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Substance Abuse in Older Adults

By Carol Colleran, CAP, ICADC

The huge baby boomer demographic includes a significant number addicted to alcohol or other substances. To be effective, treatment for this generation needs to take a new direction.

The 77 million baby boomers born between 1946 and 1964 have always assumed that they’d live longer and better than their parents’ generation. You know—continued youth, health, and vitality. But some rocky obstacles arising from lifestyle, genetics, and the inevitable aging process have obscured the boomers’ road to healthy aging.

Statistics from the National Institute on Aging-sponsored Health and Retirement Survey that began in 1992 to study 20,000 Americans over the age of 50 show that chronic pain plagues many of those in their early to mid-50s. Respondents in that age group reported poorer health, more pain, and more trouble doing routine physical tasks than their older peers had reported at the same age.

The youngest group (aged 54 to 59) reported having more pain, chronic health problems, drinking, and psychiatric problems than those surveyed earlier. Chronic conditions such as diabetes continue to increase in frequency, with a corresponding increase in late onset addiction to alcohol, medications, and illicit drugs among all respondents.

Considering that thousands of boomers turn 61 every hour, and 8 million older adults exhibit substance abuse symptoms, such findings indicate that we can expect older adult addiction to increase at an alarming rate. Late onset addiction accounts for one third of all older adult addiction among those over the age of 65, due to challenging life transitions with which people attempt to cope by abusing alcohol and medications.

A national survey conducted by the Substance Abuse and Mental Health Administration shows that between 2002 and 2005, the use of illicit drugs increased by 63% among those in their 50s, suggesting that more than 3 million adults aged 50 and over have used hashish, marijuana, cocaine, crack, heroin, hallucinogens, or inhalants.

According to a 2001 National Institute on Drug Abuse study, 12% of those aged 55 and older are either binge drinkers or heavy alcohol users. A 50-year-old-plus body can’t process alcohol in the same way a younger body does, and alcohol is often taken in combination with another substance. Of equal concern are those in their 50s who, on average, take more than one prescription medication—a profile of polypharmacy that sets the stage for a whole new realm of older adult addiction concerns.

In 2007, Scripps Howard News Service analyzed death records for more than 304,000 boomers who died in 2003. The findings reveal the legacies of early and enduring drug use, a long history of depression, and a stubborn tendency to not “act their age.” Using reports from the National Center of Health Statistics, the study found that 24% died from something other than natural causes, including more than 10% who died from some type of accident that was often related to alcohol or other substance abuse. Male boomers accounted for two thirds of accidental deaths, 64% of drug-related deaths, and 75% of suicides.

Mental health disorders frequently co-occur with alcohol and/or drug use in older adults. As a whole, boomers account for one of every two drug fatalities. Because drug deaths typically go unreported, risky substance use is likely to be more prevalent than statistics show, and its consequences will certainly continue to grow.

Developing a treatment model for young older adults requires addressing differences in what we call the traditional older adult generation vs. the baby boomers, who actually comprise two distinct groups. The Vietnam War and Civil Rights era influenced leading-edge boomers in their youth while the tail-end boomers arrived on the scene one year after President John F. Kennedy’s assassination and the killing of three civil rights workers in Mississippi. The latter have never experienced a draft but have accumulated huge consumer debt and have faced tough economic competition.

Treating the Traditional Older Adult
Detox and treatment for older adult patients require a slower paced process because of medical, cognitive, physiological, and other factors associated with aging. Holistic treatment, rooted in a 12-step philosophy, includes therapies that consider this generation’s values and world outlook. These beliefs include moral judgments about illegal drugs and people who use them, a respect for authority figures, and pride in handling one’s own problems.

Even the words alcoholism and addiction carry a tremendous stigma. Keeping demographic-specific values and taboos in mind when addressing older adults remains critical in creating a therapeutic environment.

Older adults are most comfortable sharing life stories and accepting support and treatment when they participate with peer groups. This holds true for ongoing recovery. They often resist the idea of treatment, and family members often deny the diagnosis. Because symptoms are similar to other age-related disorders and the subject is uncomfortable, physicians sometimes misdiagnose addiction. Fortunately, older adults have proven to be the most successful in recovery among all age groups.

