Addiction: How Substance Abuse Affects Older Adults

By Deborah Jeanne Sergeant

Angst-ridden teens and anxiety-ridden young adults seem easy examples of typical substance abusers; however, a growing number of older adults turn to alcohol and prescription and illicit drugs. They’re seldom identified as having a substance abuse problem.

According to the National Institutes of Health (NIH), the rate of people over 50 who abuse substances is expected to top 5.7 million by 2020.

The baby boomer generation grew up in the era of widespread drug experimentation. To those who used drugs recreationally in the ‘60s and ‘70s, the current growing expansion of acceptance of medical and recreational marijuana tacitly condones using substances to self-treat physical and mental health issues.

The NIH also states that alcohol predominates as this age group’s substance of choice, although abuse of illicit and prescription drug has risen in recent years, too.

Ironically, many older people visit a physician for chronic health issues than healthier younger people, yet a substance abuse issue often goes unnoticed. Even family and friends may not notice — or choose not to say anything if they suspect.

“Often, older adults are on many medications that can mask or mimic substance use and can easily be rationalized,” said Jennie Militello, chemical dependency manager with Rochester Regional Health. “Older adults are often isolated and can easily hide their use.”

Militello added that respect for elders and the generational mindset of minding one’s business may keep substance abuse problems taboo to discuss for either the elder or their children and the peers around them.

Mary L. Beer, public health director with Ontario County Public Health in Canandaigua, has a few ideas as to why so many in this age group have turned to substance abuse.

“The older adult population, in general, experiences a lot of loss,” Beer said. “As time goes on, your energy, social networks, spouse, family and friends: you lose a lot of these. That is a part of aging. Sometimes people self-medicate.”

For others, chronic pain from an illness or injury initiated a prescription for pain medication. Once the refills end, alcohol, others’ prescriptions or illicit drugs may stand in for pain control or to ease loneliness, depression or anxiety. Since many families spread out and neighbors aren’t always as close as they used to be decades ago, many older adults continue to abuse substances unnoticed.

Drugs and alcohol may affect older adults differently than when they were younger. For instance, muscle mass declines decade by decade as the body ages. Frail older adults have less muscle mass and cannot process alcohol and drugs as efficiently as they used to. Beer said that substance abuse can contribute to a greater risk for falling and breaking bones, which can trigger loss of independence and many negative health outcomes.

Ann Olin, program manager at Lifespan of Greater Rochester, Inc. geriatric addictions program, said that older people who abuse substances are usually either early onset users, who have been using a substance throughout their lives as a coping mechanism, or late onset users, who perhaps were social drinkers and later in life turned to a substance to cope with a tragic event.

Unfortunately, few substance abuse programs exist to help older adults who abuse substances. Olin said that many older adults feel uncomfortable in a typical group setting with mostly younger people.

“Oftentimes, we hear, ‘I don’t want to go to treatment because the person next to me saying they don’t get along with their spouse and I’m grieving for my spouse,’” Olin said.

One-on-one help may be too costly for seniors on fixed income. For some of these, accessing care is complicated by the expense of co-pays and transportation three times a week.

Lifespan offers a geriatric addiction program to provide in-home help. The organization operates on a harm reduction model.

“Some say they won’t stop using,” Olin said. “We ask them if they’re willing to cut down on their use so they can be safe and healthy in the environment of their choice. A great deal of the time, they will come to the conclusion they maybe should stop all together.”

Olin wants more providers to offer programs specific to older adults.

“Some of the treatment programs have gone to a walk-in service which isn’t necessarily a good option for an older adult,” Olin said. “That’s not so easy for someone who has to arrange rides three to five days in advance.”

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