, needs, etc. so as to find solutions to address aging and chronic drug user’s needs. Read its assessment report for more information.

The Netherlands

Due to political dynamics, the current health and social systems are under continuous reconstruction because of different governments. Read its assessment report for more information..

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Methods

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Introduction

One of the key considerations to start a new service or project, or to improve an existing one, is to have a clear idea about the strategies or approaches to be developed, as well as the methods or techniques needed.

An effective use of methods allows the work to be properly planned and structured, and also helps prioritizing the care  responses depending on the service users’ needs. However, choosing the right method can be a daunting task considering the multiplicity of existing approaches and how these are underpinned by a wide range of skills or influenced by the approach and values of the project workers.

Often times, more than one method needs to be used in conjunction with another. This is particularly relevant when working with aging drug users. Considering the complex and multidimensional set of problems experienced by this target group, social and health care projects require comprehensive approaches. Otherwise, the services offered might potentially end up becoming  limited and restrictive, impacting negatively on the service user.

Aware of these complexities, BeTrAD project has set the goal for itself of offering orientation to those service providers and decision makers that would like to develop a service targeting aging drug users. Specifically, in this section, we present a brief analysis of the methods employed by the 22 projects featured in the Best Practice Collection.

Offering a global vision that represent the reality of all services in Europe is a task that would exceed the scope and intention of this project. However, by reflecting on these successful projects, we are still able to offer key ideas and recommendations for implementation.

During the selection process, the 111 organization that submitted a project were invited to respond to an open questionnaire focused on their methodologies of work. By avoiding pre-selected answers, our intention was to maximize the diversity of result. The questions received puts in evidence not only this big variety of methodologies put at service of the care of aging drug users, but also the rich terminology by which the same methods are referred to and the specificity with which some respondents approached this task. We have decided to offer you this information in its complexity in an attempt to communicate this diversity.

However, aiming at the comparability of all the information and making it more accessible, we have grouped all of the answers into 6 broad categories, namely Housing, Mental Health, Medical Services, Social Work, Work Inclusion and Education. Taking into consideration that some of these methods would fall under more than one of these categories, we have distributed them adequately to reveal a more precise image.

Specific Services

Compared to non-specific services, the projects presented in this section have as their main focus the delivery of specific care to their clients. Having their particular needs as an starting point, the diagnosis and care offered takes into account variables such as age, type of substance consumed, comorbidity, previous treatment received, chronic conditions, among others. For this reason, clients often experience a sense of security and understanding as the care provided in this programs mirrors more closely the type of service they need.

In this category of services, the methodologies reported most by the respondents are those of Harm Reduction (20%), Activation (12%), Opioid Substitution (12%) Treatment and Counselling (10%). Following them, we encounter Referral System, Inpatient Services and Outpatient Services, all of them with 5%.

From this analysis, we can mainly deduce that the Harm Reduction (if we combine that with the OST, even more) is methodology used often when designing services for aging drug users, as well as Activation techniques, mainly in Mental Health and Vocational Work Inclusion. They are followed by many of the most classic or known methodologies, but there is still a need to improve a more widespread use of methods such as Long Term Housing, Group Therapy and Group Activities, or Neuropsychology, which has proved very effective for early and accurate diagnosis and also the efficiency of the centres, reducing health-care costs due to to early detection.

The areas of work most used are Mental Health (29%), Social Work (20%) and Medical Services (17%). These three areas are followed by other areas of intervention such as Vocational Work Inclusion (14%), Housing (14%) and finally Education (7%).

It is surprising to see that, whilst professionals working in drug addiction and social inclusion often call to incorporate more housing services, to give stability to these people and ensure good social care, only 14% of methods refer to Housing. However, the areas are quite spread out and it is clear that not only work in offering Medical Services or Mental Health but that too much weight is given to Social Work, with methods of Harm Reduction, counselling or activation, or as for example with vocational work inclusion, through activation techniques, individual case management or support in labour integration.

Non-Specific Services

During the selection process of Good Practices, 15 organisations were selected that, in addition to other target groups, also offer services to aging drug users.

Among the areas of work there is a decrease in Housing services with respect to specific services (from 14% to 7%), therefore this type of intervention should be prioritized when one develops a project aimed at aging drug users. In addition, in non-specific services, the use of social work considerably increases while the use of mental health resources decreases, the opposite of what happens in specific services. This is to be expected if we take into account that older population have more mental health problems, although it should not be at the expense of social work.

Regarding the most used methods, the same happens between the specific care services and non-specific care services, in which Harm Reduction (15%), which usually includes Opioid Substitution Treatment (12%) and Needle Syringe Programs (4%) is mostly used. Then we see the methods of Activation, Referral System and Counselling, as in the previous section.

