Substance Abuse And Addiction In The Elderly
Substance abuse and addiction were once considered an issue that primarily affected the young, however, the elderly population is increasingly abusing alcohol, prescription medications and illicit drugs.
Elderly substance abusers face a myriad risks, including cognitive impairment, harmful medication interactions, poor nutrition, social isolation and an increased risks of falls and injuries. Alcohol and drug abuse is also linked to increased mortality rates and healthcare costs.
This problem is growing at such a rate that a Clinics in Geriatric Medicine article asserts that substance use disorders (SUD) will more than double in this age group. Specifically, it’s predicted that “SUD rates among people older than 50 years are projected to increase from about 2.8 million in 2006 to 5.7 million in 2020.”
With these rising numbers comes an increased need for specialized substance abuse treatment. One scientific review comments on this, noting that “The number of elders requiring treatment for substance abuse is also expected to rise dramatically in the coming years and will double by 2020.”
As an individual ages they’re confronted with physical, mental and social changes and also those which occur to relationships and the family. With age, various health and medical needs occur more frequently, many of which are quite serious. For many, these changes bring a sense of isolation and loneliness, feelings which are frequently tied to, and exacerbated by, substance abuse.
Signs Of Drug Or Alcohol Abuse In The Elderly
While many of the signs of drug and alcohol abuse remain constant as a person ages, some may change. This can make it more difficult to identify a potential problem.
To further complicate matters, certain signs resemble symptoms of age-related disorders, cognitive impairment or other behaviors which accompany aging. Because of this, it’s important that loved ones and caregivers of senior citizens and geriatric persons be aware of the signs of substance abuse at these ages.
The exact signs of substance abuse can vary per person and per drug of abuse, but in general, in the elderly they include:
- alienating loved ones, solitary behaviors and social isolation
- the body, breath or clothing carry a strange odor
- changes in eating habits
- changes in sleeping habits
- chronic pain with no discernible cause
- health complaints with no discernible cause
- unexplainable nausea or vomiting
- deteriorating personal grooming habits
- drinking or using drugs in secret
- drinking even when medications or doctors caution against it
- extreme fatigue
- hoarding medications
- memory loss
- mood swings
- poor coordination or loss of balance
- the pupils of the eye are unusually large or small
- bloodshot eyes
- ritual use of drugs or alcohol
- slurred speech
Early recognition of a substance use disorder reduces the opportunity for drug- or alcohol-related adverse health effects. It can also help loved ones and care providers to get help more quickly for the person in need. Without help, substance-abusing senior citizens can quickly experience a severely declining quality of life and health.
A substance use disorder can prevent a person from taking good care of themselves. Drug and alcohol abuse can make it difficult to maintain good nutrition, social interaction (which is important at these ages) and adherence to medication regimes. Many forms of substance abuse also worsen depression and cognitive impairment, both conditions which many elderly individuals already struggle with.
Risk Factors For Substance Abuse In The Elderly
Some individuals experience early-onset substance use, or that which began at younger ages and continued on into later life. Other, late-onset abusers develop patterns of abuse once they’re older. Research suggests that late-onset substance use disorders occur less frequently, amounting to less than 10 percent of cases.
This latter group experiences many of the same risk factors which young drug abusers do, including:
- financial troubles
- lack of a good support system
- mental illnesses
- social isolation
Many times these risk factors occur more frequently as person ages. In addition to these, aging individuals encounter certain risk factors which are more unique to their age group, such as:
- an avoidance coping style
- changes in living arrangements
- chronic illnesses
- chronic pain
- forced or unexpected retirement
- overall poor health
- physical disabilities
- prescriptions for multiple medications
- previous substance abuse problems
Medical conditions and mental health disorders, like depression, frequently lead senior citizens to self-medicate.
Men, especially those who are more affluent, Caucasian and in the early stages of their elder years are more frequently linked to unhealthy patterns of drinking at older ages. Women, on the other hand, are associated in greater numbers with prescription drug abuse.
