According to Dr. Marvin Tark, and board-certified anesthesiologist and pain management specialist, “Addiction is a genetic trait. Prescription drug addiction is no different from alcoholism or an addiction to any other substance. If a person has a history of alcoholism or substance abuse, there is a higher chance that they will abuse prescription medication… Fifteen percent of the population has a tendency towards addiction. Seniors have the same propensity.”
The Growing Number of Seniors and Drug Use
A report published by the Hazelden Betty Ford Foundation in 2011 states that there are four main reasons that contribute to the growing number of older adults with substance abuse problems. They are:
#1 The Greying of the Population
In 2011, the first baby boomers turned 65. Every day until 2031, 8,000 -10,000 boomers will turn 65. This has been called the “silver Tsunami.”
#2 Life Changes
About half of all baby boomers grew up experimenting with illegal drugs. Most of them gave up drugs to build their careers and take care of their families. In retirement, with their kids gone, many have reverted to using recreational drugs to cope with the stress in their lives. The use of illicit drugs holds no stigma for this generation. Research indicates that the boomer generation is more likely than earlier generations to use drugs as older adults.
#3 Pain Management
The United States consumes about 80 percent of all prescription painkillers. Many painkillers belong to an addictive class of drugs that also includes heroin, called opioids. As a result, the number of people treated for opioid abuse increased 400 percent in the period between 1998 and 2008. Addicts who cannot get their pain meds by prescription have turned to buying their drugs illegally.
#4 Social Norms
Baby boomers grew up in an age of “better living through chemistry,” and have been conditioned to take medications for all that ails them. Americans filled more than 4 billion prescriptions in 2014. Adults over 65 filled more than twice as many prescriptions than those younger than 65. Drug use among the elderly is simply accepted as a societal norm. As well, the boomer generation grew up during a time when illegal drugs were easily available and their use had a certain attraction.
Signs That May Indicate an Addiction
The signs of drug abuse and alcohol dependency are often different in older adults than in younger people. Some of the many signs that may indicate addiction are:
- Drinking alone
- Secretive drinking
- Habitual drinking – a regular evening cocktail or after dinner drink, for example
- Loss of interest in hobbies
- Increased isolation from friends
- Use of tranquilizers
- Drinking while on prescription drugs
- Slurred speech
- Experiencing more headaches or dizziness than usual
- Changes in eating habits
- Empty liquor bottles
- Poor hygiene
- Suicidal thoughts
- Legal problems
- Money problems
- Health complaints
- Difficulty making decisions
- Mood swings
- Memory loss
More Severe Effects
Drug and alcohol addiction among the elderly can be severely debilitating. If an elderly person falls as a result of being under the influence, they are more likely to be severely injured than a much younger person. Additionally, the possibility of interacting with prescription medications is much higher. Combining prescription drugs with alcohol or other drugs can lead to overdose or death.
Exacerbating the problem is that older adults are often prescribed drugs to deal with issues like insomnia, anxiety, and chronic pain. Sleeping pills, tranquilizers, and narcotics (for pain relief) are some of the more common prescription drugs that are abused. And these are some of the most addictive drugs that exist.
Older adults are more likely to become addicted to alcohol and pills. It’s not unusual for older patients to address psychological issues with their doctor and be given a prescription for pain medication, antianxiety drugs, or sleeping pills. All of these drugs are highly addictive, and many users become “accidental addicts.”
- In 2015, there were 2.5 million older Americans who suffered from a drug or alcohol addiction.
- As many as 17% of adults over 60 abuse prescription drugs
- 14% of elderly emergency room visits were due to drugs or alcohol.
- 20% of elderly psychiatric hospital admissions were due to drugs or alcohol.
- Almost 50% of nursing home residents have alcohol-related issues.
- The segment of the U.S. population with the highest rate of alcoholism are widowers over the age of 75.
- From 1992 to 2008, the proportion of older adult admissions to drug treatment facilities reporting heroin as the primary substance of abuse more than doubled from 7.2% to 16%
- From 1992 to 2008, the proportion of older adult admissions to drug treatment facilities reporting cocaine as the primary substance of abuse quadrupled from 2.8% to 11.4%.