Hence, we can affirm that there is not much difference between the methods used in adult care services that only serve the aging population. It is not surprising if we observe that it is an issue of interest, and the professional sector is interested and receptive to talk about it, but without a clear idea, much less specific objectives, specific methodology and some thoughtful activities and programs only and for the needs of these people.

Description of Most Used Methods

Harm Reduction
Harm reduction, as a paradigm or theoretical-methodological model, can be described as set of strategies directed at reducing the health, social and economic harms of drug use of individuals, communities and societies. A core principle of harm reduction is the development of pragmatic responses to the negative effects of drug consumption. Consequently, harm reduction accepts that the consumption of drugs (both licit and illicit) in any society is inevitable, and therefore puts the focus on responding to the local and specific needs of those who consume drugs.

Examples of this responses may involve needle and syringe programs, opioid substitution treatment, counselling services, the implementation of drug consumption room facilities, peer education or outreach work.

Opioid Substitution Treatment
Opioids Substitution Treatment supplies illicit drug users with a replacement drug, a prescribed opioids agonist such as methadone or buprenorphine. The effectiveness of this strategy is widely recognized, and in many countries is a fundamental component of the response to health problems to opioid dependent individuals. Greater rates of success have been observed in programs that include psychosocial support next to the prescription of the substitute.

The requirements to be able to enter in substitution treatment can vary widely among the programs, as the criteria for admission depend on the different legal and health systems of each country.

Counselling, Therapy & Advice
Counselling can be described a collaborative process aimed at supporting people making necessary changes in their ways of thinking, feeling and behaving. To operate effectively, this method requires a non-judgmental and supportive environment as a means towards helping the client set viable goals, and develop the strategies and plans necessary to accomplish these goals.

Historically, counselling is one of the most important and often used intervention within the drug addiction field. As a consequence, we are able to find multiple techniques and approaches employed in a diversity of professional contexts. For example, often times is easy to find that a client parallel therapeutic processes on a psychological, social, medical and neuropsychological level. In some of this area’s, like neuropsychology,  a different array of tests are conducted to detect early pathologies and address them earlier, improving the prognosis as much as the cost efficiency of the services.

When speaking about counselling, it is important to differentiate this term from ‘therapy’, despite the fact that often times both terms are used interchangeably in the field of care for aging people with addictions. Whereas counselling typically tends to refer to a short-term process, focused on identifying and implementing potential solutions to a current issue, therapy is a medium to longer-term process focused on long-standing attitudes that have significantly impacted an individual’s quality of life, and/or relationships.

Equally, it is also necessary to distinguish the so-called ‘advising’ techniques. Within the drug-consumption context, advising techniques are usually applied when non-problematic drug users. Their function, in this way, is to act when the problem has not yet developed. For this reason, their use and application should not be ruled out in cases of older people for whom there is no need for therapy.

Choosing a method from which to approach the support of an aging drug user. For example, some clients with a high level of self-sufficiency  might not wish to access therapy and would prefer a shorter counselling format

Activation
Activation programs refer to a wide range of activities such as voluntary work, work training and placements, training courses and language courses, sports and cultural activities. These activities reintroduce structure into a person’s life, bring social contact and helps to restore self- confidence.

Activation programs are structurally implemented in a wide variety of services aimed at supporting people at risk of social exclusion. From those, the programs targeting elderly people or substance users have been proven a fundamental tool.

Experience in the field has shown that, among people who use drugs, the elderly are the ones with the most motivation to participate in activation programs. In those cases, the most successful programs are those which articulated participation around group activities, and have a direct impact in their quality of life.

In & Outpatient Approaches
The services identified within the Best Practice collection can be categorized into inpatient and outpatient procedures, or a combination of both. The difference between these two approaches is how long a person can or must remain in the facility where they receive support.

In outpatient services clients do not need to spend the night at the service. Unless complications arise, once they have performed the necessary procedure, they can leave the centre. The main advantage of this option offer a greater comfort as they are able to recover and continue living in their homes while they are still able to follow a treatment. Inpatient services, on the other side, requires the client to remain at the facilities for at least one night. During this time, they remain under the supervision of professional staff. Examples of this approach may involve a detoxification program, long-term treatment, acute intakes or services for people who do not have a house.

When implementing a service for aging drug users, there are several aspects to take into consideration. For example, when implementing an outpatient service, special care must be taken to ensure that the daily activities can be carried out independently. In case they are not, options such a home based services, or referral to protected housing could be taken. Further, considering that contact with clients often times is less than in an inpatient service, special attention should be given to how their needs for social support, leisure and daily life structure are met. so that other specific techniques such as activation techniques (day activities, group activities, daily structure programs, employment integration), social and economic reintegration, neighbourhood involvement, etc., can be used.

Despite offering a more sustained and close support to aging drug users, inpatient services involve a higher cost of treatment than outpatient ones. As a result, often times decision makers and directors of organizations need to include finding additional resources to guarantee the viability of the hospitalization and residential services.

