Covering the silent – and growing – epidemic of senior substance abuse
Older Americans have been misusing, abusing and becoming addicted to alcohol, tobacco and herbal “substances” for decades. Now they are also abusing drugs – both prescription and illegal – in increasing numbers, according to this NIA/NIH update. The most prevalent abuse is in the age 50 to 59 (trailing-edge boomer) cohort, where abuse of illicit drugs and non-medical use of prescription drugs rose from 2.7 percent to 5.8 percent between 2002 and 2010.
A CASA Columbia study found that substance abuse was an especially serious issue for older and aging women, who “get addicted faster, using smaller amounts of a substance, than any other demographic group.” The report also found that when older women show signs and symptoms of alcohol and/or prescription drug abuse, most physicians “don’t even consider an addiction diagnosis.”
The availability, and relentless direct-to-consumer marketing, of alcohol-laced/based drinks and over-the-counter and prescription stimulants, pain and psychotherapeutic medications has increased substance misuse and abuse in the whole population.
Boomers are aging into situations like chronic pain, job loss, boredom and loss of a spouse or partner that make them prime candidates for substance misuse and/or abuse.
The CDC reports that almost 20 percent of older adults are dealing with a mental health condition such as anxiety, depression, bipolar disorder or severe cognitive impairment that can lead to misuse and/or abuse of OTC and/or prescription medications.
The physical changes and slowed metabolism that come with aging makes it more difficult for older bodies to absorb and break down alcohol, medications and drugs: this increases their impact on older adults’ brains and bodies.
All of the above (and your success in getting someone to talk about their substance abuse on the record) are complicated by the stigma that accompanies substance abuse. Not only does it lead to under-reporting, says Nora D. Volkow, M.D., director of the National Institute on Drug Abuse, it’s also an “enormous obstacle” to substance abuse treatment and “lead[s] to self-fulfilling predictions that those who are addicted cannot recover or ever play positive and productive social roles.”
Diagnosis and treatment
But it’s often difficult to get older adults diagnosed and into treatment. And the “stigma” issue isn’t the only thing holding things up.
- Diagnoses (at least those that are going to get reimbursed) must be based on DSM-IV criteria that was developed and validated in young and middle-aged people, not older adults.
- Currently, diagnosis is usually done in the primary care setting by, or overseen by, a physician who has little training and experience diagnosing substance abuse disorders in older adults. Mandates laid down in the Mental Health Parity and Addiction Equity Act and the growing acceptance and use of SBRIT criteria should improve this situation.
- The majority of treatment options for substance abuse (whether covered by insurance or paid out-of-pocket) are geared to those under 50. Not surprisingly, they often don’t work well (or at all) with older adults, who tend to respond better to supportive and non-confrontational therapy, cognitive-behavioral approaches, slower treatment pace and approaches tailored to their unique physical and psychosocial needs. In addition, according to the latest National Survey of Substance Abuse Treatment Services report only 7 percent of treatment facilities (p. 26.) have programs or groups with treatment options specifically geared to those over 50.
What to cover
Senior substance use and/or abuse may be a silent epidemic now. However, as the Mental Health Parity and Addiction Equity Act gains traction, funding becomes available for treatment, better diagnosis and treatment protocols and options become available, and 76 million aging boomers (give or take a million or three) begin shattering the substance abuse cone of silence, it’s likely going to be one of this century’s biggest stories.
So here are some suggestions for topics to cover and resources to help you get started.
Explain how and why older adults may and can become substance abusers (they age with substance abuse disorder and they age into substance abuse disorder) and the different approaches needed to diagnose and address their substance misuse/abuse.
Examine and explain why, for boomers, drug and alcohol dependence and metal health/psychiatric disorders often go hand in hand. This tip sheet will get you started.
Examine the impact/consequences that boomers’ growing incidence of substance abuse will place on local health care systems, public health systems, families and, ultimately, society.
Related to the above: Write about the challenges of addressing substance abuse in older adults as a medical/public health problem, rather than a legal/law enforcement issue.
Examine the roles race, ethnicity and gender play in senior substance abuse and “chart” that data for your community. If your local university has a good urban studies department, partner with them on a series examining those “roles.”
Do a how-to-spot the signs and symptoms of substance misuse/abuse in an older adult, and provide information on what readers can do if/when they think a loved one or older adult has a problem.
Related to the above: Profile an older adult who is “in recovery.”
Examine the role the “stigma” factor is playing in keeping those with substance abuse disorders from seeking treatment … and the role it’s not going to play as “younger” older adults – those in their 50s and 60s – seek treatment.
While 7 percent of the facilities and programs in the U.S. offer substance abuse treatment and rehabilitation programs geared to the needs of older adults, all are expensive. With that in mind, write about the need for more affordable and accessible (i.e. local) treatment facilities and programs for less well-off (and/or well-insured) older adults.