Baby Boomers: Impact of an Age Wave
Unable to stop the hands of time, baby boomers continue the predictable process of aging. But this generation which has exerted a greater impact on American society than any other will remain an unprecedented force as it ages. Acknowledging this formidable force, marketers struggle and often fail to successfully address boomers’ needs. Descriptors for this age group are examined and discarded by young older adults. Senior? Mature? Elderly? None of these is eagerly embraced, presenting a conundrum to marketers and boomers alike. Are they in denial about aging or just unsure of how they want to navigate the process? This group refuses to tolerate ageism and rebuffs anything that smacks of patronization.

Our society needs to address a number of core issues related to the prevention and treatment of substance abuse among boomers, who continue to believe in their uniqueness and seek to remain vital to society. They need to care about and be energized by what they do. Most boomers aged 55 and over do not plan to retire in the traditional sense any time soon.

A controlled study of subjects aged 40 to 48 by the Mature Market Institute, with MetLife and AARP, reported that 75% of boomers who are currently working intend to work into retirement. While 30% will need to do so financially, 42% want to work and cite a desire for some kind of balance between work and leisure. Boomers seek work that is personally rewarding and/or more flexible to allow for leisure and family time.

Is 50 really the new 35? It depends. After our mid-50s, 70% of all aging is determined by lifestyle, including the following:
· activity or inactivity;
· smoking or drinking to excess;
· sleep patterns;
· interaction with friends and family;
· degree of engagement in work, community, and life.

We know that finding purpose and meaning in life affects well-being as we age; and learning healthy coping skills and finding ways to explore purpose may be lifesaving in middle life. The pursuit of vitality, for example, can be channeled into a second career, adult education, travel, and volunteerism. Issues of health, economics, lifestyle, and beliefs affect individual possibilities.

Coping with even one of multiple negative factors that impact aging can be difficult, possibly resulting in job burnout, early retirement, chronic health problems, financial pressures, and family obligations. Studies have shown that when people retire suddenly without an avocation or activities to engage them, they face a high risk for depression. Many older boomers with increased leisure time and become bored or lonely. Others may be overwhelmed by caring for an ailing spouse.

For those who have slipped into dangerous drinking, prescription and/or illicit drug abuse, or are suffering the devastating consequences of a lifetime of addiction, simply living day to day presents a challenge.

Treating the Young Older Adult
Regardless of an older person’s outlook, physical and mental factors determine tangible aspects of treatment. The detox process progresses slowly. New challenges in treating an older cohort have emerged, including the high incidence of dual diagnosis such as depression and anxiety.

While alcohol and prescription medication dependence remain most prevalent among those aged 65 and over, the young older adult frequently presents with alcohol use combined with prescription and/or illicit drugs. A medically supervised treatment program is absolutely necessary for those who mix illicit drugs or drugs with alcohol. Medical stabilization may take longer in older adults and research shows that personalized 90-day residential treatment is more successful than shorter primary residential treatment. A personalized continuing care plan, along with regular support group participation, is indicated for virtually every older boomer patient, whether in an intensive outpatient or in transitional housing setting.

For young older adults in treatment, it’s important to address some pervasive values. Boomers like to base decisions on choices. Most surf the Internet for answers to questions. They’re unimpressed with authority. All these factors can help in the recovery process, providing patients don’t direct the care or engage in compulsive behaviors such as extreme exercise regimens. A holistic care plan that treats the whole person—spiritually, medically, psychically, emotionally, and mentally—is ideal.

Many young older adults have struggled to maintain an unchanging ideal of youthful attractiveness, spending millions of dollars on plastic surgery, hair implants, and a host of noninvasive procedures in this quest. We need to examine what attractiveness means as we age. Boomers have long subscribed to the notion that every problem has a relatively quick fix. Treatment is necessarily a step-by-step process, especially when dual diagnosis, medical complications, the use of several substances, and long histories of substance use have created a complex health profile.