Referral system
A referral system can be defined as a comprehensive institutional framework that connects governmental and non-governmental entities into a network of cooperation, with the overall aim of ensuring the social, economic and health support of their clients.

The need for efficient referral systems is one of the main topics that most contributors have pointed out in the collection of Best Practices. For them to work properly, referral mechanisms need efficient lines of communication and clearly outlined referral pathways and procedures, with clear and simple sequential steps. The disposition of these good systems favours a good detection and early attention of the pathologies or problems. In addition to this, a coordinated monitoring mechanism, such as a joint database for monitoring the system of response and improving the capacity building ensures and effective referral system and service delivery

Adapted Specific Services for ADU

Through the Best Practice Collection, we have observed that specialised treatment and care programmes for older drug users are rare in Europe. This mirrors those concerns that have been voiced regarding current the state and needs of treatment and care services working with this target group. It is for this reason that the main objective of the Erasmus+ Project BeTrAD is to provide adult trainers and organisations working in the field of drug use, geriatric,  and local governments with tools and models of good practice with which to create opportunities for the establishment and improvement of services for ageing drug users.

However, despite this general landscape, in several European countries we are able to find services that target aging drug users. Examples of this initiatives include pilot projects directed at alcohol or medication abuse. Further, as presented in other sections of this Toolbox, older people and addiction is already part of the national drug action plans of several countries in Europe.

For example, in Germany we have found 8 pilot projects whose activities include education, networking and capacity building in the field of substance abuse, especially in inpatient services funded by the government. Although these services dot not target specifically aging drug users in most cases, the national drug strategy coordinates care and medication for older alcohol and drugs users. Further, there are some new inpatient services under construction (e.g. in Düsseldorf, a project with inpatient nursing care for elderly drug users). Besides these inpatient services, there are some special facilities with the possibility of outpatient nursing care, such as LÜSA Unna, Kriegkstraße Frankfurt/Main, etc.

In Luxembourg, TABA, is a work project for ageing drug users 45+ years, launched by Abrigado. Although demand for this project is high, participation is still limited to a maximum of 20 persons.

In Spain, non-specific services for drug users have been adapted to respond to the needs of aging drug users. In Barcelona, for example, the Vall d’Hebron Hospital called PAAC has initiated a project to the growing demand of services for elderly patients with substance consumption disorders,  with or without concurrent psychiatric problems.

In Austria, we have observed a development of specific services for older drug users, as much as specialized tools such as assignment forms. Furthermore, it is important mentioning CONTACT and KONNEX in Vienna. These services are intended to support the transition of opioid users from a hospital setting into other nursing facilities.

In The Netherlands, due to the existing housing programs for opioids addicted people, there are not many specific services. This is in part because of the already existing housing programs for opioid addicted people, and the existing structures of social and health care. An example of such a housing program is Woodstock, which includes a nursing service.

 

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Best Practice Collection

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Introduction

Through desktop research and stakeholder analysis, potential examples of good practice were identified within the fields of addiction-, health- and mental health care. They were sent a questionnaire with both specific (quantitative) and open (qualitative) questions, developed by Correlation. From the 111 responses received, 94 were left after pre-selection (the only criterion was actually encountering/working with ageing users in their clientele).

The best practice assessment itself involves several rounds of selection. For the first round, the examples were randomly divided across project partners to evaluate them using the assessment matrix developed by Correlation. Based on the evaluation scores, 27 examples were selected for round 2 in which every partner evaluated all examples. These results were presented at the second project meeting, at which point an additional three examples (late entries) were included for the third and final round of evaluation. For this round, a nomination model with five thematic questions were used, in which the evaluators could nominate the 5 examples they felt best fit the characteristic of the question.

This resulted in a set of ‘top’ listings, of which the top 22 examples were selected. For these examples, additional questions were sent in to supplement the information from the questionnaire. One example withdrew from participation and in two countries there were two services belonging to the same organization (CZ and IT), these were combined to be described as one example which brings the final number of examples discussed in this collection to 19.

Given their differences in (among others) examples’ offered services, organizational size and structure these examples are not ‘ranked’ in the collection and merely distinguished by whether they are ‘specific’ for ageing drug users, meaning they are exclusively for this target group or ‘non-specific’, services open to a wider age range though offer specialized/tailored services for ageing users.

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Specific services

(i.e. exclusively for ageing drug users)

Non-Specific services

(i.e. open to broader population, offer specific or tailored services for ageing users)

Download The BeTrAD Best Practices Collection as a print version

Literature

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Introduction

Another important goal of BeTrAD’s is to offer social services providers and policy-makers with literature recommendations that support the development of projects. Besides offering an entry point into the state of art regadring reserach on aging ug users , the following bibliography supported as well the development of each of the modules that strucure the Training Curriculum.