- Depression and anxiety play a large role in 63% of older adult addiction.
- Financial worries are a major contributor to about 30% of older adult addiction.
- More older Americans are hospitalized for alcohol-related issues than for heart attacks.
- Every year, almost 17 million tranquilizer prescriptions are written for older Americans, some of the most misused prescription medications.
- Almost a quarter of nursing home admissions are due to the patient’s lack of ability to manage their medications.
- The misuse of prescription medications is an indirect cause of up to 14% of hip fractures in adults over 60.
- 85% of older adults take at least one prescription drug.
- 20% of older adults use tranquilizers daily.
- 70% of older adults use over-the-counter medications daily.
- Older patients average two to three medication errors per month.
- About 40% of older adults do not follow prescription directions.
Early- and Late-Onset Addiction
When dealing with an older population, one of the keys to diagnosing addiction is to determine if their substance addiction was early-onset or late-onset.
Early-onset addicts include about 66% of all alcoholics and addicts and have been substance abusers for most of their lives. This group contains more men than women, that have suffered more severe results of their addictions such as medical issues, cognitive issues, legal and social problems. Many of them may even have been in recovery for long periods. One of the reasons that many of these early-onset addicts are entering treatment is because their aging bodies can no longer handle the effects of the substances they are abusing (due to slower metabolism and other physical changes associated with aging). Some of them may also be entering treatment because of the difficulties they encounter obtaining the illicit drugs that they need.
Late-onset addicts usually had no issues with addiction earlier in life, but some catastrophe or series of unfortunate events led to a loss of control. These events could include medical issues, access to medications, surgery, depression, loss of a loved one, and anxiety. These patients are often referred to as “accidental addicts.” This tends to comfort the addict and reduce the shame that they feel. The late-onset group is comprised of more women than men and is better educated and wealthier than its early-onset counterparts. Due to fewer medical complications (because their substance abuse does not span decades) and their general receptiveness to treatment, this group is easier to treat than the early-onset group.
Seniors and Prescription Drug Abuse
Comprising only 13% of the population, adults aged 65 and older account for almost a third of all prescriptions in the United States. In addition to being at greater risk for misuse of these drugs, older adults also use over-the-counter (OTC) medications and dietary supplements.
A study done by the National Institutes of Health found that almost 9% of study subjects aged 65-80 had recently received a prescription for benzodiazepine, and that 30% of these patients had received these prescriptions for long-term use. In another study of more than 21,000 residents of nursing homes in the U.S., about 30% were taking prescription opioids. The risk of prescription drug abuse increases in this population with medical exposure to these narcotics. Risk also increases with medical exposure to Benzodiazepines (Xanax and Valium). These drugs also carry the risk of falls due to excessive sedation.
Some common drugs that can interact dangerously with alcohol are aspirin, cold and allergy medicine, acetaminophen, cough syrup, pain medications, sleeping pills, and medicines that treat anxiety and depression.
Seniors and Alcohol Abuse
Older adults use alcohol more than any other substance. It normally takes less alcohol for older adults to become intoxicated and they may stay drunk longer, as their metabolism is slower and it takes longer for their bodies to process the alcohol. The use of alcohol makes hearing, vision, and motor coordination problems worse, and as a result, older adults are at higher risk of falls and automobile accidents. Additionally, mixing alcohol with prescription medications, many over-the-counter medications, and even some dietary supplements can be fatal.
Alcohol’s Risk for Women
Women have a higher risk for alcohol/drug interactions than do men. Alcohol typically reaches a higher concentration in a woman’s bloodstream than a man’s, due to the fact that women’s bodies are composed of less water than men’s bodies. When a woman consumes alcohol, there is less water in the body to dilute it and the concentration of alcohol in the bloodstream becomes higher. As a result, women who drink regularly have a higher risk of liver damage.