Related to the above: The number one barrier to treatment – which can include medical detoxification, in-patient and out-patient stabilization, maintenance medications, treatment for co-existing mental or physical health conditions, group therapy, individual counseling, community-based support services, – is its cost. Tell readers what treatment can/often does involve and outline local options and resources that are available (county mental health board programs, community-based programs, 12-step programs specifically for older adults, etc.) to help bring down costs.
Related to the above: The Mental Health Parity and Addiction Equity Act promises equal insurance coverage for medical and mental health conditions. Cover the current challenges and those that will be encountered as the act is implemented. Good information is at the sites of The Parity Implementation Coalition and The Employer Guide for Compliance with the Mental Health Parity and Addiction Equity Act.
Report on the inadequate education and training physicians and other health professionals have and/or are receiving about substance abuse, addiction, and geriatric care…and what schools, professional organizations and advocacy groups are doing to change this situation. Many of the organizations and experts in the resource section can provide insight and information on this issue.
Examine and explain the rocky road that is recovery and that the earlier treatment is begun the more successful it is and the fewer incidents or relapses those in recovery will have.
Examine and explain the role that family and friends play in initial and ongoing recovery. Chapter 26 in the recently-published The Recovery Book provides excellent info and insight on this topic. For review copies, contact Noreen Herits, executive publicist, Workman Publishing, 212-614-7775, firstname.lastname@example.org.
National Association of Alcoholism and Drug Abuse Counselors (to find local experts)
National Association of Addiction Treatment Providers (to find local experts)
State Association of Addiction Services (links to state and local agencies and experts)
“Co-Occurrence of Mental Illness and Substance Use” (backgrounder)
“Prescription and Illicit Drug Abuse: Improper Use of Medications” (excellent stats)
“For Family and Friends,” chapter 26 in “The Recovery Book,” TheRecoveryBook.com by Catherine Dold For review copies, contact Noreen Herits, executive publicist, Workman Publishing, 212-614-7775, email@example.com
Adults Aged 65 and Older in Substance Abuse Treatment (latest available data)
Aging, Medicines, and Alcohol (excellent for your readers, pdf)
Drug Use and the Elderly (report)
Illicit Drug Use Among Older Adults (backgrounder, pdf)
National Institute on Drug Abuse’s Media Guide (basic info, excellent glossary,pdf)
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Substance Use by Older Adults: Estimates of Future Impact on the Treatment System. OAS Analytic Series #A-21, DHHS Publication No. (SMA) 03-3763, Rockville, MD, 2002.
Overview of the Opiod Epidemic (slide presentation, pdf)
Prescription and Illicit Drug Abuse (backgrounder)
Substance and Medication Abuse/Misuse in Older Adults (slide presentation, pdf)
Substance Abuse Among Older Adults (consensus report, pdf)
Substance Abuse and Behavioral Health Treatment Locator (to find local resources)
American Association for Geriatric Psychiatry
Marjorie Vanderbilt, Acting CEO, Deputy Executive Director
Phone: 301-654-7850 x 107
American Association of Mental Health Counselors
James K. Finley, Associate Executive Director & Director of Public Policy
Phone: 800-326-2642 or 703-548-6002 , extension 105
American Psychological Association
Michael Shulman, Public Affairs
American Society of Addiction Medicine
Alexis Geier-Horan, MPP, Senior Director of Government Relations and Clinical Practice,
Phone: 301-656-3920 x103
Barbara Krantz, DO, FASAM
Director of Medical Services
Hazelden Betty Ford Clinics
Christine Anderson, Press Contact
Phone: o. 651-213-4231 or c. 612-756-4275
Hunter College Silberman School of Social Work
Alexis Kuerbis, LCSW, PhD
Las Vegas Recovery Center
Mel Pohl., MD, FASAM, Medical Director
National Association for Addiction Professionals
Jessica Gleason, JD
Director of Communications
National Center for Physician Training in Addiction Medicine
Susan E. Foster, Executive Director
Phone: 301-656-3378 x 380 or 240-762-5399
National Institute on Aging
Stephanie Dailey, Media Relations
National Institute on Drug Abuse
National Nurses Society on Addictions
Al Rundio, PhD, APRN, BC
PA Behavioral Health and Aging Coalition
Linda Shumaker, RN‐BC, M.A.
Substance Abuse and Mental Health Services Administration (SAMHSA)
Tamara N. Ward, Press Officer
Phone: (240) 276-1877
Brad Stone, Press Officer
University Hospitals of Cleveland
Raymond E. Isackila, LPCC, Assistant Clinical/Administrative Director, Department of Psychiatry/Addiction Recovery Services