Issues and Views

Nationwide problem, local solution

Community-Based Program Screens Older Adults
for Binge Drinking, Other Substance-Use Problems

By Mary Johnson

Binge drinking is a dangerous and costly public health problem, with people age 65 and older the most frequent binge drinkers, according to a new CDC report, Binge Drinking: Nationwide Problem, Local Solutions. However, a program in Massachusetts shows how a local institution, with strong support from the state, can indeed provide a simple, low-cost solution that is effective in reducing this and other substance-use problems among older adults in a range of community settings.

At Boston Medical Center (BMC), over the past five years, social workers and trained health educators have used SBIRT, a validated public-health approach, to identify people who are using alcohol or other substances in risky or unhealthful ways, and to intervene appropriately. Funding comes from the federal Substance Abuse and Mental Health Services Administration and the Massachusetts Department of Public Health's Department of Substance Abuse Services. SBIRT (for Screening, Brief Intervention and Referral to Treatment) is based on research by the National Institute on Alcoholism and Alcohol Abuse and relies on a few crucial elements:

The screen is administered as part of routine care in a healthcare setting (not one devoted
to substance abuse) and is universal.

A "motivational interview" approach is used to ensure an open and respectful conversation.

The interview and discussion are very brief—sometimes lasting only 10 minutes—as are
any necessary interventions.

Lee Ellenberg (at right), a social worker who is clinical director of Boston Medical Center's SBIRT program (called MASBIRT), attributes its success to those elements, which he says are particularly important in eliciting a forthcoming response from older people. Of the approximately 160,000 people screened, some 20 percent have been age 65 or older.

Universal screening is essential, according to Ellenberg, especially for elders: Without it, many healthcare professionals omit screening for substance use in this population because they wrongly assume that older people are not at risk for substance-use problems. In addition, older people often feel the stigma associated with alcohol and drugs. "But when everyone is asked the same questions," Ellenberg says, "no one feels singled out or embarrassed. We also are careful to be respectful, not critical or judgmental. We present this discussion as part of taking care of your health, making sure you aren't engaging in any behaviors that are risky or unhealthy. You're not being screened because we think you are an alcoholic."

Among older adults, binge drinking is more of a problem than are dependence and alcoholism, Ellenberg says. "Many people don't realize that alcohol affects them differently as they age." For example, for men younger than 65, five or more drinks on the same occasion is considered binge drinking—putting their health and safety at risk. But for men 65 and older, binge drinking is four or more drinks on one occasion. The weekly amount considered safe goes from no more than 14 drinks for men 64 or younger down to no more than seven drinks for men 65 or older. (For women, the numbers are generally the same at any age—unhealthy and unsafe drinking means four drinks or more on one occasion, and seven drinks or more over the course of a week.) "Often, just letting people know the facts is the only intervention needed," says Ellenberg.

Generally the MASBIRT program's health educators have visited sites to provide services, but increasingly, they are training site staff to do so. The program also offers training and technical assistance to healthcare and social service providers who wish to implement the approach in their own organizations. For information, contact Lee Ellenberg at Lee.Ellenberg@bmc.org.

This article is reprinted from the May-June 2012 issue of IGSW News.

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Copyright © 2013 Trustees of Boston University. All rights reserved. This article may not be duplicated or distributed in any form without written permission from the publisher: The Institute for Geriatric Social Work, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, U.S.A.; e-mail: igsw@bu.edu.