Substance abuse among the elderly (adults over the age of 60), particularly of alcohol and prescription drugs, is one of the fastest growing health problems in the United States.
Addiction among people 65 and up is often underestimated and under-diagnosed, which can prevent them from getting the help they need.
Alcohol and prescription drug abuse affects up to 17% of adults over the age of 60 as per the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Due to insufficient knowledge, limited research data, and hurried office visits, health care providers often overlook substance abuse among the elderly. This is made worse by the fact taht the elderly often have medical or behavioral disorders that mimic symptoms of substance abuse, such as depression, diabetes, or dementia.
In 2012, the U.S. Census Bureau reported that there were 43.1 million people over the age of 65 . It is believed that, by 2050, this will have risen to 83.7 million. The elderly of today are mainly from the Baby Boomer generation, meaning they were born between 1946 and 1964. When they were growing up, some were surrounded by free love and an acceptance of experimenting with drugs. Yet, very few consider just how many people in this generation continue to abuse drugs or consume high levels of alcohol. The reality is that it is likely that there are many elderly people with an addiction problem.
Alcoholism in Seniors
It is believed that alcohol is the most abused substance in senior citizens. According to the Psych Central Journal, around 3 million people aged 65 or older had an Alcohol Use Disorder, and by 2020, this is estimated to be 6 million. As people age, they have increasing physical and mental health needs, and this means they are more likely to be prescribed drugs as well. According to Psychiatric Times, around 25% of all prescriptions are given to the elderly. Additionally, they estimate 11 percent of those who are prescribed drugs abuse them. Opioid narcotics and other prescription painkillers, as well as sedatives and anti-anxiety medications like benzodiazepines are most commonly prescribed, and most commonly abused.
Prescription Drug Abuse in Seniors
The Today’s Geriatric Medicine Journal has published a piece stating that prescription drugs are used three times more in the elderly population than any other age range. Making it likely that drug abuse is higher in this demographic as well. The New York Times concurs with this, stating that between 6 million and 8 million elderly people in the US currently have a mental health disorder and/or substance abuse problem.
To treat this, specialized facilities need to be made available. The elderly are in a unique stage of their life, and they have very specific and unique needs. This means that their treatment cannot be the same as that offered to younger generations.
Treatment Centers for Seniors
Because there is an increased need for mental health and addiction treatment for the elderly substance abuse, there are now more facilities that offer specialized services. There are two main types of programs:
- Generic programs that anyone can take part in.
- Programs geared specifically to a certain demographic. There are, for instance, programs specifically for the elderly, for the young, the religious, those part of the LGBTQ community, those of a certain gender and so on.
It is often better for people to be treated in a facility where they can identify with the other individuals. This means they have similar demographics. The reason why the elderly abuse drugs and alcohol is also often different than the reason in younger people. This is why there is a case to be made for making different treatments available to them as well.
This separation can be beneficial across all different types of treatments, including:
- Support, educational, and preventative services
- Residential inpatient treatment
- Medical detox
- Outpatient services
Identifying Substance Abuse and Addiction in the Older Population
It can be quite difficult to spot and diagnose a Substance Abuse Disorder in an elderly man or woman. This is in part due to the fact that the elderly are often isolated. A good portion of elderly people are retired and live alone, with their family far away. As their friends age, some will lose independence of doing simple tasks on their own, which means they also have less of a social life. An added difficulty is that there is a type of stigma on SAD in the elderly, with some physicians having been accused of ageism for suggesting a diagnosis. Some, for instance, say that the elderly should not be diagnosed with these types of difficulties, and that they are within their rights to use substances, as they have lived a long life. However, the reality is that elderly substance abuse has a negative impact on the overall quality of life, which means some help should be made available.
The Elderly Have Unique Problems Due to Drugs and Alcohol
The elderly face unique problems because of drugs and alcohol; these span both their physical and mental health. As people become older, their brain and body start to change, which means that they are more likely to notice stronger effects from various drugs, making them less tolerant. They also have a slower metabolism, and they may also have various medical complications that change how the body breaks down drugs and alcohol. Furthermore, the elderly are at an increased risk of falls, and this risk is further increased when they abuse substances. This, in turn, can lead to broken bones, for which they may be prescribed painkillers, and so on. According to the Future Medicine journal, there is also an increased chance of having co-occurring disorders.
Difficulty of Diagnosing Substance Abuse in the Elderly
Another issue is that the signs and symptoms of addiction and elderly substance abuse are very similar to the regular signs of aging. This makes it even harder to diagnose the problem.
Often, an addiction starts very innocently, for instance, because they are prescribed medication. People who get older have psychological difficulties with becoming older. They suffer from illnesses, they often grieve, they struggle to take part in activities they used to enjoy and more Their lives change in many different ways, and it is quite understandable that they seek out some relief from all that. In fact, according to Psychiatric Times, the elderly are more likely to have a co-occurring mental health or medical problem alongside an addiction, with rates of between 21 percent and 66 percent. They also commonly suffer from anxiety and depression disorders. Many self-medicate through substances in order to reduce their symptoms, even though this will, in the long run, worsen their overall problems.