Czech Republik

Bártová, A. (2011)
Misuse of Drugs and Addictive Substances in the Old age.
Univerzita Karlova v Praze, Husitská teologická fakulta.

Baštecký J., et al (1994)
Gerontopsychiatrie.
Prague: Grada Avicenum

Bìláèková, V., et al (2016).
The Use of NSDs among Problem Drug Users: Prevalence, Patterns of Use, and Related Risks as a Challenge for Harm Reduction Programmes in the Czech Republic.
Adiktologie, 16(2), 106–119

Čeledová, L. et al (2014)
Sociální gerontologie: Východiska ke zdravotní politice apodpoře zdraví ve stáří.
Prague: Grada Avicenum

Černíková, T. (2017)
Residential social care centers with special regime for substance abusers and persons at risk of substance use.
Univerzita Karlova.

Declaration from the European Conference on the Care and Protection of the Elderly. Dignity and vulnerability of the older people. 25 & 26 of May, 2009.
Retrieved from: http://www.seniorum.cz/uploads/document/7.doc

Faiferová, M. (2011)
Úskalí užití léků ve stáří: diplomová práce.
Masarykova univerzita, Lékařská fakulta, Ošetřovatelská péče v gerontologii.

Haškovcová, H. (2010)
Začlenění seniorů v sociální struktuře soudobé společnosti.
Prague: Výzkumný ústav práce a sociálních věcí.

Kalina, K. a kol. (2001)
Mezioborový glosář pojmů z oblasti drog a drogových závislostí.
Praha: Filia nova.

Kalina, K. a kol. (2003)
Drogy a drogové závislosti: mezioborový přístup.
Praha: Úřad vlády České republiky.

Kalina, K. a kol. (2015)
Klinická adiktologie.
Praha: Grada Publishing.

Krombholz, R. & Drástová H. (2010)
Závislosti a stáří.
Psychiatr. pro Praxi, 2010; 11(3): 95-98

Lenka, P. (2017)
Substance Use in Retirement Homes from the Perspective of Workers – Experiences and Impact on Social Interaction.

Mravčík, V. et al (2014)
Somatická komorbidita uživatelů drog : Výsledky výzkumu mezi klienty pražských nízkoprahových programů.
Prague: National Monitoring Centre for Drugs and Addiction.

Mravčík, V. et al (2015)
Annual Report on Drug Situation.
Prague: National Monitoring Centre for Drugs and Addiction.

Nepustil, P. Et al (2012)
Užívání drog ve skupinách s obtížným přístupem kdrogovým službám. Situace v ČR: analýza informačních zdrojů.
Prague: National Monitoring Centre for Drugs and Addiction.

Nešpor, K. (2011)
Hazard a patologické hráčství u seniorů.
Prague: Psychiatric Hospital Bounce.

Nezdarová, E., Gabrhelík, R. (2016)
Interest of active methamphetamine users in pharmacotherapy of methamphetamine dependence.
Čes a slov Psychiat 2016; 112(2): 76–81

Ondrušová, J. (2011)
Stáří a smysl života.
Praha: Karolinum.

Pospíšilová, J. (2011)
Helpless old People and the Law. Social Psychological and Legal Problems.
Diplomová práce. Masarykova univerzita, Právnická fakulta.

Rakovcová, H., et al (2012)
Characteristics of acute poisoning in the elderly in the Czech Republic; Experience of the Czech Toxicological Information Centre in Prague.
Prakt. Lék. 2012; 92(2): 72-76

Roman Jirák, et al. (2013)
Gerontopsychiatrie.
Prague: Galén.

Skopalová, B. (2014)
Vliv alkoholu na zdravotní stav seniorů.
Adiktologie, 14 (4), s. 420-427.

Spurova, N. (2013)
Mapping and metodological management of physical complications of injecting drug users.
Univerzita Karlova v Praze, 1. Lékařská fakulta, Klinika adiktologie.

Vondráčková, P. (2011)
Užívání alkoholu u seniorů.
Retrieved from: http://www.adiktologie.cz/cz/articles/detail/
72/2935/Uzivani-alkoholu-u-senioru

Zdeněk K., et al (2012)
Křehký pacient a primární péče.
Prague: Grada Avicenum

Germany

Aidshilfe e.V. (2011):
Arbeitsschutz in der Drogen- und Aidshilfe. Schwerpunkt Infektionsverhütung.
Retrieved from: http://bit.ly/2DbwYXw

 

Akzept e.V. (2017):
Alternativer Drogen- und Suchtbericht. Berlin:
Akzept e.V. Bundesverband.

 

Becker, G. (2017):
Unsere alternde Klientel Herausforderungen für die niedrigschwellige Arbeit. In: Stöver, H., Padberg, C., Jamin, D.: Ältere Drogengebrauchende.
Frankfurt am Main: Fachhochschulverlag Frankfurt.

