Elder Substance Abuse

(Co-authored with Kimberly A. Williams)

Gladys became a drug addict at the age of 82 when the pain of arthritis got to be too much for her and she became dependent on opiates to get through the day and to sleep at night.

Frank became a dangerous, problem drinker at 66 after he retired from his job as a maintenance man in a local school. Every day he drove to a bar where he hung out with a few buddies and drank a few too many beers before he drove home.

Samuel grew up during the era of drugs, sex and rock and roll. Throughout his adult life, he smoked marijuana after work without problems at work or at home. After he retired at 65 he smoked more often and getting high began to interfere with the life he had hoped for when he retired.

For most of her adult life, Joan had had two or three glasses of wine with dinner. In her mid-60s her physical tolerance for alcohol diminished. She drank no more than usual, but by the second glass she began to slur her words and to find it hard to think clearly. She frequently fell asleep right after dinner.

These are just a few of the faces of substance abuse or misuse among older adults. They are not the images that ordinarily come to mind when we think of substance abuse, and this is a major reason why these problems often go undetected in elders. Of course, there are older adults who are alcoholics and/or addicted to illegal drugs such as heroin, but fewer and fewer as people age, in part because so many people addicted to alcohol or drugs die prematurely and in part because some survivors turn their lives around.

For older adults, drinking too much and misusing medications are the major substance use problems, affecting as many as 20 percent of them (1). They are particularly vulnerable to the mental and physical effects of alcohol and drugs because of physiological and cognitive changes that take place with age. And, even if they are not addicted to alcohol or illegal substances, they are at risk for serious problems including:

• Adverse drug reactions, including fatal overdoses,
• Accidents -- including falls and traffic accidents,
• Exacerbation of health problems,
• Social isolation,
• Sleep disturbances,
• Inactivity,
• Loss of cognitive capacity and
• Suicide -- which is more likely among older adults than any other age group.

In general, substance abuse and misuse vastly limit the potential to live well in old age.

During the elder boom there will be tremendous growth of the number of older adults with substance use problems, in part because of the growth of the population of older adults, but also because baby boomers use substances -- including illegal substances -- much more commonly than their parents' generation.

For example, a study done by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) projects the growth of people 60 or over who need substance abuse treatment from about 700,000 in 2000 to about 2,300,000 in 2020 (2). Recent surveys (3) confirm that this is already happening, with marked growth of the use of marijuana.

In addition, the CDC recently released a report projecting a vast increase in addiction to prescription painkillers and in deaths due to overdoses, which already kill more Americans than heroin and cocaine combined (4).

Will you, a member of your family, or a close friend be among the older adults with serious substance use problems? Here are a few signs that should cause concern (5).

• Getting unusually high without an increase in use
• Use of alcohol or drugs to sleep and then finding it difficult to get going in the morning
• Reliance on opiates to manage pain in doses that exceed a doctor's prescription
• Going from doctor to doctor to get additional prescriptions
• Using over-the-counter drugs in amounts or in combinations of medicines that are not recommended
• Cognitive or memory impairments, difficulty concentrating, or confusion
• Slurred speech
• Increased isolation
• Difficulty participating in ordinary activities
• Weight loss and/or poor nutrition
• Increased fatigue and/or weakness
• Poor personal hygiene
• Unusual restlessness or agitation
• Persistent irritability or altered mood
• Balance problems and/or frequent falls

These symptoms can, of course, have causes other than substance abuse or misuse, but if a person is using alcohol or other drugs and has these symptoms, substance use may be a major cause.

You may be able to recognize substance use problems in yourself or a friend or family member. You may be able to cut back or help someone to cut back. But many people need professional help. Talk frankly with your physician. If you don't know where to turn for help, call 1-800-273-TALK. This is the National Suicide Prevention Lifeline, and it can connect you with mental health or substance abuse services near your home.

Michael B. Friedman and Kimberly Williams are the co-founders of the Geriatric Mental Health Alliance. He is now retired except for teaching at Columbia University. She is the Director of The Center for Policy, Advocacy and Education of the Mental Health Association of NYC.

(1) Blow, F. "Baby Boomers, Mental Health, and Aging: New Challenges and Opportunities." Keynote address to the Geriatric Mental Health Alliance Annual Conference, May 2011. http://www.mha-nyc.org/media/9736/fred%20blow%20keynote%20presentation%20[compatibility%20mode].pdf

(2) Gfroerer, J. et al. "Substance Abuse Treatment Need Among Older Adults in 2020: The Impact of the Baby Boom Generation" in Drug and Alcohol Dependence, 2003.http://johnstrogerhospital.org/cru/images/education/519cd99e959493c0c6ad6bf40b928794.pdf

(3)Substance Abuse and Mental Health and Services Administration. "Illicit Drug Use Among Older Adults." National Survey on Drug Use and Health, 2011.http://oas.samhsa.gov/2k11/013/WEB_SR_013_HTML.pdf

(4) Center for Disease Control. "Prescription Painkiller Overdoses At Epidemic Levels: Kill More Americans Than Heroin and Cocaine Combined." Press Release, November 1, 2011.http://www.cdc.gov/mmwr/pdf/wk/mm6043.pdf.

(5) Blow, F. "Substance Abuse Among Older Adults." SAMHSA TIP 26, 1998http://www.ncbi.nlm.nih.gov/books/NBK14467/?report=printable