Addiction Medicine: Closing the Gap between Science and Practice

to the treatment needs of adolescents with
addiction.^201 Yet, effective evidence-based
treatment approaches for adolescents do exist.^202
Despite this, in 2010, only 28.8 percent of
facilities nationwide that provided addiction
treatment services offered adolescent-specific
services.^203

Barriers to treatment for adolescents include
lack of support among parents and school
personnel and lack of interest on the part of
adolescents in participating in treatment.^204
These barriers may result in difficulty recruiting
adolescents to participate in treatment.^205 One
national survey found that adolescents frame
their reasons for not wanting to participate in
treatment as they “are not ready to stop
substance use,” “didn't want others to find out”
and because they “could handle the problem
without treatment”--barriers that are similar to
those offered by the general population and are
at least in part reflections of the disease itself
and of the stigma attached to it.^206 Other barriers
include insufficient research on the safety and
efficacy of evidence-based addiction treatments
for use in adolescent populations, particularly
pharmaceutical therapies.^207

Older Adults ...............................................................................................................

Older adults are less likely than younger people
to be identified as having addiction or to be
referred to treatment;^208 those who do try to
access treatment often have difficulty finding
age-appropriate treatment services.^209 In 2010,
only 6.9 percent of facilities nationwide that
provided addiction treatment services offered
services specific to older adults.^210

Older smokers, for example, may be less aware
of the harmful consequences of tobacco use and
may focus more on the perceived benefits, such
as its use as an aid in coping with stress or
controlling weight.^211 Some may feel that it is
“too late” to reverse the effects of smoking and
therefore may not be motivated to seek out
smoking cessation services; this belief is
reflected in the failure of many health care
providers to counsel older adult patients to stop
smoking and support them through a cessation
attempt.^212 Some physicians may have concerns

about the safety of prescribing pharmaceutical

interventions for smoking cessation to older

patients.^213

Adults who develop late onset addiction

involving alcohol are less likely than those with

early onset addiction to have a family history of

addiction (21 percent vs. 72 percent)* and are

more likely to try to hide their illness; further,

the symptoms associated with addiction

involving alcohol--such as disorientation or

confusion--may be misinterpreted as cognitive

or physical deficits such as dementia, depression

or other medical problems common in the

elderly.^214

CASA Columbia’s 1998 report, Under the Rug:

Substance Abuse and the Mature Woman, found

that when physicians were asked for five

possible diagnoses of a hypothetical 68-year-old

female patient with an array of complaints

typical of risky use of alcohol or prescription

drugs, only one percent identified a substance

use problem as a likely diagnosis. Contrary to

the evidence, only 62 percent of physicians

reported believing that addiction treatment is

somewhat or very effective for older women.^215

The Homeless.............................................................................................................

Mental illness and co-occurring addiction are

highly prevalent in the chronically homeless

population.^216 Addiction, like other health

problems in the homeless population, too often

goes unaddressed until it is severe enough to

require costly urgent care and hospitalization,

resulting in a great deal of unnecessary human

suffering and a serious, yet avoidable burden on

health care systems.^217

Seeking addiction treatment may be a low

priority for homeless individuals who must

contend with the competing needs of securing

food, clothing and shelter and who rarely have a

network of social support to help them access

and succeed in treatment.^218 Given homeless

individuals’ lack of resources, their ability to

find appropriate treatment programs and pay for

* In a study of men ages 60 and older admitted to a

VA geriatric outpatient treatment program.