Prescription for Wellness

Special Populations

There are several special populations receiving treatment for substance use disorders that have distinctive treatment needs. While special populations may have treatment needs in common with other members of the same group, each person should be considered and treated as an individual. Because treatment resources are limited, persons with special needs usually are integrated into generic intensive outpatient treatment programs. The following principles emerge regarding the treatment of special groups:

• Consider cultural competence in matching consumer to treatment provider.
• Develop educational, support groups, and other programming designed to address special needs.
• Reflect openness and support for diversity in program mission and philosophy by developing mission statements with input from representatives of the special populations.
• Design training to develop staff competency in recognizing, supporting, and addressing the needs of special populations.
• Involve community in program goal development, networking, and patient entry and retention in treatment to improve overall effectiveness.
• Involve family members and significant others.
• Demonstrate sensitivity to cultural, ethnic, and regional variations in family structures and the way individuals define their family.

The following information briefly describes special populations and cites their unique characteristics. Treatment approaches determined to be effective for special populations are discussed in the Best Practices Section of this assessment.

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Dually Diagnosed/Substance Use and Co-Occurring Mental Disorders

The term dual diagnoses in the context of substance abuse is a common term that indicates the simultaneous presence of two independent medical disorders, specifically substance use and mental health disorders. Persons with mental disorders have an increased risk for substance use disorders, and patients with substance use disorders have an increased risk for mental disorders. Persons who are dually diagnosed need treatment from providers that are able to recognize and address co-occurring disorders. Establishing an accurate diagnosis for patients in substance abuse and mental health settings is essential to the treatment process. Some of the difficulties in determining an accurate diagnosis are:

• Substance use can cause psychiatric symptoms and mimic psychiatric syndromes.
• Substance use can initiate or exacerbate a psychiatric disorder.
• Substance use can mask psychiatric symptoms and syndromes.
• Withdrawal can cause psychiatric symptoms and mimic psychiatric syndromes.
• Psychiatric and substance use disorders can independently coexist.
• Psychiatric behaviors can mimic substance use problems.

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Elderly

Identification, screening, assessment, and treatment are necessary to decrease the serious negative impact of substance use disorders among the elderly. Many elderly persons are likely to conceal substance use problems and are reluctant to seek help. Their family and friends may ignore the possibility of abuse or dependence. Symptoms of depression are often viewed as an expected part of the aging process. Disorders such as dementia and delirium can mask or mimic the effects of alcohol. Many elderly persons are prescribed multiple medications without adequate medical oversight for the possibility of prescription interaction or misuse. As a greater number of Americans grow older it will be helpful to consider the following additional unique risk factors:

• age-related stress;
• loss of a spouse;
• loss of meaningful activities;
• decreasing capabilities;
• increasing medical conditions;
• stigma of substance use disorders; and
• loneliness.

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HIV/AIDS/Hepatitis C Virus (HCV)

Those who use and are addicted to drugs, particularly injecting drug users, are at increased risk for HIV/AIDS/HCV. In order to reduce the risk to the individual and the community, drug addiction treatment is needed and is, in effect, disease prevention.

• Those who inject drugs and do not enter treatment are up to six times more likely to become infected with HIV than injectors who enter and remain in treatment.
• Those who enter and continue in treatment reduce activities that can spread disease, such as sharing injection equipment and engaging in unprotected sexual activity.
• Participation in substance abuse treatment presents opportunities for screening, counseling, and referral to additional HIV services.
• Successful treatment programs provide HIV counseling and offer confidential HIV testing to their patients.

K. Mueller, Austin/Travis County Health and Human Services (personal communication, February 13, 2001) reports that there are an estimated 13,000 cases of HCV in Travis County. However, there is no definitive number since in the past only acute cases of HCV were reported, which were minimal. Recently (December 2000), reporting of all newly diagnosed HCV became effective and it is expected within a year numbers will be available.

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Homeless

Homeless individuals are those members of our society who lack a fixed, regular, and adequate night-time residence. Homeless persons may sleep in shelters designed to provide temporary accommodations; institutions that provide short-term residence for individuals intended to be institutionalized; or public or private places not designed for, or ordinarily used as, a regular sleeping accommodation for human beings. Homeless persons face multiple challenges:

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Pregnant/Parenting Women

Specialized services for women are not always available in the community to address the issues listed below. Women often require specialized or enhanced medical, psychosocial, family, peer support, and other treatment services. Prevention, early intervention, and treatment services are essential during the prenatal period for the health of the women, their fetuses, and their newborns after birth. Various risk factors may interact with substance use disorders to impact women and their families:

• poor nutrition;
• history of substance use disorders;
• sexual, physical, and emotional abuse that has gone unnoticed and/or untreated;
• many women were recipients of poor parenting;
• lack of access to prenatal care;
• unstable home environments and homelessness;
• use of substances before pregnancy is known; and
• higher risk of continuing use during pregnancy.

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Youth

Adolescents differ from adults both emotionally and physiologically and have some unique treatment needs. Intervention is often preceded by high-risk behaviors, violence, and criminal justice involvement. The lack of sufficient community-based and criminal justice resources results in delayed and therefore exacerbated need for more intensive and costly intervention. Treatment of youth must be sensitive to differences in:

• gender;
• age;
• cultural background;
• cognitive, emotional, physical, social, and moral development;
• family and peer environment; and
• sexual orientation.

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