Effects of Prescribed Medication on the Elderly
A lot of the medication that is prescribed to the older population also alters the mind, and many are addictive. This means that, if they take it for a long time, they become dependent on it and, eventually, addicted. It is also more likely for the elderly to need medication for longer and to have to take multiple medications at the same time. This is according to a report by the National Institute on Drug Abuse on senior citizens and addiction. These drugs all affect the chemical makeup of the brain, and this can lead to a full blown addiction over time.
Often, this starts with the elderly taking more than their prescribed dosage of medication. They may also take alcohol alongside their prescribed medication which may have negative interactions. Furthermore, it is common for the elderly to have some financial difficulty, and this can encourage them to share medications with others, thereby saving money overall.
Elderly Substance Abuse Treatment
Whenever people are dependent or addicted to substances, they must go through a period of detox first, during which time the substance is completely removed from their system. This goes hand in hand with withdrawal symptoms, some of which can be dangerous. This is why detox should be conducted under medical supervision. In many cases, people are also prescribed medication to better manage the withdrawal symptoms.
When health professionals treat an elderly person going through medical detox, they must be mindful of any medication the elderly is taking to manage various health conditions. Sometimes, these medications are addictive and therefore need changing. At other times, they may negatively interact with any drugs given to combat withdrawal symptoms. It is particularly important with the elderly that their various medical conditions continue to be managed properly, while also being mindful of the unique challenges the biology of elderly people presents. For instance, according to the Substance Abuse and Mental Health Services Administration, elderly people should not be prescribed any benzodiazepines, because these can create permanent toxic or cognitive effect in elderly bodies. However, benzodiazepines are almost always used to treat the withdrawal in people who are addicted to psychoactive prescription drugs. Hence, with the elderly, a different solution has to be found. This is also why it is so important that, if you have an elderly loved one with a substance abuse problem, make sure that you enroll this person in a treatment center that is aware of how to manage the senior population.
Usually, in both inpatient and outpatient treatment programs, patients will receive a number of different services, including:
- Cognitive behavior therapy
- One to one counseling
- Group counseling
- Family counseling
- 12 Step programs
- Educational opportunities
- Workshops for life skills training
- Holistic healing methods
If people attend an outpatient facility, they will go there several times per week for several hours per day, sometimes as often as eight hours per day, five days a week. At night, however, they will return home to their family. With an inpatient facility, by contrast, they become residents of a certain facility, receiving round the clock care and supervision.
Senior citizens have very different lives than younger people. This is why certain elements of their treatment will have to be adapted so that these are more appropriate to their age. It is common for centers, whether they target a specific demographic or not, to create group therapy sessions where everybody is around the same age. This is true for counseling, support groups, education, and life skills training.
Need to Treat Co-occurring Disorders
As stated, it is very common for the elderly to have a co-occurring disorder. It is vital that they receive proper integrated treatment so that mental and medical health professionals work together in order to treat both issues at the same time. It is common for elderly people to have complex health needs and to be prescribed various drugs to manage them. It is vital that all the different service providers are on the same page when it comes to their treatment.
A key component of addiction therapy is behavioral therapy. This helps patients to recognize their different triggers and how these connect to negative thoughts that can eventually lead to an addiction. Triggers can be physical, social, or emotional, and each individual has unique triggers. In the elderly, however, they tend to center around circumstances or events that are very specific to their age group, and younger people will often struggle to relate to them.
Another popular form of therapy is Motivational Interviewing. Here, patients learn to recognize that they have to change, but they learn this in a way where there is acceptance, rather than being confronted and threatened. The factor of age alone often leads to threatening, confrontational behaviors and thoughts, which is why MI has proven to be so effective in this population group.
Importance of an Inpatient Rehab Facility
The best place to receive treatment from is an inpatient rehab facility. Here, senior citizens can receive all the care that they need, around the clock. They can be appropriately medicated and any negative side effects can be managed at the same time. Furthermore, they usually have a greater access to additional therapies such as walking groups, yoga, and massage therapy, although this will depend on the center that they go to. More importantly, when people attend inpatient treatment, they will also have their nutritional needs catered to, something that is hugely important in the elderly population.
Recovery Support and Relapse Prevention
One essential part of treatment is aftercare, which is offered once the initial rehab has been completed. However, even with aftercare, relapse is common. Relapse means that the patients return to the behavior that they have left behind. Relapse is always dangerous, but perhaps more so in elderly substance abuse issues. This is because many people overdose during relapse and it takes very little for a senior citizen to overdose.
The reason why overdoses are so common is that addicted individuals build up a tolerance to their substance and therefore start to take increasingly large doses. When they become clean through rehab, their tolerance drops again. Hence, if they use again and take the dosage they usually took before going to rehab, it will be far too much for their body to cope with.
To prevent relapse, rehab facilities offer a range of different services. These include referrals to 12 step programs and other self-help groups. These, in turn, exist specifically for seniors as well. Additionally, SAMHSA has recommended that elderly people are checked up on by a case manager regularly once they leave rehab. This can also be done by requesting them to attend regular meetings in a community center. Trained professionals can monitor for the signs of relapse, thereby ensuring that the chances of them returning to their addictive behavior are significantly reduced.