Visions Journal

A supportive network for family and friend caregivers of older adults who use substances or alcohol

Michee-Ana Hamilton, MSc and Jan Klimas, MSc, PhD, C.Psychol., Ps.S.I

Reprinted from the Supporting Parents issue of Visions Journal, 2021, 17 (1), pp. 12-13

Detecting problematic substance use in older adults is often hard because many symptoms of substance use are similar to the symptoms of other physical illnesses common in the aging population.^1,2 The use of substances and alcohol also makes an elderly person's care needs more complex. Family caregivers are critical in helping to manage substance use and promoting successful aging. Caregiving requires many sacrifices, and often caregivers end up giving up their own well-being while providing care for their loved ones.

Yet, the contributions of family and friend caregivers are often overlooked and undervalued in the care system. These family members and friends also frequently struggle to identify with the term "caregiver." This is in part because helping financially or providing weekly emotional support through a phone call feels like a natural way to support an older family member who uses substances, whereas caregiving feels more formal and implies looking after all of the needs of a loved one.

The lack of recognition for the contribution of family and friend caregivers results in a shortage of programs, resources and supports to meet their needs. Caregivers are often at risk of experiencing depression, anxiety and burnout.³ When caring for an aging adult who uses substances or alcohol, the risk of caregiver burnout goes up. Not only are family and friend caregivers helping their loved ones deal with a stigmatized and misunderstood health condition, they also often help coordinate other formal care and treatment for their loved ones and provide support for other important needs (like finding adequate housing).

Stigma and lack of understanding around substance use also affect these family members and friends; for example, caregivers often feel isolated and do not have a place to share their experiences. Additionally, children who care for an aging parent who uses substances sometimes feel pressure to provide a level of care and support for their parents that goes beyond their means or abilities.

The strain on caregivers will only grow over time. In Canada, the number of older adults with substance use disorders will rise significantly in the coming years. This is due to many factors, including:

• lifestyle changes (e.g., grief, social isolation) that may lead to increased substance use

• increased prescription medication use to manage illnesses as physical health weakens. This can lead to misuse of prescription medications and substance use disorders

• aging among people with substance use disorders, who experience huge barriers because of changes across many health domains

For all of these reasons, we created the "Thrive" program. Thrive works with caregivers to build a supportive network where family members and friends can connect with people who have similar experiences. We aim to help prevent caregiver burnout and protect caregiver well-being through our resources and support. We offer practical tools, helpful resources and a stigma-free environment. In some cases, Thrive is the only space where caregivers can freely talk about their feelings and concerns about their loved ones' substance use and circumstances.

When caregivers do not have enough support and knowledge about substance use in seniors, it is harder for them to notice when their loved ones experience problematic substance use. Through Thrive's partnerships, we work to increase knowledge around substance use in older adults in various ways. This includes providing a workshop, in collaboration with the Canadian Deprescribing Network, on the potential harms of using multiple prescription medications in older adults. Right now, Thrive holds monthly remote support groups for family and friend caregivers throughout BC. We also offer our monthly support groups to those who care for an older adult who may be at risk of harms associated with prescription medication misuse.

Substance use in older adults is often neglected, which can lead to older adults falling through cracks in the care system.^4,5 In the past year, 39% of people who died from illicit drug use in BC were over 50 years old;⁶ it is clear that this group of people and those in their support systems urgently require attention and care. Thrive's services are open to caregivers of older adults 65 years old and above. We are also open to providing services to caregivers of older adults 55 years old and above.

In our monthly support groups we use practices to encourage mental wellness, such as heart breathing, which increases awareness of the breath and helps people connect to feelings like gratitude, appreciation and compassion. We offer practical skills as well. These include knowledge about factors that affect decision-making (such as ambivalence, which is when someone has mixed feelings on a subject) and skills for empowering family and friend caregivers to make positive changes that improve their wellness as they care for others, such as using a decisional balance tool (a grid where people can consider the advantages and disadvantages of a choice from every angle).

These are resources a person can use when making positive changes in their life. Our approaches are found in the principles of motivational interviewing (MI), a counselling approach that helps people deal with uncertainty around decisions. The principles of MI are compassion, acceptance, partnership and evocation (i.e., bringing a feeling to mind). We adapt Thrive's programming to meet the needs of the caregivers we interact with. For example, we take their feedback into consideration as we plan our support-group program focus. We also provide ad hoc virtual workshops and refer family and friend caregivers to useful resources.

For more information about Thrive, please contact the program coordinator by email, at michee.hamilton@ubc.ca, or by phone, at 236-335-5793. The Thrive program is funded by the Government of BC, managed by the United Way and affiliated with UBC's Department of Family Practice and the BC Centre on Substance Use. Thrive is also supported by Family Caregivers of BC.