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According to information provided by the National Council on Alcoholism and Drug Dependence, an advocacy organization that provides information regarding substance abuse issues and treatment, substance abuse is a problem among seniors in the US.
According to the National Institute on Drug Abuse (NIDA), even though individuals over the age of 65 represent only approximately 13 percent of the US population, this group accounts for more than one-third of total expenditures on prescription medications. Older individuals are more likely to be prescribed multiple prescription medications due to high rates of illnesses and other issues. In addition, it is estimated that a high rate of older individuals who are also on prescription medications use over-the-counter medications and supplements, which can compound the effects of the prescription medications they use; this includes the use of alcohol by individuals on multiple prescription medications.
In general, most sources suggest that substance abuse among senior citizens falls into two categories. Some senior citizens have been abusing substances for many years (even with significant periods of abstinence in between); they are sometimes referred to as hardy survivors. There are also seniors who develop issues with misuse and abuse of drugs or alcohol after the age of 65; they are sometimes referred to as late-onset individuals.
The major substances abused by seniors include prescription medications like benzodiazepines, alcohol, nicotine products, and some over-the-counter medications. Elderly individuals are far less likely to use illicit drugs like cocaine, heroin, crystal meth, etc., although baby boomers may be more likely to use cannabis products than previous generations.
Substance abuse and substance use disorders in individuals over the age of 65 are often underdiagnosed, overlooked, and undertreated, resulting in these individuals not getting the help they need.
NIDA and the Substance Abuse and Mental Health Services Administration (SAMHSA) report the following:
As a group, individuals who are over the age of 65 have relatively lower rates of substance use disorders compared to most other age groups. Nonetheless, as individuals age, they begin to confront numerous issues that can be stressful. These issues include changes in personal obligations, health changes, significant changes in peer groups that include friends and family, and even potential feelings of inadequacy or being outdated.
Additional issues include:
Those individuals who have a prior history of substance abuse and continue to use drugs or alcohol will continue to display these issues with drug abuse as they age. Substance use disorders typically do not resolve without treatment. Individuals who have previous mental health diagnoses, such as major depressive disorder, bipolar disorder, anxiety disorder, etc., are also at increased risk for developing issues with substance abuse.
Those who take multiple prescription medications are at risk to misuse these medications. Combinations of medication, such as benzodiazepines or narcotic pain medications, can result in the development of significant physical dependence, which can lead to issues with misuse and abuse. Individuals who feel isolated, hopeless, or perceive that they are losing control or that powerless as a result of the complications of getting older may turn to substance abuse in an effort to regain control of their lives.
Substance misuse/abuse is particularly devastating for individuals over the age of 65 because these individuals are more sensitive to the detrimental effects of drugs and alcohol.
Some of the signs of substance abuse in elderly individuals include:
Some of the symptoms that may be associated with substance abuse may also actually be signs that an elderly individual is developing some other condition, such as dementia, or they may reflect more acute conditions, such as a stroke.
The misuse of prescription medications is also very common among elderly individuals. Some seniors may have cognitive issues that interfere with their ability to regulate their own use of medication. These individuals might forget that they took the medications and take them too frequently, or they may take doses that are too large. They may also not always follow the instructions on medications and may take medications that are designed to be taken after a meal on an empty stomach, which can lead to issues with confusion and other physical and mental signs that suggest intoxication or abuse. Some individuals may misuse medications like benzodiazepines because they believe that the medications are not working; for example, individuals taking benzodiazepines for anxiety may not achieve immediate relief when they take a longer-acting benzodiazepine and may take more of the drug in an effort to get immediate relief.
NIDA and SAMHSA report that elderly individuals can benefit from standard treatment protocols for substance use disorders as well as any other age group. However, there are some considerations.
The special issues associated with substance abuse in elderly individuals is a broader problem. It requires the development of specialized research protocols to assist clinicians and researchers to:
Finally, elderly individuals can benefit from psychoeducation. The best form of treatment is prevention, and educating elderly individuals about the signs of substance abuse and misuse can go a long way in reducing the prevalence rates of substance abuse in those over the age of 65. Helping these individuals to understand the triggers and driving forces of substance abuse, to get them more involved in community affairs, and to keep them active will help to inoculate them against potential substance abuse.