Alcohol Abuse In The Elderly
Elderly adults abuse alcohol more frequently than any other drug.
As a person ages their body becomes more sensitive to alcohol, many times experiencing a reduced tolerance. Many individuals feel alcohol’s effects much faster than they did at younger ages. Individuals over age 65 need to be especially wary of these changes. Amounts which may have been previously consumed safely can become unhealthy and harmful at these ages.
Further, the Substance Abuse and Mental Health Services Administration (SAMHSA) notes that levels of binge drinking are often considered to be smaller for this age group. They write that “Binge drinking for older adults is sometimes defined as drinking more than two drinks for women and more than three drinks for men on a single occasion, which is a lower threshold for binge alcohol use than for adults overall.”
Even with these risks, far too many elderly Americans jeopardize their life and health by drinking:
- SAMHSA writes that “nearly 16.2 million adults aged 65 or older drank alcohol in the past month, with 3.4 million reporting binge alcohol use and 772,000 reporting heavy alcohol use.”
- Almost half of individuals living in a nursing home have alcohol-related problems.
- The number of older adults hospitalized for problems relating to alcohol is equal to those hospitalized for heart attacks.
- The highest rates of alcoholism in the nation are found in widowers over the age of 75.
- 20 to 25 percent of adults aged 75 and older take part in intermittent heavy drinking
The Risks And Dangers Of Drinking For Older Adults
Drinking at these ages can cause a number of health problems. Certain individuals have a greater risk of this, including persons who:
- take certain medications.
- have health or medical problems.
- are heavy drinkers.
These individuals may need to be completely abstinent from alcohol or reduce their consumption. The National Institute on Alcohol Abuse and Alcoholism advises that healthy individuals who don’t take medications should consume no more than:
- 3 drinks per day
- 7 drinks over the course of a week
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Should an individual consume excess to these amounts, they could experience severe alcohol-related problems. Despite this risk, a significant number of older Americans drink beyond these levels, as found by one study. In current drinkers age 60 or older:
- as many as 12 percent of women and 30 percent of men occasionally drink three or more drinks in one day.
- 45 percent drink more than seven drinks per week.
- 25 percent drink more than 14 drinks per week.
Older adults face a variety of health and medical conditions, a number of which can be made worse by patterns of heavy drinking. These include:
- congestive heart failure
- high blood pressure
- liver problems
- memory problems
- mood disorders
The quicker onset of alcohol’s effects and diminished tolerance at these ages also make the elderly more prone to automobile crashes, falls and injuries.
Older Adults And Illicit Drug Abuse
While illicit drug use was once viewed as an issue which mainly impacted the young, trends have recently shifted as older Americans increasingly abuse illicit substances.
A review published in The Primary Care Companion for CNS Disorders presented statistics on adults over age 50 who were admitted to the emergency department for illicit drug abuse. It found that the most commonly abused substances were:
- cocaine (roughly 50 to 60 percent of cases)
- heroin (roughly 25 percent)
- marijuana (roughly 20 percent)
The review found that the youngest of these individuals (those aged 50 to 64 years of age) preferred cocaine and heroin and that the older individuals (those over age 65) preferred cocaine and marijuana. While young individuals are more apt to use marijuana for pleasure, older persons use this drug more frequently to self-medicate pain or stress or to stimulant the appetite.
SAMHSA published findings on illicit drug use which offer even more perspective on abuse in this population:
- roughly 469,000 older adults abused some form of an illicit drug in the past month
- on a typical day 132,000 older adults used marijuana
- on a typical day 4,300 older adults abused cocaine
The Dangers Of Illicit Drug Abuse For The Elderly
Any form of illicit drug abuse is dangerous. These behaviors increase an elderly person’s risk of adverse health effects, withdrawal complications and overdose. What follows are the dangers of the illicit substances most frequently abused by this population:
- Cocaine: Many of cocaine’s greatest health hazards are also conditions older individuals are prone to. These include cerebrovascular accident, delirium, heat stroke and myocardial infarction. Using cocaine at these ages may increase the risk of a person developing these conditions.
