The Cotter Model for Older Adults

Intervening and Treating the Older Adult (50+) for Alcohol and Prescription Drug Dependence.

Worldwide, there are few illnesses as stigmatized as the illness of addiction. And, very few addictions carry a more powerful stigma than that of addictions among older adults and the elderly. Whether it’s alcoholism in the elderly, prescription drug abuse or even prescription drug addiction, until recently, our addicted older adults have been yelled at, indulged and even ignored, but ultimately, they were left alone to suffer, without help or hope.

In recent years however, attitudes have begun to change for the better. Today, thankfully, family members and friends are beginning to understand the critical need of stepping forward to offer help and treatment for prescription drug abuse and alcoholism.

In an effort to stay ahead of the changing needs of older adults and the elderly with dependencies and addictions and to provide a resource to accommodate these needs, I have refined The Cotter Model to specifically address the chemically dependent older adult. As you read further, I believe you will see the opportunity and efficacy, along with the ever-present attention to dignity and respect, afforded by The Cotter Model.

Bruce Cotter approaches each intervention on an older adult as though he were intervening on his own mother (who, unfortunately, never had the benefit of an intervention for alcohol problems,) or father. Believing the person's road to recovery begins the instant he meets them, he immediately creates a climate of dignity and respect.

The Cotter Model blends the intervention into the entire treatment process. It is not treated as an isolated event. As a recovering alcoholic, Cotter is able to conduct his private, one-on-one intervention meeting with the identified person (IP) with an open dialogue between two people discussing a problem and how to solve it together, as a team.

This is in stark contrast to the group, surprise party intervention. Group interventions can deteriorate into a threat and demand filled confrontation sermon, by a group of people who are determined to bully the IP into surrendering to their perception of “help.”

When a person has reached the point where an intervention is necessary, they are a veritable buffet of negative emotions. They are already embarrassed, guilt-ridden, paranoid, confused, and angry. In addition, they are usually suffering from low self-esteem, if not self-loathing. To have a group of their best friends and close relatives, often accompanied by their cleric, surprise them and detail their dreadful behavior, is less than conducive to a positive result. The IP may very well accept this onslaught and go passively into a treatment center. But their road to recovery begins with negative motivations. This positions treatment and recovery as penance, when in fact, it should be a positive journey.

Specifically, patients entering treatment following such a confrontation may be so angry, it might be several days or weeks before the counselors “break through” the anger and begin the education necessary to address recovery. In some cases the anger lasts for years. Too often, the IP will leave treatment before completion and once home, will continue to drink as before. Now, the people who tried to help by investing considerable emotion, time, and money, are angry and disappointed. This makes the next offer of help, if there is one, even less likely to succeed.

The Cotter Model is designed to offer an adult, with alcohol, medication, or other drug issues a comfortable and secure environment in which to discuss their problem. They are encouraged to talk openly and honestly about their feelings. In this setting, they reveal their fears and concerns as well as their hopes and dreams. This presents the opportunity to explain the valuable benefits of addressing their problem. Once the process of treatment is explained and any reluctance it dealt with, they will begin to see to expediency of living their life free of alcohol or (prescription) drug dependency. This positive, compassionate method greatly enhances the prognosis for long term recovery. In a sense, the idea of getting help for their problem becomes their idea and one to embrace.

When combined with the Cotter Model’s year-long program of Continuing Care, the stage is set for adults to learn to appreciate a life free from alcohol or other drug addiction.
 

CASE NOTES: "Never Too Late"
(When They Won't Quit, page 72)

I intervened with a lovely socialite of about 80 years of age. At first, her sons were reluctant to change her life, thinking they should let her live out her days as she wished, even if it meant as an alcoholic. But her youngest son was deeply concerned. He felt that his Mom's quality of life was so poor - she was no longer invited to the luncheons and fundraisers; she no longer used her box at the ballet; her fantastic trips abroad were no more. He felt his Mom was just a shell of the dynamo she once was, that she was lonely and that a change should be made. Just a few months after we intervened, she was back in the mainstream of the New York social scene and has been joyously sober for more than five years.

CASE NOTES:  "A Grateful Daughter"
(When They Won't Quit, page 112)

"Mom was diagnosed with lung cancer and died in October, 2001.  She was an
amazing woman and stepped up to the plate when challenged.  When she was
diagnosed, she was able to deal with the physical and emotional aspects of cancer because of her experience being treated for alcoholism.  God works in
mysterious ways.  He led us to you to help prepare for the road ahead of us.
I learned to love and respect my mother for the many beautiful traits that she had.  I was given a bonus year with her that I would not trade for the world.  The last year of her life was completely different than it would have been if she had still been drinking."