 

Böllinger, L. & Stöver, H. (2002):
Drogenpraxis. Drogenrecht. Drogenpolitik. Handbuch für Drogenbenutzer, Eltern, Drogenberater, Ärzte und Juristen.
Frankfurt am Main: Fachhochschulverlag.

 

Böllinger, L. & Stöver, H. (2002):
Drogenpraxis. Drogenrecht. Drogenpolitik. Handbuch für Drogenbenutzer, Eltern, Drogenberater, Ärzte und Juristen.
Frankfurt am Main: Fachhochschulverlag.

 

Bundesministerium der Justiz und für Verbraucherschutz (2017):
Verordnung über das Verschreiben, die Abgabe und den Nachweis des Verbleibs von Betäubungsmitteln (Betäubungsmittel- Verschreibungsverordnung – BtMVV).
Retrieved from: : http://bit.ly/2qLO6R7

 

BZgA (2013):
Alte Menschen. Expertise zur Lebenslage von Menschen im Alter zwischen 65 und 80 Jahren.
Retrieved from: http://bit.ly/2CWGukx

 

BzGA (2016):
STI – Sexuell übertragbare Infektionen. Erkennen. Behandeln. Sich schützen.
Retrieved from: http://bit.ly/2mi0N1p

 

BZgA (2017):
Drogenlexikon.
Retrieved from: http://bit.ly/2FgQWAC

 

Dachverband Wiener Sozialeinrichtungen (2014):
Qualitätshandbuch ambulant. Evidenzbasierte Handlungsleitlinie. Umgang mit Sucht/Abhängigkeit von Substanzen.
Retrieved from: http://bit.ly/2mfWfZn

 

Dachverband Wiener Sozialeinrichtungen (2014):
Umgang mit Sucht in Wohn- und Pflegeeinrichtungen. Handlungsleitlinie.
Retrieved from: http://bit.ly/2CUqFtr

 

Degkwitz P. & Zurhold, H. (2010):
Die Bedarfe älterer Konsumierender illegaler Drogen. Zukünftige Anforderungen an Versorgungskonzepte in der Sucht- und Altenhilfe in Hamburg. Hamburg.
Retrieved from: http://bit.ly/2CVpvij

 

Degkwitz, P. (2014):
Konsumreduktion oder die (unabgeschlossene Geschichte der) Zieldifferenzierung in der Suchtbehandlung.
Suchttherapie. 4-2014. 15. Jahrgang. S. 154-164.

 

Deutsche Alzheimer Gesellschaft e.V. (2016):
Demenz. Das Wichtigste. Ein kompakter Ratgeber.
Retrieved from: http://bit.ly/2eXatc4

 

Deutscher Evangelischer Verband für Altenarbeit und Pflege e.V. & Gesamtverband für Suchthilfe e.V. (2017):
Teilhabe älterer suchtkranker Menschen. Eine Handlungsorientierung.
Retrieved from: http://bit.ly/2Fjaog0

 

DHS (2017):
Suchtstoffe und Suchtverhalten.
Retrieved from: http://bit.ly/2m9MMBQ

 

DHS/Akzept e.V. (2005):
Konsenspapier. Ziele, Grundlagen und Prinzipien der Sucht- und Drogenhilfe.
Retrieved from: http://bit.ly/2md0bt0

 

Dürsteler-MacFarland, M., Herdener, M. &Vogel, M. (2014):
Probleme älterer Patienten in der Substitutionsbehandlung.
Suchttherapie. 3-2014, S. 113-117.

 

Eisenbach-Stangl, I. & Spirig, H. (2010):
Drogenabhängige werden älter…Zur Lebenssituation einer Randgruppe. Wien.
Retrieved from: http://bit.ly/2maHztK

 

Fachverband Drogen- und Suchthilfe e.V. (2017):
Arbeit und Bildung. Teilhabe ermöglichen. Eine Handreichung für die Suchthilfe.
Berlin: FDR.

 

Fölsch, D. (2017):
Ethik in der Pflegepraxis: Anwendung moralischer Prinzipien im Pflegealltag.
Wien: Facultas.

 

Förster, M. &Thomas, C. (2009):
Aspekte der Substanzabhängigkeit im Alter aus geriatrischgerontopsychiatrischer Sicht. In: Suchttherapie: Prävention, Behandlung, wissenschaftliche Grundlagen,
Jg. 10 (2009), H.1, S.12-16.

 

Fuhrmann, K. (2005):
Umfrage zur speziellen Situation von Drogenkonsumentinnen und Drogenkonsumenten über 40 Jahre.
München: Condrobs (Selbstverlag).

 

Guillod, O. (2013):
Rechtliche Aspekte der Substitutionsbehandlung.
SuchtMagazin. 2013-1. S.19-22.