- Heroin: Elderly individuals frequently encounter declining mental and physical health, including greater instances of physical disabilities. Research has documented that for every year of continued heroin use the odds of developing a severe physical disability rise by roughly five percent. Prolonged heroin abuse can also cause a person’s mental ability to deteriorate.
- Marijuana: Marijuana (cannabis) abuse has been linked to major depressive disorder, a mental illness may elderly individuals struggle with. Marijuana reduces what can already be slowed reaction times in older individuals, making driving even more dangerous. The cognitive impairment caused from marijuana is suspected to aggravate existing cognitive troubles, including memory, on a short-term basis in some individuals.
The Clinics in Geriatric Medicine article cautions that “Marijuana is known to cause…elevated blood pressure; and a 4-time increase in the risk for heart attack after the first hour of smoking marijuana. These risks may be pronounced in older adults whose…cardiovascular systems may already be compromised.”
Senior Citizens And Prescription Drug Abuse
Older adults are considered an at-risk population for prescription drug abuse.
According to the National Institute on Drug Abuse, “More than 80 percent of older patients (aged 57 to 85 years) use at least one prescription medication on a daily basis, with more than 50 percent taking more than five medications or supplements daily.” With this number of prescriptions older adults have more opportunities to divert and misuse their medications.
The Clinics in Geriatric Medicine article reported on the prevalence prescription drug misuse and abuse, finding that:
- “In 2012, 2.9 million adults aged 50 years and older reported non-medical use of psychotherapeutic medications in the past year.”
- It’s estimated that 11 percent of older women misuse prescription medications.
- Non-medical use of prescription opioids was higher than rates of sedative, stimulant and tranquilizer misuse.
While some individuals use a medication incorrectly, leading to unintentional complications, many knowingly misuse or abuse their own, or someone else’s, prescription. Quite often the latter individuals receive prescription medications from a good intentioned friend or relative who has no idea that the drug will be misused.
Prescription drug abuse primarily occurs for two reasons: as a person seeks to self-medicate a physical or mental health concern or as they use the substance recreationally to elicit a pleasurable feeling or high.
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Opioid pain relievers, like hydrocodone (Vicodin) and oxycodone (OxyContin and Percocet), are frequently prescribed to treat many conditions elderly persons are diagnosed with, such as cancer or pain. A large number of older Americans take benzodiazepine medications for mental health concerns. Examples include alprazolam (Xanax), diazepam (Valium) and lorazepam (Ativan). Prescription sleeping pills, such as zolpidem (Ambien) and zaleplon (Sonata), are also abused by the elderly.
These classes of medications are also some of the most frequently abused by this age group. Illustrating this point, Medscape writes that “approximately 20% of individuals aged 65 years and older take analgesics several times per week and that rates of abuse or addiction in those with chronic pain is 18%.”
Prescription drug abuse can easily lead to overdose, especially in those individuals who take multiple medications or who consume alcohol. Research presented by Harvard suggests that individuals taking benzodiazepines may have an increased likelihood of developing dementia and Alzheimer’s, two conditions which run high in the elderly population.
Alcohol And Drugs Cause Harmful Interactions With Medications
Alcohol, abused prescription medications and illicit drugs can cause dangerous interactions with both prescription and over-the-counter medications. Certain dietary supplements, such as herbal remedies, can also cause these dangerous complications. These effects range from reducing a medication’s effectiveness to causing life-threatening complications.
The following medications can cause harmful reactions with alcohol:
- anxiety or depression medicines
- cold and allergy medicine
- cough syrup
- pain medication
- sleeping pills
These harmful interactions can occur even when an individual isn’t abusing these drugs. Complications can arise when an individual takes a prescribed or recommended amount of these medications while abusing alcohol.
