Tip Sheets
Drinking whiskey and rye: Alcohol use disorders and older adults
Public health experts have long projected that the number of people over the age of 50 with a substance use disorder would double by 2020, going from about 2.8 million per year from 2002-2006, to about 5.7 million in 2020. Although that doubling reflects the sheer increase in the number of baby boomers approaching later life, it may also reflect some of that generation’s lifetime behavior surrounding alcohol and drug use and abuse.
Tom Hill, vice president, addiction and recovery, National Council for Behavioral Health, notes that although previous generations were more likely to have had ready access to alcohol, [Learn more about AHCJ’s Aug. 24 webinar, which featured Hill discussing addiction here] boomers had easier access to alcohol, and other substances, such as marijuana, cocaine, crack, and prescription medications. Some people developed lifelong habits and disorders, and some reached late life with their substance use disorders intact.
Multiple chronic diseases multiple medications = lots of confusion
In many ways, boomers have been lucky. Advances in medical technology and practice along with public health mean that they have an average life expectancy of 79 (which varies considerably by race, region, and gender)
That long life has come with a price in terms of multiple chronic conditions often associated with old age, such as arthritis, diabetes, cancer, and heart disease. As Sally Abrahms reported in the Washington Post, boomers are in worse health than their parents were at similar ages.
According to the Centers for Disease Control and Prevention, nearly 75 percent of people aged 65 and older have multiple chronic conditions. The CDC defines chronic conditions and diseases as those that will last a year or more and that limit activities of daily living.
Treating and managing multiple chronic conditions often leads patients and families to multiple specialists and medications which, in turn, leads to a complex treatment regimen (that may or may not mention over-the-counter medications, and is unlikely to include alcohol or illegal drugs). In the last decade or so, Medicare and some private insurers have offered programs focused on “patient activation” and “chronic disease self-management”. Although such patient-centered disease-management programs may seem promising for addiction medicine, more research is needed to determine whether or not they work.
At any age, taking the wrong dose of a medication, mixing meds, or somehow using a medication incorrectly can be disastrous; all too often, even deadly. Imagine any number of medication warning labels, and it’s clear what disasters might ensue. These grow when the patient is old, and has other health problems that are compounded by alcohol and other drug abuse. In such cases, mixing medications can be lethal.
Tell me who has the opioids?
Despite national reports about the opioid crisis of overprescribing and abuse, the actual rate of prescription opioid use disorder among adults aged 50 and older is 0.13 percent. For older adults, dependence on opioids is more common than abuse. In either case, however, this means that the person must have the drug/medication in question or risk severe withdrawal symptoms.
This article in Clinics in Geriatric Medicine states that: “Although the current proportions of older adults with substance use disorders remain low compared with the general population, a growing proportion and number of older adults are at risk for hazardous drinking, prescription drug misuse, and illicit substance use and abuse.”
For older adults who are using these drugs/medications without a doctor’s order or supervision, misuse or misadventure can occur. Opioids depress the central nervous system, and in combination with alcohol or benzodiazepines, can quickly lead to overdose and death.
A September 2017 JAMA Psychiatry opinion article highlights a dramatic increase in the prevalence of at-risk, high-risk, and alcohol-use disorder drinking disorders across all age groups. Those increases, the authors write, which affect, “… women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.”
The JAMA study found that at-risk drinking increased from 9.7 percent of the population to 12.6 percent, while alcohol use disorder (AUD) increased from 8.5 percent to12.7 percent.
Trends in substance use and abuse among elders
Data on current trends in substance use admissions among older adults provides additional background material.