 

Körkel, J. (2014):
Das Paradigma Zieloffener Suchtarbeit: Jenseits von Entweder-Oder.
Suchttherapie 2014; 15, S. 165-173.

 

Körkel, J., Becker, G., Happel, V. et. al. (2011):
Selbstkontrollierte Reduktion des Drogenkonsums: Eine randomisierte kontrollierte klinische Studie in der niedrigschwelligen Drogenhilfe.
Frankfurt am Main: Abschlussbericht für das Drogenreferat der Stadt Frankfurt am Main

 

Krausz, M. & Strasser, J. (2013):
Heroingestützte Behandlung heute und die Substitutionsbehandlung der Zukunft.
In: SuchtMagazin. 1-2013, S.11-13.

 

Kutschke, A. (2012):
Sucht – Alter – Pflege : Praxishandbuch für die Pflege suchtkranker alter Menschen.
Bern: Huber.

 

Modellprojekt Netzwerk 40+ (2017):
Ältere Drogenabhängige in Versorgungssystemen“. Ein Leitfaden.
Retrieved from: http://bit.ly/2mhKDEY

 

Oliva, H. & Walter- Hamann, R. (2013):
Suchthilfe in Netzwerken: Praxishandbuch zu Strategie und Kooperation.
Freiburg, Br.: Lambertus.

 

Poehlke, T., Heinz, W. & Stöver, H. (2016):
Drogenabhängigkeit und Substitution ein Glossar von AZ.
Berlin, Heidelberg : Springer Berlin Heidelberg.

 

Projekt Sucht im Alter (ohne Jahresangabe):
Das Modell der Aktivitäten und existentiellen Erfahrungen (AEDL) nach M. Krohwinkel.
Retrieved from: http://bit.ly/2DcuZlL

 

RKI (2016):
DRUCK-Studie − Drogen und chronische Infektionskrankheiten. Infektions- und Verhaltenssurvey bei injizierenden Drogengebrauchenden (IVD) in Deutschland.
Retrieved from: http://bit.ly/2CMaM4Y

 

Sarbandi, M. & Froitzheim, S. (2014):
Hygiene in der stationären Suchthilfe.
Berlin : Ninoy Publ.

 

Sarrazin, C. & Reimer, J. (2017):
Leitlinie kompakt. Hepatitis C. Aktuelle Empfehlung zur Therapie der chronischen Hepatitis C.
Stuttgart/New York: Thieme.

 

Schuntermann, M. F. (2011):
Die Bedeutung der ICF für das deutsche Gesundheits- und Sozialsystem.
Suchttherapie, 12, S. 8-13.

 

Sedmak, C. (2014):
Sucht und Alter: Ethische Aspekte.
Suchttherapie. 3-14. 15. Jahrgang, S. 118-125. Wittchen,

 

Vogt, I. (2011):
Auch Süchtige altern. Probleme und Versorgung älterer Drogenabhängiger.
Frankfurt am Main: Fachhochschulverlag.

 

Vogt, I. (2011):
Drogenabhängigkeit und Demenz. Vogt, I.: Auch süchtige altern. Probleme bei der Versorgung älterer Drogenabhängiger.
Frankfurt am Main: Fachhochschulverlag Frankfurt

 

Zölch, K., Brandt, P.W. (2016):
Zusammenarbeit für ein gutes Sterben in Der Substitutionsbehandlung.
SuchtMagazin. 2-2016. S. 25-30.

 

 

Luxembourg

Mantaigu, G. Toxicomanie au Luxembourg :
la difficile prise en charge des consommateurs chroniques. Le Quotidien, 18.06.2018.
Retrieved from:

 

Ministère de la Santé (2015).
Plan d’action drogues 2015-2019.
Retrieved from:

 

Origen, A. (2016)
Surdoses et inégalités sociales. Mieux comprendre les décès liés à l’usage de drogues pour mieux agir.
Louvain la Neuve: L’harmattan.

 

Origer, A. Et al (2017)
The state of the drugs problem in the Grand Duchy of Luxembourg.
Luxembourg: Luxembourg Institute of Health.

 

Trautmann, F. & Braam, R. (2014)
Evaluation of the Governmental Strategy and Action Plan 2010-2014 of Luxembourg regarding the fight against drug and addictions.
Utrecht: Trimbos-Instituut

The Netherlands

Bovens R.H.L.M, van Etten D.M. & Weingart S.W.S.M. (2013)
Ouderen en Verslaving.
Amesfoort: Resultaten Scoren.