Alcohol is a central nervous system (CNS) depressant. This means that it slows down critical life-support systems in the body, such as blood pressure, breathing, heart and respiratory rates. As such, it’s particularly dangerous when abused with prescription medications.
The most dangerous reactions occur when alcohol is mixed with other CNS depressants, such as opioid pain relievers and benzodiazepine medications. Similarly, prescription opioid painkillers can be deadly when mixed with benzodiazepine medications or certain sleeping pills.
The Elderly Face Increased Hospitalizations From Substance Abuse
Far too often drug and alcohol abuse leads to emergency department (ED) visits and hospitalizations. The National Council on Alcoholism and Drug Dependence estimates that six to eleven percent of elderly individuals admitted to the hospital and 14 percent admitted to the ED are for alcohol- or drug- related problems.
According to SAMHSA, on a typical day in 2011, 290 ED visits were for illegal drug use, non-medical use of prescription medications or for use of alcohol mixed with another drug.
Of this number:
- 118 involved prescription or nonprescription pain relievers
- 48 involved benzodiazepines
- 25 involved alcohol in combination with other drugs
- 23 involved antidepressants or antipsychotics
- 13 involved cocaine
- 7 involved heroin
- 5 involved marijuana
- 2 involved illicit amphetamines or methamphetamine
Pursuing treatment for a drug or alcohol addiction is the best course of action when seeking to protect elderly individuals from these and other risks.
Treatment Options For Elderly Individuals
In 2014, over one million individuals aged 65 or older had a substance use disorder. In 2012, in this same age group, there were only 14,230 admissions to substance abuse treatment programs, as detailed by SAMHA.
If the number of older individuals experiencing a SUD in 2012 were even remotely similar to 2014, there is a vast discrepancy between need and acquired treatment in this population. In order to combat this, elderly persons and their families need access to comprehensive treatment options which meet and respect their changing needs.
Some elderly persons may be reluctant to leave the familiarity of their surroundings to seek treatment. A professionally-led intervention may be worth considering in these instances, should a person refuse treatment for this or any other reason.
The best treatment outcomes for the elderly are the result of a collaborative and individualized treatment approach. Treatment should address the full spectrum of a person’s needs, including chronic health and medical conditions, co-occurring disorders, financial troubles, the lack of a social support system and physical and nutritional health deficits.
Due to the intensive physical, psychological and emotional needs of aging adults, inpatient drug rehabilitation programs are often recommended, should a person’s health permits.
Many older individuals have complicated health and medical concerns. Because of this, individuals anticipating withdrawal should consider a medically-supervised detoxification. The most severe withdrawal symptoms occur from alcohol, benzodiazepines and opioids, three of the substances most frequently abused by these ages.
Once a person enters rehab, the best programs utilize a combination of research-based behavioral therapies and counseling. These sessions facilitate mental and emotional healing, stability and enhanced coping skills. Should an individual choose, family therapy may also be integrated to help build a better support system. Nutritional support and guidance, along with supervised physical fitness may be an option for certain individuals.
This integrated care is delivered by a highly-trained and compassionate team which may consist of physicians, nurse practitioners, nutritionists, licensed therapists, counselors, social workers and other trained clinicians, some of whom may specialize in geriatric concerns.
Contact Addiction Campuses to learn more about addiction treatment options for seniors.Article Sources
Harvard Heath Publishing - https://www.health.harvard.edu/blog/benzodiazepine-use-may-raise-risk-alzheimers-disease-201409107397
Medscape - https://www.medscape.com/viewarticle/776128
National Council on Alcoholism and Drug Dependence - https://www.ncadd.org/about-addiction/seniors/alcohol-drug-dependence-and-seniors
National Institute on Alcohol Abuse and Alcoholism - https://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/older-adults
National Institute on Drug Abuse - https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse
Substance Abuse and Mental Health Services Administration - https://www.samhsa.gov/data/sites/default/files/report_2792/ShortReport-2792.html
US National Library of Medicine - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505129/
US National Library of Medicine - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714873/
US National Library of Medicine - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146436/