New Leadership for Older People Struggling With Addiction

    • August 4, 2008

Position: Director, Women of Wonder Institute
Rochester, N.Y.

Carol D'Agostino felt alone.

In her work with older people suffering from substance abuse problems, D'Agostino found herself turning many tenets of the alcohol treatment field upside down and inside out. Some of her colleagues believed so strongly that she was on the wrong track that they refused to help her get her program off the ground.

Working with people age 55 and older living in Rochester, N.Y., who had alcohol or drug problems, D'Agostino found that many treatment and medical providers overlooked or treated this group poorly. So, in 2001, D'Agostino started the Geriatric Addictions Program (G.A.P.) at Lifespan, an organization that provides services to older people.

Tailoring Treatment

Based on her experience as a social worker and her own recovery from alcoholism, D'Agostino believed that the traditional 12-step recovery program would not work for many older people. For example, she knew 12-step programs require that addicts agree to complete abstinence. D'Agostino believed that in some cases vulnerable elderly people should not have to make that commitment in order to receive help.

Moreover, proponents of 12-step programs believe that people should come forward to ask for help and do not generally seek out people who have substance abuse problems. D'Agostino's experiences indicated that many older people cannot easily leave their homes, and they find it difficult to ask for help.

What's more, older people may not feel up to the demands of 12-step programs and may not want to share their stories with younger group members, both those who are alcoholics and those who also are addicted to illicit drugs.

Older Addicts: An Ignored Group

D'Agostino first became interested in helping older people when she worked in a hospital emergency room as an intern. She routinely saw older people with alcohol problems patched up and sent on their way because of their age.

"Older people would come in with their head split open from falling because they were drunk," D'Agostino says. "They would get their head stitched up and be sent out the door without any intervention and still reeking of alcohol. If a younger person did that, they would have had tons of intervention. But for these patients, it was like 'why bother? They're old, they're adults, and they're going to die anyway.'"

Up to 19 percent of older Americans may have problems with alcohol or medication misuse, according to several sources, including the National Institute on Alcohol Abuse and Alcoholism.

Under G.A.P., D'Agostino and her staff visited people in their homes to assess them for one of three types of treatment:

  • Inpatient or outpatient chemical dependency treatment programs and/or 12-step programs.
  • Programs that improve their health, safety and functioning, thereby reducing the risk and harm caused by substance abuse.
  • Intensive services such as home health care, senior living communities or nursing homes for people with disorders such as dementia or chronic illnesses along with their substance abuse problems.

The program's ultimate goal for its patients was abstinence.

Getting Her Fellowship

G.A.P. had been operating for a year when D'Agostino received her Developing Leadership in Reducing Substance Abuse fellowship in 2002. She learned about Developing Leadership through an advertisement in a national trade magazine. She said one of her main goals was to find a mentor who could help her improve G.A.P. and expand its reach.

"I was very frustrated by the lack of supervisors or mentors or leaders in my community," she says. "I knew that I had a huge uphill battle. It went against the 12-step philosophy. Rochester is a very 12-step community. Because we didn't require abstinence, a lot of people refused to be on my advisory committee because they are recovering alcoholics and they don't believe in [this approach]."

Frederic Blow, PhD, a professor in the department of psychiatry at the University of Michigan, Ann Arbor, and an expert in substance abuse and older people mentored D'Agostino through her fellowship. D'Agostino had known Blow professionally and said she was thrilled when he agreed to be her mentor.

Blow gave D'Agostino the support and national exposure that she was looking for. He took time to visit D'Agostino in Rochester and she visited him in Detroit.

Working With Her Mentor

"He's just an incredibly good friend," D'Agostino says of Blow. "He really watched over me. When we had our conference calls, he was always checking to make sure that I wasn't overdoing, that my family was okay. I'm a type A and I get off and running and start spinning my wheels. I really needed to have somebody slow down the process."

With her mentor, D'Agostino evaluated 120 participants in G.A.P. Preliminary findings indicate that people who received comprehensive services including care management and attention to their physical and psychological needs were more likely than people who did not receive comprehensive services to access substance abuse treatment.

D'Agostino hopes that the findings will persuade administrators of programs such as Medicaid to cover her program and others like it.

A National Platform

Blow also helped D'Agostino understand the importance of getting her work published in peer-reviewed journals. Their article on the G.A.P. evaluation was published in the Journal of Dual Diagnosis. See the Bibliography for details.

Blow also helped D'Agostino gain an appointment to the expert panel at the federal Older Americans Substance Abuse and Mental Health Technical Assistance Center.

As a panel member, D'Agostino provides advice and guidance to the center on how to develop, plan, communicate and disseminate information on a range of issues related to substance abuse and mental health programs for older adults.

D'Agostino gives talks at national conferences about her approach to helping older people with addictions. The exposure and the practice made her more confident about speaking out about a controversial subject, she reports.

"I have no problem being in a national forum and telling the audience what I believe is wrong and what needs to be fixed," she says. "I've grown in that I believe what I have to say has value and I feel respected for my perspective."

D'Agostino and her staff at G.A.P. received the 2006 Healthcare and Aging Award issued by the American Society on Aging and the National Council on Aging. The award is for cutting-edge and innovative approaches to aging.

Since her fellowship ended, D'Agostino has worked on writing a training manual for people interested in starting a program patterned after G.A.P.

A New Direction

During her fellowship, with Blow's encouragement and help, D'Agostino used part of her fellowship stipend to earn her second master's degree, this one in creative writing. She also began wondering whether she needed to move in a new professional direction.

"In the process of working with Fred Blow and a personal coach, I went to school for a master's degree," she says. "I began paying attention to women who were clients. They needed something with more TLC [than my program]. I wrestled with it for a year."

D'Agostino said that the support she gained from her fellowship helped her make the leap from a comfortable position overseeing one program to taking the chance to follow a new dream.

In June 2006, she founded Women of Wonder Institute, a new organization for women age 50 and older. There, she provides individual and group therapy to women and offers classes in creative writing and spirituality.

"I would say without Fred as my mentor and professional counsel, I would not have been able to spend time learning where my heart was and know that I have the leadership ability to pull this off."



(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)


D'Agostino CS. "Addressing the Aging Face of Addiction: Complex Client Profiles Suggest Need for Creative Clinical Approaches." Addiction Professional, 21–25, 2003.

D'Agostino CS. "Overcoming Barriers to Geriatric Substance Abuse Treatment: A Model Community Outreach." Counselor, 6(4): 51–55, 2005.

D'Agostino CS, Barry KL, Blow FC and Podgorski C. "Community Interventions for Older Adults with Comorbid Substance Abuse: The Geriatric Addictions Program (GAP)." Journal of Dual Diagnosis, 2(3): 31–45, 2006.