Interactive therapies within a holistic care plan have proven effective. Motivational interviewing helps individuals move though their ambivalences about recovery and engage in the process. Dialectical behavior therapy allows a person to learn to stabilize mood and address life with mindfulness and acceptance. The patient needs to understand the bioneurobiological basics of addiction and the effects of substances on the brain, particularly because polypharmacy and dual diagnosis are prevalent.

Wellness therapies such as massage are well received, especially in a serene and nonmedicinal setting. Wellness activities such as tai chi, gentle yoga, and aquatics, offer appropriate choices. And pet therapy can help a person who is emotionally isolated to reconnect with others. The Labyrinth is a wonderful spiritual exercise. Expressive therapies such as art therapy, music, and journaling are also effective.

For some patients, professionals, and reluctant retirees who were so oriented to being in control, the exploration of spirituality, including connectedness to self, others, and a deeper meaning in life, can lead to an unexpected “a-ha” moment which becomes a catalyst for change.

Sometimes it takes a personal crisis or an intervention for people to enter treatment, and for older adults, waiting for a crisis can mean death. An attorney in his late 50s almost died before experiencing a lifesaving intervention and subsequent agreement to enter treatment. He had tried repeatedly to detox from debilitating painkillers, only to become bedridden and then to start doctor shopping for multiple prescriptions all over again. Today he credits his family, the intervention, and the ensuing treatment with saving a life that is now worth living.

Substance abuse in the new age wave will significantly impact our culture and institutions, from healthcare to housing and from the workplace to family life. Addiction is an insidious thief that, left untreated, will rob the individual of health, relationships, and a life with meaning. Aging boomers who suffer from debilitating addictions deserve the chance to explore the possibilities of decades of a healthier life and renewed connection to loved ones and community.

— Carol Colleran, CAP, ICADC, a certified alcohol and drug counselor specializing in the treatment of older adults, is executive vice president of public policy and national affairs at Hanley Center in West Palm Beach, FL.

Treatment Admissions and Outcomes for Older Adults

The Drug and Alcohol Services Information System Report, “Older Adults in Substance Abuse Treatment: 2005,” reports that admissions for those aged 50 and older accounted for about 184,400, or 10%, of the 1.8 million treatment admissions included in the Treatment Episode Data Set. Alcohol was the most frequently reported primary substance of abuse among all admissions but the highest levels of alcohol abuse reported for adults aged 50 and over ware among those over the age of 65. Admissions among those aged 50 to 64 had more extensive substance abuse treatment histories than those aged 65 and over.

While there is a need for further research, studies show that older adults who have received treatment for alcohol and chemical addictions experience an increased incidence of improved health over other age groups. As early as 1998, the Substance Abuse and Mental Health Administration Treatment Improvement Protocol (TIP) Series 26 reported that studies over some decades show older adults are more compliant with treatment and have outcomes as good as or better than other patients. TIP Series 26 also reported earlier studies that age-specific treatment improves older adults’ compliance and outcomes.

Results of a study published in 2000 and led by Frederick Blow, PhD, of the University of Michigan department of psychiatry, substance abuse division, indicate that a large percentage of older adults who receive gender-specific treatment attain positive outcomes across a range of outcome measures. In a one- and five-year treatment outcome study by Sonne Lemke and Rudolf H. Moss, PhD, published in The Journal of Substance Abuse Treatment in January 2003, older adults aged 55 and over were found at one year to have significantly reduced alcohol use and less physiological distress than middle-aged patients. At five years, older adults had a higher incidence of reduced alcohol use, drinking problems, and psychological distress than groups aged 19 and over. Even given better intake factors, such as less heavy drinking, the older adults showed better outcomes than either young or middle-aged adults. Patients who had more months of continuing care in the first year following residential treatment had better outcomes, and those who were involved with self-help groups had better outcomes.

While there is a need for more research on relapse among older adults, the factors of health, comorbid psychiatric conditions, self-help groups, social and family support, financial status, and housing conditions all play a role in risk for relapse.