Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Over the past decade, the percentage of adults over age 50 receiving treatment for heroin use has doubled (3.9% to 8.4%; USDHHS, 2003). Yet, little research has reported on the experiences of older methadone clients, particularly older African Americans. Using the innovative technique of photovoice - a participatory means of sharing knowledge and expertise through visual images and accompanying narratives - this study provides some of the first data on this population from their perspective. This project actively involved older methadone clients in identifying their service needs and examining barriers and supports to abstinence from illegal drug use.

Methods: In photovoice, people receive cameras, which allow them to act as recorders and potential catalysts for change in their communities (Wang & Burris, 1997). A strength of this method is the inclusion of participants as partners in the research process. University researchers collaborated with ten African American methadone clients (5 men, 5 women) over age 50, meeting for six weekly 2-hour sessions. Participants chose a weekly theme and in the ensuing week took pictures related to that topic. Photographs from the previous week were brought to the next session, during which participants engaged in individual and group discussions. The analysis process was also collaborative; participants and university researchers met for three additional sessions to identify commonalities and differences among the photographs and to select and arrange photographs and narratives for public presentation.

Results: Results are presented using participants' photos and narratives. Service needs identified include age-appropriate physical and mental health services and activities to address social isolation. Barriers to abstinence from illegal drug use include neighborhood crime and violence, employment and transportation problems, and negative influence of family and friends. At the same time, participants reported receiving support from many family members and friends, as well as from other methadone clients. Religion was also a source of support for many participants. Extensive caregiving responsibilities for grandchildren and other family members, although burdensome, provided motivation for drug abstention.

Implications for Policy and Practice: The striking nature of the photographs and accompanying narratives is particularly useful for effecting policy and practice changes. Specifically, there is a need for existing senior centers to be more welcoming to this population and/or for methadone maintenance programs to develop community programming for their older clients. In addition, treatment for opiate addiction must address geriatric health and mental health problems. Further, many older African American methadone clients need support for their extensive caregiving responsibilities. Finally, community problems, including neighborhood crime and lack of adequate transportation, need to be confronted. In 20 years, older adults will comprise over one-fifth of those in methadone treatment. Social work, with its expertise in geriatric services, has the opportunity to take the lead in assisting this vulnerable population.