Alcohol abuse among the elderly can also cause (or make worse) many health problems including ulcers, liver disease, hypertension, anxiety, sleep disorders, diabetes, congestive heart failure, osteoporosis, and depression.
Misdiagnosis and Lack of Treatment
Substance abuse is often misdiagnosed in older adults for several reasons. Doctor’s visits are usually hurried affairs, and lack of training among medical professionals may be involved. Symptoms of drug and alcohol abuse in older adults often mimic symptoms of medical conditions and behavioral disorders common to this population. Some of these conditions are diabetes, depression, and dementia.
Lack of Social Responsibility
Older adults are also less likely to use drugs and alcohol in public, and they may not have responsibilities such as work or school where their performance would be scrutinized by others. As many adults age, they withdraw socially and become more invisible to society.
In addition, when drugs are prescribed to a patient, misuse can be more difficult to identify. Many older Americans use mood-altering drugs for non-medical reasons. As with any addiction, their sensitivity to the drug diminishes over time, and more of the drug is necessary to achieve the same effect.
Children of older addicts may not necessarily see that there is a substance abuse problem. Lack of contact due to busy lives or geographical distance is often the culprit.
There is also some age-related bias involved in treating substance abuse among the elderly. Older adults with substance abuse problems may feel guilt and shame, not to mention the privacy of the matter. Health care professionals (as well as many of the adult children of the elderly) may feel that treatment at that time of life is unnecessary and a waste of healthcare dollars.
Assessing Drug and Alcohol Addiction in Older Adults
If you suspect drug or alcohol addiction in a senior that you are caring for, these questions will help you decide if help is needed:
- Has their behavior or mood changed?
- Are they taking more medication than their prescription calls for?
- Are they concerned about taking their medication?
- Are they coming up with excuses as to why they need more medication?
- Do they have an “emergency supply” of medication stashed away?
- Have they been treated for substance abuse in the past?
- Have they changed pharmacies or doctors?
- Do they have multiple current prescriptions for the same medication from different doctors or pharmacies?
- Do they hide medications?
- Are they sensitive about discussing their use of medications?
Getting Help for Prescription Drug Addiction
If you suspect that someone you love or take care of has an addiction problem, there are many ways to get help.
- Make sure that they are following the prescribed dosage of their medications.
- Make sure you know what prescription medications they are taking.
- Control access to their prescriptions.
- Investigate drug-free alternatives for pain management. Seek the help of a pain management specialist.
- Urge them to take pain medications only when they absolutely need them.
- Remind them to avoid alcohol with sedatives and narcotics.
- If you suspect a problem, talk with their primary care physician.
- Bring all of their medications to their annual checkup.
- Investigate substance abuse rehab programs and facilities. Ask about programs designed for older adults.
The key to any substance abuse treatment is the diagnosis of the problem. Many older adults fail to realize how dangerous mixing prescription drugs with other drugs or alcohol can be. In some cases, bringing this to their attention can start them on the road to recovery.
One stumbling block for addicted seniors seeking treatment is stigma. Theirs was a self-sufficient generation, and seeking help for such a deeply personal problem is a sign of weakness. Often, it is the children or caregivers who identify the problem and help get treatment. It can also be the legal system, as the result of a DUI conviction.
There are many different options for treatment of seniors’ substance abuse. These include detoxification, support groups, individual therapy, addiction rehab, and 12-step programs.
- Support groups can be beneficial because they can help older adults with substance problems build a new life with other people who share some of the same problems as they do.
- Therapists can help the elderly identify the root problems of their addiction and help them find positive, constructive solutions
- Addiction rehab combines elements of traditional therapy and support groups for a comprehensive approach to getting better.
It is important to remember that older adults need more time to detoxify (due to a slower metabolism) and a more carefully timed treatment period. It is also vital that older adults with substance abuse problems connect with their peers and use them to build a support network.
On a positive note, sobriety success rates are higher among older adults than among those who are younger. Older adults have more life experience to draw on than younger addicts, and they tend to be more disciplined about reaching their goals.