Elderly Substance Abuse:
Explosion on the Horizon – Really!
It’s something that we never associate with the elderly, but it does, in fact, exist ---- substance abuse. According to the NYS Office of Alcoholism and Substance Abuse Services (OASAS), this “hidden national epidemic is diagnosed in only 37% of those age 60+ suffering from addiction. Many organizations have new guidelines for doctors and health professionals to screen every patient for alcohol and drug abuse.
According to the Hazeldon Betty Ford Foundation, there are two types of elderly abusers: those who are continuing their heavy substance use cultivated over their lives, and those who, due to the disappointments and struggles of later years, have turned to alcohol and drugs as a way to cope with their pain -- physical and psychological. OASAS calls these groups “hardy survivors” and “late onsets”.
Women, who generally live longer, are more likely to fall prey later in life. Alcohol is usually the drug of choice, but prescription medications rank just below that. Many of these prescription drugs include opiates for pain relief for diseases like arthritis and sedatives for anxiety and sleep disorders.
According to Dr. Andrew Kolodny of the Physicians for Responsible Opioid Prescribing, middle aged women saw an increase of 900% (not a typo!) in addiction to both opioids and heroin since 1997 with a concurrent 450% increase in deaths due to overdose since 1999. The potential to overwhelm the medical system and society is enormous.
The opioids are prescribed for pain, but due to their high acclimation effect, higher and higher doses are needed to get the same result. Doctors, given specious information from drug companies and largely untrained in pain management, prescribe them again and again to improve quality of life and patients are not educated in alternative methods.
There are acute risks associated with elderly substance abuse.
First, the elderly use so many prescription and over-the-counter drugs that their adverse interactions with alcohol or narcotics could be disastrous.
Second, because the way we metabolize alcohol as we age changes, it actually takes much less alcohol for the elderly to become intoxicated. This leads to a greater risk for impaired cognitive functioning, depression and general confusion. They may even become so confused that they take extra doses of medication resulting in overdose or death.
Third, already compromised with many seniors, brain cells essential for memory, thinking and decision making are destroyed with heavy drinking.
Fourth, being sedated by drugs or alcohol combined with its cumulative effects, increases the risk of falls and serious fractures to the elderly which are often accompanied by fatal complications.
Up to this point, addiction and substance abuse has primarily been seen as a young person’s affliction, but a whole generation of younger people is aging out. Furthermore, as baby boomers enter the golden years, their exposure to alcohol and drugs as youngsters makes them more open to them now. The Hazeldon Betty Ford Foundation estimates that 17% of those 60 and older abuse substances, including prescription drugs. They estimate the number to double by 2020.
The Center for Applied Research Solutions reports, though it is difficult to tease out the symptoms of abuse since they mimic many of the common signs of aging, things to watch out for are:
• Memory loss
• Lack of balance
• Shaky hands
• Mood swings
• Chronic boredom
The Center for Substance Abuse Treatment adds the following symptoms to the list:
Changes in sleeping habits
Being unsure of yourself
Unexplained chronic pain
Changes in eating habits
Wanting to stay alone much of the time
Failing to bathe or keep clean
Having trouble concentrating
Difficulty staying in touch with family or friends
Lack of interest in usual activities
Many doctors and professionals are reluctant to confront this since they feel “you can’t teach an old dog new tricks”, but that is a fallacy. The elderly can be very nimble as proved by their ability to adapt to their personal deficiencies fairly rapidly. They react better to intervention than other age group and require less intensive rehab called “brief alcohol interventions”. They recognize the benefits of sobering up since not doing so threatens their independence as well as their cognitive and physical abilities. Early evidence supports the finding that baby boomers are more amenable to recovery since they don’t carry the shame of addiction of previous generations.
Some suggestions for managing this problem include:
Paying close attention to the elderly family member’s daily comings and goings.
Getting a drug interaction list of the elderly patient’s medications from the pharmacist.
Raising your concerns with the doctor and having him/her assess and screen thoroughly for the problem.
Increasing the activity level and social activities for the elderly loved one.
Participating in a 12 step program or support group.
Having diplomatic, nonjudgmental conversations with your elderly relative.
The key really is to avoid the opioid addiction cycle to begin with. Just as we plan for later years, that could begin as early as middle age. Let us know if we can help!