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.
- There are an estimated 2.5 million elderly adults with the drug or alcohol problem in the United States.
- An estimated 20 percent of psychiatric hospital admissions of all elderly people also involve the use of alcohol or drugs.
- An estimated 14 percent of emergency room admissions involving elderly people are associated with drug or alcohol abuse.
- An estimated 6-11 percent of hospital admissions of the elderly are a result of alcohol or drug abuse problems.
- About half of nursing home residents have alcohol- or drug-related problems.
- One of the highest risk groups for an alcohol use disorder includes widowers over the age of 75.
Substance Abuse and the Elderly
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:
- The most common substance use disorder in individuals over the age of 65 is alcohol use disorder.
- The most misused drugs in individuals over the age of 65 are benzodiazepines. Benzodiazepines are commonly prescribed to elderly individuals for the treatment of anxiety, to help with sleep, and for the control of seizures.
- The combination of benzodiazepines and alcohol misuse/abuse is a serious and potentially fatal condition in anyone, and the risk of serious and even fatal consequences as a result of mixing these drugs is exacerbated in elderly individuals.
- The highest rates of substance use disorders involving prescription medications in the elderly occur in those who are nursing home residents.
Contributing Factors to Substance Use Disorders in the Elderly
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:
- Loneliness and isolation as a result of the loss of a life partner, close friends, family members, and other individuals the person normally associates with, due to death, dementia (no longer recognizing the person), sickness, or relocation
- Significant issues with idleness and boredom associated with retirement
- Poorly develop coping skills that can lead to reliance on substances
- Cognitive decline as a result of the normal aging process
- Numerous complications associated with declining health as a result of aging
- Financial issues and loss of income sources
- Conflicts in one’s family or close circle of friends
- Development of issues with depression
- Actual physical relocation or removal from one’s home that can include placement in a retirement community, assisted living facility, or nursing home
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.
- The use of alcohol in conjunction with the use of prescription medications
- Solitary use of alcohol by elderly individuals
- Maintaining a ritual of using alcohol before, during, and/or after a meal
- Demonstrating a decline in grooming, having frequent falls, becoming increasingly isolated, or displaying physical signs of intoxication, such as slurred speech, in the absence of a diagnosed neurological condition
- Frequently using benzodiazepines and/or narcotic pain medications
- Uncharacteristic signs of hostility, irritability, or depressed mood
- Issues with decreased cognitive abilities, such as problems with memory or attention
- A loss of interest in activities that were once important to the person, such as hobbies, socializing with other people, exercising, etc.
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.
Treatment Issues for Elderly Individuals with Substance Abuse Problems
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.
- No specific treatment or overall program will work for everyone. There are a number of different approaches to treating substance use disorders, and there is no one specific treatment that can be used in every case. Even though there is an overall blueprint regarding the types of interventions that should be used for successful recovery, the blueprint needs to be personalized to fit the needs of the individual.Elderly individuals are often very resistant to becoming involved in psychotherapy or seeing a psychotherapist. These individuals need to be educated regarding the types of treatment they are receiving. Elderly individuals are often more suited for group substance use disorder therapy initially to allow them to identify with others, understand the treatment process, and feel as if they are not being targeted or singled out. The groups should consist of individuals in the same age group in order for these people to be able to identify with one another more readily. It also helps to have an older therapist.
- The treatment protocol needs to be readily available for the individual. Older individuals often have restrictions that may keep them from becoming involved in certain types of treatments or certain groups. It is imperative to ensure that the individual can participate in treatment.
- The treatment should be appropriate for the individual’s age, their medical condition, and any cultural issues. For example, individuals from certain cultural backgrounds may have objections to certain types of treatment providers or therapists. Is important to recognize this.
- Often, elderly individuals respond to substance use disorder treatment when it is integrated into their primary care routine. This means getting their primary care physician on board and having that physician recommend the treatment to them. Then, have the primary care physician follow their progress.
- The treatment must meet the special needs of the individual. Elderly individuals may have issues with loneliness, isolation, or cognition. The treatment must be adjusted to meet their special needs.
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:
- Understand the specific effects that certain medications and alcohol have on elderly individuals: Often, prescription medications and alcohol affect elderly individuals much differently than younger individuals. Older people frequently need lower doses of certain prescription drugs and have different side effect profiles than younger individuals. The use of prescription medications and even over-the-counter medications in elderly individuals should be monitored closely by treatment providers and family members.
- Promote better public awareness and identification of substance abuse in the elderly: Often, issues like substance abuse, depression, feelings of isolation, etc., in elderly individuals are not recognized by those close to them until they have greatly progressed. Protocols to screen elderly individuals for potential issues with substance abuse or misuse and other psychological problems like depression, and to gauge their understanding of the medications they use, should be implemented.
- Recruit more professionals: There is a relative shortage of therapists who specialize in geriatric issues or who are trained in treating older individuals. There is also a relative shortage in treatment programs aimed at addressing substance abuse issues in senior citizens. These services need to be increased.
- Fund and support research: There is also a need to increase research to identify effective assessment approaches and treatment protocols for individuals over the age of 65.
- Develop more integrated treatment resources for elderly individuals: Integrated treatment protocols are used when individuals have a co-occurring substance use disorder and some other mental health disorder. Integrated treatment protocols designed specifically for elderly individuals are rare. Because elderly individuals, like everyone else, are at increased risk of developing issues with substance abuse if they have some other mental health condition, there should be an increase in integrated treatment protocols for this group.
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.