Experiencing co-occurring mental health and substance misuse disorders: the voices of rural older adults

University of Minnesota Ph.D. dissertation. Major: Social work. Advisor: Jeffrey L. Edleson. February 2013. 1 computer file (PDF); xx, 294 pages, appendices A-G.This exploratory qualitative study investigated the perspectives of rural older adults who experience co-occurring mental health and substance misuse disorders. These disorders co-occur frequently and have serious consequences. Risk and protective factors have been identified for older adults with co-occurring disorders. A treatment model addressing the specific needs of rural older adults with co-occurring disorders has not been developed. The literature does not reflect the views of rural older adults about their experiences with these disorders, treatment, or recovery. Critical theory was employed to examine the inattention to co-occurring disorders in rural older adults. Resilience theory facilitated understanding participants’ strength in coping with these disorders. Grounded theory was used to develop theory throughout the exploration and analysis of rural older adults’ perceptions of their experiences. Data consisted of in-depth qualitative interviews collected from older adults living in rural Iowa who identified as having co-occurring disorders. Interviews with 23 older adults ages 55 to 90 living in rural Iowa explored their perceptions of experience with co-occurring disorders; the responses of family, providers, and community; treatment and recovery; and policy issues. The analysis reveals that older adults experience multiple individual, community, and structural service risks to develop co-occurring disorders. Individual resilience, supportive relationships, and treatment lead to recovery. The treatment model developed from the analysis focuses on principles of treatment; prevention that provides information for individuals, family, community, and providers; and integrated treatment that includes older adult role models, responds to the needs of older adults, and is accessible to those living in rural communities. The study concludes that in spite of risks and lack of appropriate prevention and treatment, rural older adults with co-occurring disorders exhibit resilience that can be supported through culturally relevant prevention and treatment. Barriers and risks need to be addressed at individual, community, and service structure levels. Stigma about `co-occurring disorders, age, and rural communities contributes to the absence of appropriate services. Implications for social work education and practice, policy, and research are noted