Substance Abuse in Older Adults

The illegal use of drugs usually declines as people move from young adulthood into middle adulthood. And the percentage of people with substance use disorder (SUD) shows the decline in use as people age. But still, more than 1 million people aged 65 or older (older adults) had an SUD as reported in data from 2018. This includes:

978,000 older adults with an alcohol use disorder (AUD) and
161,000 who had an illicit drug use disorder.

This research indicates that substance abuse is a growing public health problem among this country’s older adults. The rise of SUDs in older adults as a public health concern partly reflects the higher drug use rates of the baby boom generation (born between 1946 and 1964) compared to other generations. As a result, there is a group of older adults who may be experiencing the negative consequences of SUD.

Negative Consequences of Substance Abuse in Older Adults

Family problems
Criminal justice involvement
Death from a drug overdose
Physical and mental health issues
Adverse interactions with prescribed medications

Substance Abuse in Older Adults: “Baby Boomers”

Baby Boomers are unique in comparison with other generations because they came of age during the 1960s and 70s. That was a time of changing attitudes toward drug and alcohol use. The rates of substance use disorder have remained high among this group as they age. Both the proportions and actual numbers of older adults needing SUD treatment are expected to grow significantly.

About Substance Abuse in Older Adults

Alcohol Use Disorder

The most used drug among older adults is alcohol. About 65% of people 65 or older relate that they have engaged in high-risk drinking. This means that they exceeded daily guidelines at least once a week in the past year. And more concerning, more than 1/10^th of older adults currently binge drink, which is defined as drinking five or more drinks on one occasion for men, and four or more drinks for women. Similarly, research published this year shows that increases in alcohol consumption have been greater for people aged 50 and over compared to younger age-groups.

Substance abuse in older adults is different from that of younger adults in general. As people get older, their bodies metabolize alcohol slower. Because of that, they have an increased sensitivity to and lower tolerance for alcohol. Even small amounts of alcohol can have serious consequences. Although consuming alcohol can have some physical and psychological benefits for older people, it can create danger by causing:

Confusion
Depression
Early death
Increasing falls
Dangerous medication interactions

Complicating or causing medical conditions such as:

Stroke
Diabetes
Osteoporosis

Memory loss
Mood disorders
High blood pressure

Combining medications or pairing medications with alcohol will affect older adults stronger than younger adults and may call for visits to the emergency room.

Prescription and Over-the-Counter (OTC) Medication Misuse

According to a report by the Special Committee on Aging, older adults consume prescription drugs almost 3 times as often as the general population. They also buy nearly three-fourths of all OTC medications. Medication misuse includes:

Missing doses
Consuming extra doses
Not filling prescriptions

Misunderstanding doctor’s instructions
Taking medication at the wrong time
Stretching out medications to last longer

Older adults are especially at risk for unintended medication misuse because of the use of multiple medications at the same time. Their systems are more sensitive to the medications’ effects due to the aging process. As the body ages, changes in digestion, kidney, and liver function affect the way medications are absorbed and metabolized (processed).

The most commonly misused prescription and OTC medications include:

Diet aids
Painkillers
Sleeping pills
Decongestants
Antipsychotic drugs—These drugs are often prescribed inappropriately to older adults with behavior problems. Their continual use can lead to dangerous side effects.

Many older adults have several doctors prescribing medications for them and may not be aware of the drug interactions. In addition, some medical providers don’t have the training and education in working with older adults. In that case, they may prescribe inappropriate medications or dosages.

Opioid Use in Older Adults

The population of adults 55 and older in the U.S. increased by about 6% between 2013-2015., but the proportion of individuals in that age group looking for opioid use disorder treatment increased by 54%. The proportion of older adults using heroin more than doubled from 2013-2015.

Constant pain may be more complicated in elderly adults who are experiencing other health issues. Up to 80% of people with cancer report pain, as well as 77% of patients with heart disease. From 1995 to 2010, the prescribing of opioids for older people during regular office visits increased by 9 times.

Medical Marijuana Usage Among the Elderly

Close to ¼ of marijuana users age 65 or older reported that a doctor had suggested marijuana in the past year. Research implies that medical marijuana may help relieve symptoms of chronic pain, sleep, depression, or help with side effects of cancer treatments.

However, the Food and Drug Administration has not approved it as a medicine. The benefits of medical marijuana should therefore be weighed against its risks especially for people who have other health conditions or take other prescription medications.

Recreational use

For lifelong recreational drug users, especially those who use marijuana, they could find that their drug use becomes more of a problem. This is due to their changing bodies, and circumstances that increase isolation such as retirement, lack of childcare responsibilities, and a lack of nearby friends to interact with.

Illegal Drug Use in Older Adults

The use of illegal substances is on the rise in older adults. It may reflect the generation of “sex, drugs, and rock and roll”. It might also reflect the number of people whose lives have been saved by methadone treatment or by better medical care for HIV/AIDS. Also, it might reflect the treatment of other diseases and injuries that hard-core drug users are exposed to.

Hard-core drug addicts who survive to old age may feel a lot of sadness when they realize that they have passed up some major opportunities. However, those that continue to abuse drugs such as cocaine and heroin are at a very high risk of a physical downslide that results in disability and premature death.