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Number of elders needing treatment for substance abuse will increase from 1.7 million in 2000–2001 to 4.4 million in 2020
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Boomers had more exposure to drugs, alcohol and tobacco at a younger age, which is reported to be a risk factor for substance use and abuse in later life
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Although use of illicit drugs among adults age 50–59 almost doubled between 2002 and 2007 (from 5.1 percent to 9.4 percent), of those aged 50-59 who were using illicit drugs in 2007, almost 90 percent had started using them before the age of 30
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Among people aged 65–74, being white, male, and divorced or widowed was associated with higher odds of lifetime alcohol use disorder
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Older women had lower rates for alcohol dependence or abuse, drug dependence or abuse or both conditions, and lower past-year use of illicit drugs, compared to older men
Barriers to care: the song remains the same
People of all ages face similar challenges in accessing substance abuse treatment—and yet at each age or phase of treatment, specific problems may arise. For example, systems of care and treatment have been created to meet the specific needs of children and adolescents, and employee assistance programs can help working adults, but no national programs exist for the growing needs created by adults with substance use problems and cognitive decline.
This oversight may be the result of a general belief that older people don’t drink, or don’t use drugs, or are better able to solve their own problems. However, the problems they do encounter are often made worse by problems elsewhere in the health care system, such as lack of access to transportation, or problems with mobility; or, multiple comorbidities and other barriers to care.
Their primary care physicians may not recognize the symptoms of alcohol or drug abuse in older adults, or may not be familiar with screening and assessment tools. Physicians and other clinicians may not have staff who are familiar with community-based resources, or who know how to reach the recovery community.
In some cases, the health care system itself may have concluded that a 65-year old with a drinking problem is just like a 20-year old with a drug problem, and group all patients in a similar residential treatment setting. While such programs offer intergenerational opportunities for learning and sharing, those struggling with the workforce shortage may not be able to provide the level of care (i.e., medication management, explained earlier) that these elders require.
For the most part, some researchers and advocates suggest that older adults who find it hard to access programs in their own communities consider online programs grounded in some form of mutual aid, self-help, or twelve-step process to recover from an addiction.
Resources
The first two links provide more reputable information than do simple Google searches, which can lead desperate families to unscrupulous, private-pay addiction treatment programs. (Read: Review sites have deep ties to the rehabs they promote.) SAMHSA will not track personal information, but Google (and its advertisers) will.
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Behavioral Health Treatment Services Locator
From SAMHSA, with a focus on behavioral health programs nationwide. SAMHSA also had a page on peer support, peer recovery, and 12-step programs, with links to national offices. -
Center for Integrated Health Solutions funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Services and Resources Administration (HRSA)
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Recovery and Recovery Support from SAMHSA with an overview of what recovery is, how to locate resources, and how to become engaged in the recovery community, or how to become a peer support specialist or leader.
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National Council on Aging hosted a March 2015 webinar on substance abuse and older adults, which featured three speakers. The webinar recording or PowerPoint are still available. Sessions with speakers and their then-current emails listed below.
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Older adults and substance abuse: What can we do to help? Kristen Lawton Barry, Ph.D.
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REAP: Embedding a Brief Alcohol Intervention in a Community-Based Prevention Program Renee Pepin, Ph.D.
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Implementation of SBIRT Model for Older Adults in Varied Settings: Florida BRITE Project Robert W. Hazlett, Ph.D.
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National Institute on Aging: Several videos directed to older adults on how to broach the topic of alcohol abuse with family members and physicians.
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myStrength: Recommended by Tom Hill, partner organization for National Council on Behavioral Health. Online program to track progress toward goals related to physical and mental health.
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Women for Sobriety: Online mutual support group for women with alcohol abuse disorder, follows a 13-step program and offers some member-led face-to-face programs.
Sources
Tom Hill, M.S.W., vice president, addiction and recovery, National Council for Behavioral Health, [contact via Aaron Cohen, PR person, aaroncohenpr@gmail.com]
Alexi Kuerbis, L.C.S.W., Ph.D., Columbia University Medical Center, widely cited researcher on older adults and addictions, alexis.kuerbis@gmail.com
Diana Williams, M.S.W., L.C.S.W., Behavioral Health Technical Assistance Center, Altarum Institute [contact via Sarah Litton, press@altarum.org]
Janice Lynch Schuster, an award-winning nonfiction writer, was a senior writer for Altarum from 2008 to 2014. In addition to the expertise that she provided in covering topics such as multiple chronic conditions, aging, end-of-life care, and hospice and palliative care, she has written about many public health issues.