Health

HEALTH • Fall 2018 17 81 Hope Avenue, Worcester, MA 01603 • 508.755.2340 • sevenhills.org Building the Foundation for All Abilities Seven Hills Foundation offers integrated supports that build confidence, community, friendships, and independence. For over 60 years, we have helped transform the lives of thousands of children and adults who are now using their abilities to overcome challenges and embrace opportunities. Community living is setting the standard for all of our programs, which include: n Developmental Disabilities Supports n NeuroCare/Brain Injury Supports n Behavioral Health Supports n Medically Intensive Supports n Residential Options n Child & Family Services Staff provides care with encouragement for everyone to SEE the possibilities, BELIEVE in their abilities, and ACHIEVE their dreams. To learn more, call 508.755.2340 or visit sevenhills.org. H Total United States 13.6% 1.8% 0.3% 6.0% 51.7% Massachusetts 18.6% 2.7% 0.3% 7.2% 59% Boston 23% 4.0% 0.5% 9.3% 58.2% Central 17.1% 2.4% 0.4% 7.1% 54.3% Metrowest 18.7% 2.6% 0.2% 7.1% 65% Northeast 16.7% 2.2% 0.3% 6.4% 58% Southeast 17.2% 2.5% 0.3% 6.9% 58.5% Western 20.4% 2.5% 0.39% 7.43% 56% Marijuana use Cocaine use Heroin use Alcohol use Alcohol use, Substate Region past year past year past year disorder past year past month Drug use and alcohol use disorder by region Sources: U.S. Substance Abuse and Mental Health Services Administration Estimated percentages for people ages 12 and older based on 2014-2016 data behavioral health at the Edward M. Kennedy Community Health Center in Worcester, said that, even if peo- ple suspect their use of a drug may be slipping into unhealthy territory, the social stigma around addiction can make it hard to seek help. "Of course the older someone is, the more aware they are of the kind of reaction to using substances that other people typically have," she said. "Additionally, I think older folks have—stereotypically—less aware- ness that prescription medicines also can be misused." When it comes to alcohol, Fierro said, some people may have absorbed ideas years ago that don't fit with more recent research, or that no lon- ger apply to their current situation. "Sometimes people heard way back that a glass of wine with every meal is going to improve your health," she said. "That's not necessarily untrue for every single person, but it may not be true for every person." That's a particular issue for people who face one health issue or another. Alcohol can interact with other drugs in ways that reduce their effi- cacy, and it can also exacerbate health problems like depression in ways that may not be obvious. "What is challenging to convey to people is because alcohol is a depres- sant it's going to have an effect on your mood," Fierro said. "Before, it helped you to relax and get to sleep, but ultimately what it does is become incredibly disruptive to the sleep process." For people living with debilitating chronic pain, she said, things can be even more complicated. "The more research that is done about chronic pain, the more we rec- ognize it is a situation that is incredi- bly damaging to health and not straightforward to solve," she said. Just as with many health issues, including diabetes and depression, Fierro said the best treatment for pain involves a combination of medi- cine and lifestyle changes. Drugs that temporarily relieve pain can help people gather the energy to exercise or do mindfulness or breath exercis- es—therapies that don't produce immediate results but that can help over time. But the effect of medica- tion alone declines over time, so, when something that seemed mirac- ulous at first becomes less so, people may be tempted to take more. Another complicating issue is the way that medical institutions and insurance systems are set up to deal with addiction. In some cases, Fierro said, insurance may cover intensive detox treatment for people with acute substance abuse problems, but it may limit behavioral health visits for those who need less intense sup- port over a long time period. In the case of Medicare, the main health insurance provider for most older Americans, Digravio said there are some specific gaps in coverage. For example, Medical typically won't cover methadone maintenance thera- py delivered on an outpatient basis, or other intensive outpatient treat- ment. Medical professionals are working hard to improve care for older people dealing with substance use disorders. Buivydas said medical facilities fre- quently request his help teaching doctors, including gerontologists, to identify symptoms of the disorders. "At least that's opening up, reduc- ing some of the barriers to under- standing how to treat older adults," he said. Buivydas said facilities like Spectrum are also learning how to serve their older patients better. For example, standard interventions like behavioral therapy and motivational interview techniques, can be more useful to seniors if they're conducted at a slower pace. Fierro said many people facing a number of concurrent medical issues may not see their substance use as a problem at first. But once medical professionals work with them to address issues like chronic pain, depression, or anxiety, they may begin to realize that their use of drugs is making it harder to recover. Fierro said her advice to older adults is "don't underestimate how much control you actually do have to feel better in your life." Particularly for people with chronic illnesses, she said, "it's kind of easy to let that life get more and more shut in. the more that happens, the bottom line is, the less healthy somebody can be." Past month marijuana use 14% Past month other illicit drug use 3.8% Past year misuse of pain relievers 3.9% Past month alcohol use 59.2% Past month binge alcohol use 28.5% Illicit drug use disorder (past year) 3.3% Pain reliever use disorder (past year) 0.7% Alcohol use disorder 7.5% Substance use disorder 9.8% Needing but not receiving treatment for illicit drug use 3.2% Needing but not receiving treatment for alcohol use 6.9% Needing but not receiving treatment for substance use 8.8% Massachusetts statewide drug use and misuse

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