A recent survey regarding the homeless people in the Detroit area found that 51% of the people questioned are at risk of dying on the streets, a 9% increase above the national average.
The Neighborhood Service Organization, in coordination with Detroit area homeless service providers, surveyed Detroit, Hamtramck, and Highland Park identifying and counting people to find those that are most at risk of dying on the streets. 211 people were surveyed during three nights during the hours of 4 and 7 a.m.
The survey found that the average number of years homeless is 5.38. 99 people reported a dual diagnosis of mental illness and substance abuse. 29 of the people surveyed were veterans and 32 people reported having a history of foster care. There were a total of 358 inpatient hospitalizations in the past year with a total of 456 emergency room visits in the past three months. 103 people reported having no insurance; 74 people reported having been in prison and 149 people reported having been in jail.
13% of the people were aged over 60, the oldest respondent being 72 years old.
Treating a dual diagnosis of mental illness and chemical dependency is very difficult. Some mental health services are not equipped to deal with patients having both disorders and as a result, only one issue is identified. However, if both diagnoses are identified, the patient may be bounced between treatments for mental health and substance abuse.
Research studies have concluded that a minimum of 50% of the mentally ill population also have a substance abuse problem. People with mental illnesses may have a chemical dependency problem that their family is not aware of; or the family may underestimate the extent of drug dependency. It may be difficult to determine which behaviors are attributed to mental illness versus what behaviors are caused by chemical dependency.
In order to have an accurate diagnosis of a mental disorder, the cause of behavior has to be determined. If a person is experiencing delusions or hallucinations, the delusions may be a result of schizophrenia, depressive disorders, mania, Alzheimer’s related dementia, panic attacks, or drug or alcohol intoxication. Treatment for schizophrenia is different from treatment for chemical dependency, which is why it is important to pinpoint the cause of behavior to ensure the most effective treatment.
Chemical dependency complicates treatment of mental illness. The individual may be difficult to engage in treatment, they may be in denial; and their diagnosis is further complicated because of the interacting effects of substance abuse and mental illness. Individuals may frequently relapse and require hospitalizations and may not be tolerated in community rehabilitation programs.
Some individuals may begin to drink or use drugs for recreational reasons, but their reasons for continuing use may differ. It is likely that many individuals continue using as a way to treat symptoms or side effects from the medication. Drug use may reduce the level of anxiety or depression, at least short term. It is possible that an underlying vulnerability exists in the individual that precedes mental illness and chemical dependency.
Social factors, such as living environment, may also account for continued drug use. People may find themselves living in neighborhoods where drug use is prominent. An individual may find himself more easily accepted in a social setting when the group’s activity is based on drug use, particularly if he or she has difficulty establishing social relationships.
Typically, there are separate treatment programs for mental health and substance abuse. Clients with a dual diagnosis are referred back and forth between the treatments, but hybrid programs that address both issues prove to be extremely beneficial. Such a program is available at Apex Behavioral Health, in our Westland office.
Drug program treatments are limited in helping mental illness patients because the programs are too confrontational and people with severe mental illness are too fragile to benefit from that particular type of treatment. Confrontation, emotional jolting, and discouraging use of medications has proven to be detrimental to mental health patients. The treatments may lead to stress which can cause relapse.
Desirable treatment programs for a dual diagnosis should be less confrontational and take a more gradual approach. Clients have to proceed at their own pace during treatment and credit should be given for any accomplishments regarding their drug use decreasing.
It is argued that substance abuse treatment programs are more geared toward the young male population. Rehabilitation, substance abuse, and gerontology literature pay little attention to elderly drug abuse and largely ignore it, therefore, little information is known about prevalence or occurrence about drugs in the elderly population.
The types and extent of drug and alcohol use among the elderly is elusive. Individuals aged over 65 make up 12.4% of the total US population; however, by 2030 this group is expected to double in size. At that time, the elderly population will include baby boomers, many of whom have already been exposed to drugs or alcohol in the 1960s.
Researchers have noted that drug or alcohol symptoms seen in the elderly are often mistaken for various symptoms of aging, such as dementia or depression. It is unknown if elderly patients would require unique substance abuse treatment since little research has occurred on senior illicit drug use.
However, significant data is available for the elderly population on prescription drug use. Elderly adults consume more over-the-counter and prescription drugs than any other age group on a daily basis. One researcher noted that elderly adults are 2-3 times more likely than younger individuals to be prescribed psychoactive drugs, including benzodiazepines.
The elderly population is not immune from chemical dependency; there is not an age limit for addiction. Further research needs to be conducted to determine the prevalence of drug abuse among the elderly population. The seniors may require different substance abuse treatment then the youth. There has not been enough research done to prove that the generic substance abuse treatment is effective for all age groups.
It is probable that a 70-year-old male will require different substance abuse rehabilitation treatment than an 18-year-old female. A 70-year-old female suffering from depression and drug use will require different treatment from a 75-year-old male who has PTSD and an alcohol problem.
Treatment is unique for each individual and this is especially true for individuals with a dual diagnosis. Treatment for depression is different than treatment for substance abuse, and a person who has a dual diagnosis will require a different, combined treatment which is available at Apex Behavioral Health.
It is important that the elderly get treated for depression. While the elderly population accounts for 13% of the US population, they account for over 18% of all suicides.
Some people believe that depression is a normal component of aging, but that is not true. Physical ailments and medications can cause depression.
The following diseases or physical problems may result in depression.
- thyroid disorders
- Parkinson’s disease
- multiple sclerosis
- some viral infections
The following medications may cause symptoms of depression:
- blood pressure medication
- arthritis medication
Many elderly people will hide their depression or substance abuse so it is important to notice subtle hints. Untreated depression is the number one cause of suicide.
Suicide warning signs include:
Appearing depressed or sad most of the time.
Talking or writing about death or suicide.
Withdrawing from family and friends.
Feeling strong anger or rage.
Feeling trapped — like there is no way out of a situation.
Experiencing dramatic mood changes.
Abusing drugs or alcohol.
Exhibiting a change in personality.
Losing interest in most activities.
Experiencing a change in sleeping habits.
Experiencing a change in eating habits.
Losing interest in most activities.
Performing poorly at work or in school.
Giving away prized possessions.
Writing a will.
Feeling excessive guilt or shame.
A dual diagnosis can be treated effectively with the proper treatment for a person of any age. Please call Apex Behavioral Health if you or someone you know needs treatment.