Heroin Use

The proportion of older adults using heroin more than doubled from 2013-2015. This is due, in part, because older people who were prescribed opioid pain relievers were misusing their prescriptions. Then, when the prescription expires, they switch to cheaper heroin.

Barriers to Addiction Treatment for Seniors

Failures in Screening

Medical professionals working with older adults, including primary care physicians, often don’t recognize substance abuse and misuse in their patients. They don’t appear to know that substance use issues affect 15% of the elders they serve.

Some of them even refuse to see abuse as a substantial problem for older adults. Therefore, they don’t view treatment as important or successful for this group of individuals. Some providers feel “Why change anything in their lives, considering their age?” The answer is that it is a quality of life issue.

Lack of Training

Providers who know that they need to look for signs of substance abuse often don’t have the professional training or skills to recognize the signs in an older population. The signs and symptoms of alcohol and medication abuse are similar to what could be a normal part of the aging process.

Shame and Stigma

Many retired elders drink quietly at home or in local bars close to home. They aren’t likely to get into trouble with the law or their places of work as younger people might. Besides, many older adults and their family members don’t realize that they have a drinking problem or are misusing medications. When they finally realize it, they often feel shame or guilt and don’t want the stigma of alcohol or drug addiction.

Challenges of Treatment for Older Adults

Family Involvement

Geriatric psychiatrist Susan Lehmann says that her “first job as a clinician is to convince these patients to cut back on using.” She also says that involving the family is important because a spouse or partner might also be drinking heavily and could be sharing opioids with loved ones.

Lack of Screening in Primary Care

A major challenge is that SUD in older adults is a hidden problem because, once again, a lack of screening in primary care. There are no guidelines for assessing older adults who might be using. It’s common for primary care providers, specialists, and emergency doctors to prescribe opioids and benzodiazepines (a sedative) on a long-term basis. That can lead to dependence and negative cognitive (thinking and reasoning) effects.

Benevolent Ageism

Dr. Lehmann is also concerned about what she calls “benevolent ageism.” She says doctors may worry about being considered disrespectful if they confront older people about possible substance abuse. Likewise, children of older adults may hesitate to intrude in their personal life. Often, family members say “He’s not driving anymore, so what harm can a few drinks do?” Or, “Drinking is the last pleasure he has!”

Substance Interactions

These days, many people in their 60s and 70s are more active than their parents were. But even one drink a day can be a problem because aging slows the liver enzymes that process alcohol. Of concern to Dr. Lehmann is the uptick in marijuana use, even the legal forms. “We simply don’t know very much about the possible interactions of marijuana with prescription medications that older patients are taking.” The effects can be harmful when mixed with alcohol and prescription drugs.

Professional Treatment for Substance Abuse in Older Adults

Assessments

Older adults need accurate assessments. Evidence shows that SUDs among older people are frequently underdiagnosed and poorly treated. Diagnostic standards that recognize SUDs in younger people tend to underestimate SUDs among older patients.

The Consensus Panel of the Treatment Improvement Protocol recommends that doctors screen for alcohol and prescription drug use disorders as part of regular physical exams among adults aged 60 and older.

Detox for the Older Adult

The detox process goes slowly for older adults. Detox for older adult patients requires a slower-paced process because of the cognitive, physical, and other issues associated with aging. Some new challenges in treating an older group have developed, including the high rate of dual diagnoses such as depression and anxiety. It is critical to have co-occurring conditions treated at the same time.

Medical Supervision

A medically supervised program is necessary for those who mix illicit drugs or prescription drugs with alcohol. Medical stabilization may take longer for older adults. During detox, withdrawal symptoms may become severe. Signs of withdrawal in seniors may include:

Confusion or detachment from reality
Abnormal or prolonged illness
Changes in mental health such as depression, anxiety, mood swings, and irritability

Physical Withdrawal Symptoms

The type of drug, and the intensity of the use, play a large part in the severity of withdrawal. It can be dangerous but it can be treated. The most commonly used drugs by seniors and their withdrawal symptoms are:

Opiate painkillers: Withdrawal is very uncomfortable and can be deadly in some cases. Seniors have a high degree of risk.

Joint/muscle pain
Flu-like symptoms
Increased blood pressure
Vomiting and diarrhea (dehydration)

Alcohol: Alcohol withdrawal can be deadly. It is important to get professional care when detoxing from alcohol.

Profuse sweating
Nausea and vomiting
Seizures
Delirium tremens

Sedatives: Can also be a life-threatening withdrawal due to the slowed metabolism of older adults.

Headache
Insomnia
Nausea
Loss of appetite

When supervised by medical professionals, the chances of a safe detox and long-term recovery improve substantially. Studies have shown that elderly patients do as well as, if not better than other age groups. Treatment specific to older adults tends to have a better result. Cognitive behavioral therapy has been proven to be effective in reducing alcohol and drug use.

Where Can I Get Treatment?

Do you have a substance abuse disorder? Do you need a medical assessment? We have medical professionals at Coastal Detox that can help you enjoy your quality of life once again. Our staff is licensed and experienced and their only purpose is helping people like you.

Maybe you have an older loved one that needs treatment for a substance use disorder. Help that person by reaching out to us now. We are available around the clock to talk to you. For yourself or someone you love, contact us now.

References:

Detox for Seniors