The GET SMART (Geriatric Evaluation Team: Substance Misuse/Abuse Recognition and Treatment) program was established in 1991 by the United States Department of Veterans Affairs, West Los Angeles Healthcare Center. As a clinical care program, GET SMART addresses the unique treatment needs of older adults with alcohol and/or substance abuse problems. Although research has shown that older adults remain in, and benefit most from, substance abuse programs targeted specifically to the needs of the older patient, nationally GET SMART has been one of few such programs.
In its inception GET SMART consisted of a Geriatric Psychiatrist, Pharmacist, Social Worker, Nurse, and a Computer Assistant. The program was primarily manual driven and focused on providing group treatment modalities including support, structured educational, and cognitive-behavioral relapse prevention groups.
In 1999, as a result of staff reductions and ongoing downsizing, GET SMART began a process to redesign itself. Staff incorporated current research to readjust the program so that it would not only be treatment-effective but cost-effective. The critical element in this new design was that of program and staffing flexibility allowing adaptation to continual changes in the hospital system.
Today, GET SMART has evolved into an adjunctive program in support to the patient’s primary treatment. Based on research results demonstrating effective outcomes, brief interventions based on motivational approaches were included. The stage-specific strategies of the “transtheoretical model” have shown to foster behavioral change through tailoring interventions to the client’s readiness. As a result of the program’s evolution, the primary role of the GET SMART clinician has become focused on one key task -- to elicit and enhance client motivation for change.
To accommodate staffing limitations and to increase the hospital’s ability to address substance abuse in older adult patients, on-going training, mentoring and consultation services are provided to clinical staff.
Veterans 60 years of age and older are identified by inpatient screening, healthcare system referrals, community outreach. A multidimensional approach that acknowledges patient needs in medical, social and mental health areas are addressed with patients in the context of substance abuse treatment. Motivational enhancement approaches have yielded comparable overall outcomes comparable to traditional longer treatment methods at reduced cost.
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