 

CELSUS (2016)
Report on the Regional Implementation Strategy (RIS) of the Madrid International Plan of Action on Ageing (MIPAA) in The Netherlands.
Ministry of Health, Welfare and Sport.
Retrieved from: https://www.government.nl/binaries/government/documents/reports/2016/10/01/report-on-the-regional-implementation-strategy-ris-of-the-madrid-international-plan-of-action-on-ageing-mipaa-in-the-netherlands/MIPAA+RIS+3rd+Review.pdf

 

de Gee, A., Laghaei, F. & van del Poel, A. (2016)

Het somatisch onderzoek bij opiaatverslaving (SOO).
Utrecht: Trimbos-Instituut.

 

Expertisecentrum Forensische Psychiatrie (2016)
Landelijk zorgprogramma voor clienten met problematisch middelengebruik en (een risico op) delictgedrag.
Utrecht: EFP

 

Long Alliantie Nederland (2011)
Richtlijn Palliatieve zorg voor mensen met COPD.
Amersfoort: LAN

 

Muusse C., van Wamel A & van Rooijen S. (2012)
Het vormgeven van woonbegeleiding aan mensen met een dubbele diagnose. Utrecht:
Trimbos-Instituut.

 

Netwerk Kwaliteitsontwikkeling GGz (2016)
Landelijk samenwerkingafspraken tussen huisarts, generalistische basis GGz en gespecialiseerde GGz.
Utrecht: Netwerk Kwaliteitsontwikkeling GGz.

 

Resultaten Scoren (2012)
Angst en verslaving.
Amersfoort: Resultaten Scoren.

 

Richtlijndatabase.
Opiaatverslavingrichtlijn.
Retrieved from www.richtlijnendatabase.nl

 

Schippers, G.M., Broekman, T.G., & Buchholz, A. (2011).
MATE 2.1. Handleiding en protocol. Nederlandse bewerking: G.M. Schippers & T.G. Broekman

 

van der Stel, J. (2010)
Heroïne op medisch voorschrift. De geschiedenis van een geneesmiddel in Nederland.
Utrecht: Centrale Commissie Behandeling Heroïneverslaafden

 

Van Wamel A., Muusse C. & van Rooijen S. (2012)
Geïntegreerde behandeling van dubbele diagnose cliënten.
Utrecht: Trimbos-Instituut.

 

Verenso (2011)
Multidisciplinaire Richtlijn Pijn. Herkenning en behandeling van pijn bij kwetsbare ouderen. Utrecht: Verenso.

 

Zorginstituut Nederland (2018)
Model Kwaliteitsstatuut GGZ.
Retrieved from: https://www.zorginzicht.nl/bibliotheek/model-kwaliteitsstatuut-ggz/Paginas/Home.aspx

 

Spain

Adan, E. et al (2012)
Protocols de Reducció de Danys. Barcelona: Generalitat de Catalunya.
Direcció General de Salut Pública.

 

Arza, J. et al (2000)
Contextos, sujetos y drogas. Un manual sobre drogodependencias.
Madrid: FAD.
Barcelona: Ajuntament.

 

Baldacchino, A., Armanyous, M., Balfour, D., Humphris, G. and Matthews, K. (2017)
Neuropsychological functioning and chronic methadone use: A systematic review and meta-analysis.
Neuroscience & Biobehavioral Reviews 73: 23-38

 

EMCDDA (2017)
Informe Europeo sobre Drogas 2017: Tendencias y novedades.
Luxemburgo: Oficina de Publicaciones de la Union Europea

 

Fernández, J., & Pereira, C. (2007)
Guía para el tratamiento de la dependencia de opiáceos.
Valencia: Socidrogalcohol

 

Majó, X., Ilundain, E., Valverde, C. (2009)
Manual per educar en prevenció i assistència a les sobredosis.
Barcelona: Generalitat de Catalunya. Direcció General de Salut Pública.

 

Oficina contra la Droga y el Delito (2003)
Abuso de drogas: tratamiento y rehabilitación Guía práctica de planificación y aplicación.
Viena: UN

 

Organizacion Mundial de la Salud (2010)
Estrategias de autoayuda para reducir o eliminar el consumo de sustancias. Una Guía.
Washington: OMS

 

Organizacion Mundial de la Salud (2011)
Guía de intervención mhGAP para los trastornos mentales, neurológicos y por uso de sustancias en el nivel de atención de la salud no especializada.
Washington: OMS

 

Subdirecció General de Drogodependències (2009)
Tratamiento con matenimiento de metadona. Manual de práctica clínica.
Barcelona: Generalitat de Catalunya

 

Subdirecció General de Drogodependències (2011)
Guia de Pràctica Clínica sobre el tractament de la dependència de la cocaina.
Barcelona: Generalitat de Catalunya

 

Subdirecció General de Drogodependències (2017)
Guía de Práctica Clínica sobre el tratamiento de la dependencia de la cocaína.
Barcelona: Generalitat de Catalunya

 

Other Countries

Anderson, T. and Levy, J. (2003).
Marginality among older injectors in today’s illicit drug culture: assessing the impact of ageing.
Addiction, 98(6):761-770.

 

Ayres, R.M., Eveson, L., Ingram, J., Telfer, M. (2012)
Treatment experience and needs of older drug users in Bristol, UK.
Journal of Substance Abuse, 17(1):19-31.

 

Beynon, C. M. (2009)
Drug use and ageing: older people do take drugs!
Age and Ageing, 38(1):8–10.

 

Blank, K. (2009) Older Adults & Substance Use:
New Data Highlight Concerns.
SAMHSA News, Jan/Feb 2009.

 

Butler A.J, Rehm J. & Fischer B. (2017)
Health outcomes associated with crack-cocaine use: systematic review and meta-analyses.
Drug and Alcohol Dependence, 180:401-416.

 

Carew A.M. & Comiskey C. (2018)
Treatment for opiod use and outcomes in older adults: a systematic literature review.
Drug and Alcohol Dependence, 182:48-57.

 

Cooper, L. (2012)
Combined Motivational Interviewing and Cognitive-Behavioral Therapy with Older Adult Drug and Alcohol Abusers.
Health and Social Work, 37(3):173-179.

 

Douglas M.K., Rosenkoetter M., Pacquiao D.F., Callister L.C., Hattar-Pollara M., Lauderdale J.,

Milstead J., Nardi D. & Purnell L. (2014)
Guidelines for Implementing Culturally Competent Nursing Care.
Journal of Transcultural Nursing, 25(2):109-212.

 

EMCDDA (2008)
Drugs in Focus. Substance Use among Older Adults: A Neglected Problem.
Luxembourg: Publications Office of the European Union

 

Fine P.G. (2012)
Treatment Guidelines for the Pharmacological Management of Pain in Older Persons.
Pain Medicine, 13:57-66.

 

Gossop M., Moos R. (2008)
Substance misuse among older adults: a neglected but treatable problem.
Adiction, 103(3):347-8.

 

Granerud, A. & Toft, H. (2015)
Opioid dependency rehabilitation with the opioid maintenance treatment programme – a qualitative study from the clients’ perspective.
Substance Abuse Treatment, Prevention, and Policy, 10:35.

 

Gray, M.T. (2014)
Habits, rituals, and addiction: an inquiry into substance abuse in older persons.
Nursing Philosophy, 15(2):138-51.

 

Johnson, M.J (ed) (2005)
The Cambridge handbook of age and ageing.
Cambridge: Cambridge University Press.

 

Kenneth Teck Kiat Kim & Rongjun Yu (2015)
Aging and wisdom: age-related changes in economic and social decision making.
Frontiers in Aging Neuroscience 18(7):120.

 

Kuerbis, A., Sacco, P., Blazer, D.G. & Moore, A.A. (2014)
Substance abuse among older adults.
Clinics in Geriatric Medicine, 30(3):629-54.

 

Mimi M.Y. Tse & Suki S. K. Ho, (2013)
Pain Management for Older Persons Living in Nursing Homes: A Pilot Study.
Pain Manadment Nursing, 14(2):10-21.

 

National Institute on Drug Abuse (2017)
Chart of Evidence-Based Screening Tools for Adults and Adolescents

 

Ohara Y., Yoshida N, Kawai H., Obuchi S., Yoshida H., Mataki S., Hirano H. & Watanabe Y. (2017)
Development of an oral health-related self-efficacy scale for use with older adults.
Geriatrics and Gerontology International, 17(10):1406-1411.

 

Palmore, E.B. (1999)
Ageism: negative and positive.
New York: Springer

 

Phillips, Gregory et al (2016)
Willingness to use HIV pre-exposure prophylaxis among community-recruited, older people who inject drugs in Washington, DC.
Drug and Alcohol Dependence 1(164):8-13.

 

Roe, B., Beynon, C., Pickering, L. & Duffy, P. (2010)
Experiences of drug use and agein: health, quality of life, relationships and service implications.
Journal of Advanced Nursing, 66(9):1978-79.

 

Simoni-Wastila L., Yang H.K. (2006)
Psychoactive drug abuse in older adults.
The American Journal of Geriatrical Parmacotherapy, 4(4):380-94.

 

Stephen J. Bartels, Frederic C. Blow, Aricca D. Van Citters & Laurie M. Brockmann (2006)
Dual diagnosis among older adults: co-occurring substance abuse and psychiatric illness.
Abuse and Psychiatric Illness.Journal of Dual Diagnosis, 2(3): 9-30.

 

Thienhaus O. (2017)
Substance Abuse in Older Adults.
Retrieved from: https://aging.arizona.edu/sites/default/files/fact-sheet-pdfs/substance_abuse_in_older_adults_1_0.pdf

 

Wang Y.P., Andrade L.H. (2013)
Epidemiology of alcohol and drug use in the elderly.
Current Opinion in Psychiatry, 26(4):348-8

 

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